介入科防控新型冠状病毒感染的策略与建议

【摘要】　2019新型冠状病毒（2019 novel coronavirus, 2019-nCoV）感染疫情正在蔓延,严重威胁我国及境外人民的生命安全。2019-nCoV感染的肺炎作为急性呼吸道传染病已纳入《中华人民共和国传染病防治法》规定的乙类传染病,按甲类传染病管理。为进一步做好2019-nCoV感染预防与控制工作,有效降低2019-nCoV在医疗机构内传播风险,规范医务人员行为,现根据国家卫生健康委发布的技术指南、方案及有关资料,特起草介入科防控2019-nCoV感染的策略与建议。该文重点介绍介入科防控总体原则、门诊防控管理、会诊防控管理、病房防控管理和手术室防控管理等。     

Informed Consent for Interventional Radiology Procedures: A Survey Detailing Current European Practice

Purpose: Official recommendations for obtaining informed consent for interventional radiology procedures are that the patient gives their consent to the operator more than 24 hr prior to the procedure. This has significant implications for interventional radiology practice. The purpose of this study was to identify the proportion of European interventional radiologists who conform to these guidelines. Methods: A questionnaire was designed consisting of 12 questions on current working practice and opinions regarding informed consent. These questions related to where, when and by whom consent was obtained from the patient. Questions also related to the use of formal consent forms and written patient information leaflets. Respondents were asked whether they felt patients received adequate explanation regarding indications for intervention, the procedure, alternative treatment options and complications. The questionnaire was distributed to 786 European interventional radiologists who were members of interventional societies. The anonymous replies were then entered into a database and analyzed. Results: Two hundred and fifty-four (32.3%) questionnaires were returned. Institutions were classified as academic (56.7%), non-academic (40.5%) or private (2.8%). Depending on the procedure, in a significant proportion of patients consent was obtained in the outpatient department (22%), on the ward (65%) and in the radiology day case ward (25%), but in over half (56%) of patients consent or re-consent was obtained in the interventional suite. Fifty percent of respondents indicated that they obtain consent more than 24 hr before some procedures, in 42.9% consent is obtained on the morning of the procedure and 48.8% indicated that in some patients consent is obtained immediately before the procedure. We found that junior medical staff obtained consent in 58% of cases. Eighty-two percent of respondents do not use specific consent forms and 61% have patient information leaflets. The majority of respondents were satisfied with their level of explanation regarding indications for treatment (69.3%) and the procedure (78.7%). Fifty-nine percent felt patients understood alternative treatment options. Only 37.8% of radiologists document possible complications in the patients chart. Comments from respondents indicated that there is insufficient time for radiologists to obtain consent in all patients. Suggestions to improve current local policies included developing the role of radiology nursing staff and the use of radiology outpatient clinics. Conclusions: More than 50% of respondents are unhappy with their policies for obtaining informed consent. Interventional societies have a role to play in advocating formal consent guidelines.     

Operational Strategies to Prevent Coronavirus Disease 2019 (COVID-19) Spread in Radiology: Experience From a Singapore Radiology Department After Severe Acute Respiratory Syndrome

As coronavirus disease 2019 (COVID-19) infection spreads globally, the demand for chest imaging will inevitably rise with an accompanying increase in risk of disease transmission to frontline radiology staff. Radiology departments should implement strict infection control measures and robust operational plans to minimize disease transmission and mitigate potential impact of possible staff infection. In this article, the authors share several operational guidelines and strategies implemented in our practice to reduce spread of COVID-19 and maintain clinical and educational needs of a teaching hospital.     

The Battle Against Coronavirus Disease 2019 (COVID-19): Emergency Management and Infection Control in a Radiology Department

ObjectiveTo describe the strategy and the emergency management and infection control procedure of our radiology department during the coronavirus disease 2019 (COVID-19) outbreak.MethodsWe set up emergency management and sensing control teams. The team formulated various measures: reconfiguration of the radiology department, personal protection and training of staff, examination procedures for patients suspected of or confirmed with COVID-19 as well as patients without an exposure history or symptoms. Those with suspected or confirmed COVID-19 infection were scanned in the designated fever-CT unit.ResultsFrom January 21, 2020, to March 9, 2020, 3,083 people suspected or confirmed to be infected with COVID-19 underwent fever-CT examinations. Including initial examinations and re-examinations, the total number of fever-CT examinations numbered 3,340. As a result of our precautions, none of the staff of the radiology department were infected with COVID-19.ConclusionStrategic planning and adequate protections can help protect patients and staff against a highly infectious disease while maintaining function at a high-volume capacity.     

