An international web-based information and support system focusing on mobile chest x-ray of patients who have Covid-19, has been launched.
Led by Professor Peter Hogg of the University of Salford and Ken Holmes, University of Cumbria, the resources have been developed in close partnership with the European Federation of Radiography Societies (EFRS) and the International Society of Radiographers and Radiologic Technologists (ISRRT), with significant input from the Italian Federation of Scientific Radiographers Societies (FASTeR), the Society and College of Radiographers, and e-Learning for Health (e-LfH).
"CT and mobile chest x-ray (CXR) are considered to be two valuable imaging tools in the management of Covid-19, but due to CT safety and logistics, CXR is used more extensively," Peter Hogg said.
"Mobile radiography is an art and a science and not all radiographers are up to date with this technique. Consequently, due to the rapid rise in demand for mobile CXR imaging, many radiographers will have to be reskilled and upskilled."
Peter continued, "We know this will place a huge resource burden, both locally and nationally, in order to create and deliver learning opportunities to meet training and educational needs.
"Providing a single web-based information and support resource with links to other sites, including e-LfH, means that tens of thousands of hours can be saved across the world by reducing or even eliminating the need for replication of effort. More time can therefore be spent on caring for patients.
"Also, it is worth noting that within and between countries, the information provided to radiographers about PPE and professional/social practices to minimise Covid-19 infection is highly variable."
Charlotte Beardmore, the SoR director of professional policy, aid, "It is fantastic that this resource has been developed and is available for radiographers worldwide. The College of Radiographers is pleased to be helping support this collaboration with resources soon to be available worldwide for radiographers on the Covid-19 eLfH platform. More information will follow."
Multinational effort
From conception to publication, the system was developed and published within 16 days. A multinational team of over 40 people was assembled, and in excess of a thousand hours of human effort went into its creation. The team worked in small sub-groups on specific topics. Nobody could meet in person due to social distancing and some sub-groups did not know each other before the project.
Time zones created additional difficulties, as synchronous working was hard to achieve around the globe. However, once each sub-group produced material about a topic, it was peer reviewed quickly and suggestions were made for improvement; revisions with turned around within hours. At the same time, they worked closely with Elsevier, the publishers of Radiography journal, to identify articles that had value to the work and the review and publication process was expedited so links could be made to articles from the website.
Peter Hogg noted, "We must accept two caveats:
- Practice and legal variations will occur within individual countries and we could not address them here
- The subject of mobile chest x-ray imaging and PPE for Covid-19 is changing fast; you should always check for up-to-date evidence and your government's guidelines, where they exist.”
eLfH resources
Four new e-learning sessions have been developed using the international materials. These will soon be going live in the Covid-19 programme of e-LfH. The Resources for Radiographers sessions are:
- Minimising Risk during Mobile Radiography
- Mobile Chest Radiography
- Radiographic Procedure
- Image Evaluation for the Diagnostic Quality of Chest Radiographs including COVID-19 cases
There will also be articles and other supporting e-learning sessions in this programme to further support radiographers.
Website content
Peter Hogg commented, "We have created a lot of learning materials and guidance documents with links to external sources. To minimise the time you spend searching through the website, we have provided a brief explanation of each section. It could be worth your while to review the brief explanations and then decide which sections are relevant to you. Each heading below is a clickable link directly to the content."
Covid-19 ISRRT Response Document
Whether you are experienced in mobile chest radiography or not, this document is worth reading. It is a check list of things to consider before, during and after the imaging procedure.
Section 1: What is a virus? What is Coronavirus and why is it different?
If you don’t know a great deal about viruses or Covid-19 then this is worth reading as it sets a good foundation and context on which you can learn about Covid-19 and why it is so risky to humans. This section gives a clear explanation on why it is easy to catch if you are not careful. Working through this section will allow you to understand the nature of viruses, describe how they multiply within their host, understand the nature of Covid-19, describe ways of minimising the spread to yourself and the community, and list ways you might be managed/treated if you catch the virus.
Section 2: Measures radiographers can take to minimise risk to themselves during professional working and their families
There are three main components to this section:
- PPE and practices in professional work and minimising risk to your loved ones
- Physical and mental well-being of radiographers during self-isolation due to Covid-19
- Coping with wearing PPE in your professional work
There is special emphasis on the radiographers’ wellbeing, be that physically, mentally and, for some, spiritually, as these are exceptional circumstances and we all need to look after ourselves as well as our patients and colleagues.
Section 3. Effective communication
Content is being added to this section and it should be complete by 9 May.
Section 4: Mobile x-ray equipment
As the pandemic progresses, the medical community will frequently rely on portable chest radiography due to its widespread availability and the infection control issues that currently limit the use of CT. This section explains how to use a mobile x-ray machine effectively to perform an examination for a Covid-19 patient. It also helps you to understand the parameters which can optimise the radiation dose.
Section 5: Radiographic procedure
Undertaking radiographic procedures when there is a possibility that the patient may be Covid-19 positive brings its own challenges. This section explains how to undertake a mobile chest x-ray examination on a Covid-19 patient and it enables you to discuss how to produce a diagnostic image at the first opportunity.
Section 6: Radiation protection
As with many radiographic procedures, radiation dose is important and this should always be kept As Low As Reasonably Achievable/Practicable (ALARA/P). This session will help you understand the radiation protection measures that are required for a mobile chest x-ray examination.
Section 7: Image review and reporting
It is very important to be able to assess the images you produce so that they are of sufficient quality to assist in patient management. It is also important to be able to note and recognise any abnormalities. This section will help you apply, effectively, a 10-point plan to ensure the image is diagnostic for a mobile chest radiograph and to identify common pathological appearances on the radiograph of Covid-19 and communicate the findings to the referrer.
Section 8: Patient informatics
Content is being added to this section and it should be complete by 9 May.
Section 9: Audit and learning
Content is being added to this section and it should be complete by 9 May.