介入医务工作者应对新型冠状病毒感染防控专家共识

2019年12月以来,我国爆发新型冠状病毒肺炎(COVID-19)疫情。疫情期间大量患者需要介入手术治疗,存在院内感染隐患,也给疫情防控带来挑战。如何在开展介入手术的同时做好防控工作,对预防院内感染至关重要。为了进一步规范介入医务工作者的医疗行为,做好患者救治和疫情防控工作,中国医师协会介入医师分会组织人员起草了本专家共识。本共识在"疫情防控为重,严防院内感染"的前提下,结合属地突发公共卫生事件等级,对患者进行分类管理,指导介入医务工作者在COVID-19疫情期间安全地开展各类介入手术,同时针对COVID-19疫情期间手术室、门诊和会诊的防控管理,以及教学和科研等方面提出了建议。希望指导介入医务工作者在抗击COVID-19疫情的同时,做好自身的防护,更好地服务患者。     

Beyond business as usual: Radiology residency educational response to the COVID-2019 pandemic

The COVID-19 pandemic has disrupted standard hospital operations and diagnostic radiology resident education at academic medical centers across the country. Deferment of elective surgeries and procedures coupled with a shift of resources toward increased inpatient clinical needs for the care of COVID-19 patients has resulted in substantially decreased imaging examinations at many institutions. Additionally, both infection control and risk mitigation measures have resulted in minimal on-site staffing of both trainees and staff radiologists at many institutions. As a result, residents have been placed in nonstandard learning environments, including working from home, engaging in a virtual curriculum, and participating in training sessions in preparation for potential reassignment to other patient care settings. Typically, for residents to gain the necessary knowledge, skills, and experience to practice independently upon graduation, radiology training programs must provide an optimal balance between resident education and clinical obligations. We describe our experience adapting to the challenges in educational interruptions and clinical work reassignments of 41 interventional and diagnostic radiology residents at a large academic center. We highlight opportunities for collaboration and teamwork in creatively adjusting and planning for the short and long-term impact of the pandemic on resident education. This experience shows how the residency educational paradigm was shifted during a pandemic and can serve as a template to address future disruptions.     

Infection Control in Interventional Radiology During the COVID-19 Era

The COVID-19 pandemic has challenged the capacity of interventional radiology departments worldwide to effectively treat COVID-19 and non-COVID-19 patients while preventing disease transmission among patients and healthcare workers. In this review, we describe the various data driven infection control measures implemented by the interventional radiology department of a large tertiary care center in the United States including the use and novel re-use of personal protective equipment, COVID-19 testing strategies, modifications in procedural workflows and the leveraging of telehealth visits. Herein, we provide effective triage, procedural, and management algorithms that may guide other interventional radiology departments during the ongoing COVID-19 pandemic and in future infectious disease outbreaks.     

Clarifying and visualizing sources of staff-received scattered radiation in interventional procedures

OBJECTIVE: Interventional radiology tends to involve long procedures (i.e., long fluoroscopic times). Therefore, radiation protection for interventional radiology physicians and staff is an important issue. We examine and identify sources of staff-received scattered radiation in an interventional radiology system using a pinhole camera method. CONCLUSION: Physicians and staff are exposed primarily to two sources of scattered radiation: radiation scattered from the patient and radiation from the cover of the x-ray beam collimating device. Those who stand close to the patient and the x-ray beam collimating device, where scattered radiation is higher, have higher radiation doses. Thus, radiation protection during interventional radiology procedures is an important problem.     

Summary of the Italian inter-society recommendations for radiation protection optimization in interventional radiology

Objectives

A Working Group coordinated by the Italian National Institute of Health (Istituto Superiore di Sanità) and the National Workers Compensation Authority (Istituto Nazionale per l’Assicurazione contro gli Infortuni sul Lavoro, INAIL) and consisting of 11 Italian scientific/professional societies involved in the fluoroscopically guided interventional practices has been established to define recommendations for the optimization of patients and staff radiation protection in interventional radiology. A summary of these recommendations is here reported.

Materials and methods

A multidisciplinary approach was used to establish the Working Group by involving radiologists, interventional radiologists, neuroradiologists, interventional cardiologists, occupational health specialists, medical physicists, radiation protection experts, radiographers and nurses. The Group operated as a “Consensus Conference”. Three main topics have been addressed: patient radiation protection (summarized in ten “golden rules”); staff radiation protection (summarized in ten “golden rules”); and education/training of interventional radiology professionals.

Results

In the “golden rules”, practical and operational recommendations were provided to help the professionals in optimizing dose delivered to patients and reducing their own exposure. Operative indications dealt also with continuing education and training, and recommendations on professional accreditation and certification.

Conclusions

The “Consensus Conference” was the methodology adopted for the development of these recommendations. Involvement of all professionals is a winning approach to improve practical implementation of the recommendations, thus getting a real impact on the optimization of the interventional radiology practices.

     

Radiación ocupacional y embarazo: realidad o desinformación. Revisión en la literatura y actualización según guías clínicas vigentes

Exposure to ionizing radiation is a decisive factor in women's choice of entering the field of interventional radiology. This issue explains the low percentage of women in interventional radiology and the high number of women who take leave from work when they are pregnant even though they have no problems with their pregnancy.The current guidelines and legal framework regarding pregnancy and ionizing radiation from different national institutions are not in line with the scientific evidence. They establish recommendations based on disinformation and a need to protect the fetus that has not been scientifically validated. Lack of knowledge and lack of evidence-based information could contribute to gender-based inequality at work.This article reviews the evidence from the articles and clinical guidelines in PubMed, paying special attention to publications from the last five years (2015-2020). Additionally, it reports the results of an online survey of healthcare professionals exposed to radiation in their work.     

Methicillin-resistant Staphylococcus aureus: implications for the radiology department

OBJECTIVE: The purpose of this article is to discuss some of the implications of methicillin-resistant Staphylococcus aureus (MRSA) for the radiology department. CONCLUSION: MRSA is an infectious organism that has been increasing in prevalence and has presented a challenge to hospitals worldwide due to its drug resistance and propensity to cause serious infections. The radiology department is a site of high patient traffic and regularly encounters MRSA-positive patients. Guidelines for implementation of MRSA infection control practices are available and should be adapted to the radiology department. A summary of recommendations for MRSA infection control in the radiology department is provided.     

Staff Radiation Doses to the Lower Extremities in Interventional Radiology

The purpose of this study was to investigate the radiation doses to the lower extremities in interventional radiology suites and evaluate the benefit of installation of protective lead shielding. After an alarmingly increased dose to the lower extremity in a preliminary study, nine interventional radiologists wore thermoluminescent dosimeters (TLDs) just above the ankle, over a 4-week period. Two different interventional suites were used with Siemens undercouch fluoroscopy systems. A range of procedures was carried out including angiography, embolization, venous access, drainages, and biopsies. A second identical 4-week study was then performed after the installation of a 0.25-mm lead curtain on the working side of each interventional table. Equivalent doses for all nine radiologists were calculated. One radiologist exceeded the monthly dose limit for a Category B worker (12.5 mSv) for both lower extremities before lead shield placement but not afterward. The averages of both lower extremities showed a statistically significant dose reduction of 64% (p < 0.004) after shield placement. The left lower extremity received a higher dose than the right, 6.49 vs. 4.57 mSv, an increase by a factor of 1.42. Interventional radiology is here to stay but the benefits of interventional radiology should never distract us from the important issue of radiation protection. All possible measures should be taken to optimize working conditions for staff. This study showed a significant lower limb extremity dose reduction with the use of a protective lead curtain. This curtain should be used routinely on all C-arm interventional radiologic equipment.     

Inpatient admissions for interventional radiology: philosophy of patient management

As an alternative to performing interventional radiology on inpatients under the care of internists and surgeons, the authors have established a cardiovascular radiology admitting service for well-screened, elective patients. The patients are admitted under the care of a cardiovascular radiology fellow and a staff physician. From April 1982 to December 1983, 133 patients were admitted to the service. Patients are cared for in a surgical ward or in an intermediate unit, as determined by the clinical situation. Advantages of this approach include a broader patient referral base, improved rapport with clinical colleagues and patients, improved follow-up data, and rapid evaluation and treatment, resulting in short hospital stays. The major disadvantages involve the commitment of time and staff necessary to provide quality care. The concept of the interventional radiologist in the role of admitting physician has important implications in terms of negotiations for additional financial compensation, commensurate with the skill and time required for performing these procedures and caring for the patient.     

介入病房临时改造为感染病房的新型冠状病毒感染管理与实践

新型冠状病毒(COVID-19)主要通过呼吸道飞沫和密切接触传播,可经人与人传播,人群普遍易感,随着感染病例的不断增加,参与新型冠状病毒肺炎患者救治的医务人员存在较大的医院内交叉感染风险。因此,采取适当的医院感染防控措施对有效预防院内感染十分重要。该文总结了介入病房临时改造的感染病房在抗击新型冠状病毒中的感染防控策略,涉及病区结构、人员培训、消毒隔离制度和工作流程等方面,实现了医务人员零感染,可为其他隔离病房的感染管理工作提供参考。     

Evidence-based radiology: why and how?

Purpose

To provide an overview of evidence-based medicine (EBM) in relation to radiology and to define a policy for adoption of this principle in the European radiological community.

Results

Starting from Sackett’s definition of EBM we illustrate the top-down and bottom-up approaches to EBM as well as EBM’s limitations. Delayed diffusion and peculiar features of evidence-based radiology (EBR) are defined with emphasis on the need to shift from the demonstration of the increasing ability to see more and better, to the demonstration of a significant change in treatment planning or, at best, of a significant gain in patient outcome. The “as low as reasonably achievable” (ALARA) principle is thought as a dimension of EBR while EBR is proposed as part of the core curriculum of radiology residency. Moreover, we describe the process of health technology assessment in radiology with reference to the six-level scale of hierarchy of studies on diagnostic tests, the main sources of bias in studies on diagnostic performance, and levels of evidence and degrees of recommendations according to the Centre for Evidence-Based Medicine (Oxford, UK) as well as the approach proposed by the GRADE working group. Problems and opportunities offered by evidence-based guidelines in radiology are considered. Finally, we suggest nine points to be actioned by the ESR in order to promote EBR.

Conclusion

Radiology will benefit greatly from the improvement in practice that will result from adopting this more rigorous approach to all aspects of our work.     

介入放射科医疗风险的防范

简要介绍介入放射医疗风险种类,防范要求和内容。加强医疗风险管理是减少医疗差错、改善患者安全的有效途径。介入放射科风险具有一些独特的特征,其风险管理工作应根据风险的特征进行。     

European consensus on patient contact shielding

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.     

The Impact of Nonphysician Providers on Diagnostic and Interventional Radiology Practices: Regulatory,Billing, and Compliance Perspectives

The numbers of nurse practitioners and physician assistants are increasing throughout the entire health care enterprise, and a similar expansion continues within radiology. Some practices have instead embraced radiologist assistants. The increased volume of services rendered by this growing nonphysician provider subset of the health care workforce within and outside of radiology departments warrants closer review. The authors evaluate the recent literature and offer recommendations to radiology practices regarding both regulatory and scope-of-practice issues related to these professionals. Additionally, billing and compliance issues for care provided by nurse practitioners, physician assistants, and radiologist assistants are detailed. An analysis of the integration of these professionals into interventional and diagnostic radiology practices, as well as potential implications for medical education, is provided in the second part of this series.     

Day-case diagnostic and interventional peripheral angiography: 10-year experience in a radiology specialist nurse-led unit

We describe a prospective evaluation of the safety of peripheral angiography procedures performed on day-case patients in a dedicated radiological nurse-led and administrated unit. Patients referred for peripheral vascular angiography, over a 10-year period, were pre-assessed by a radiology specialist nurse in a nurse-led clinic. Radiologists performed all procedures, whereas radiology specialist nurses were responsible for patient care before, during and after angiography and during the 24 h follow-up. Procedures were divided into diagnostic or interventional; complications were divided into immediate or delayed (24 h follow-up) either requiring hospital admission (major) or day-case unit management (minor). Patient acceptability was assessed using a standard questionnaire. Cost analysis was also performed. 401 day-case peripheral angiography procedures (144 diagnostic and 257 interventional) were performed in 310 patients. 109/401 (27.2%) procedures were performed on patients with diabetes mellitus. In diagnostic studies, 16/144 (11.1%) immediate and 6/144 (4.2%) delayed complications occurred whereas, in interventional studies, 65/257 (25.3%) immediate and 13/257 (5.1%) delayed complications were noted. A major complication occurred in 17/257 (6.6%) of patients in the interventional group and 3/144 (2.1%) in the diagnostic group. Puncture site haematoma was the most common complication. Nurse-led care was acceptable to the patient, with a high level of patient satisfaction seen. In conclusion, day-case diagnostic and interventional peripheral angiography procedures can be performed safely in a specialist nurse-led and administrated unit, with complication rates being within the accepted guidelines.