Education | Health Care | Research | Site Map

Radiology

Search:  

 

GENERAL INFORMATION

General Info Quick Links Consultations Administration Problems Computer Systems Scheduling Consent Critically Ill Patients Patient Holding Exams for Trauma

Portable X-ray Film Ownership Film Loans Report Availability

Outside Films Flash Card Reading Radiation Risk Quality Improvement

 

RADIOLOGY COMPUTER SYSTEM/TERMINALS

 

In order to be able to schedule, take out film loans, review reports and access information about film location, physicians must be entered into the Radiology computer system.

New staff members can be entered into the system by obtaining physician I.D. forms in the Radiology Department (ground Dulles) Radiology reception area (x3000).

The terminals on the floors are also able to present Radiology information. Access to information is gained by entering physician's social security number.

Back to Top

SCHEDULING

 

1. Telephone Numbers:
   1. Routine: In and outpatient radiology examinations can be scheduled by calling 662-3000, 6:00 am - 5:30 pm, (including weekends and holidays).
      
   
   
   2. Exceptions: The exceptions are:
      • IR 662-4034
      • Neuroradiology 662-3064
      Note: CT and MRI Exams cannot be scheduled for patients over 300 lbs.
      
      
2. Inpatient Requests:
   1. On-admission chest examinations should be obtained during the admissions process, not after the patient reaches the unit. "On-admission” is not a reason for a radiological procedure to be performed.
      
      
   2. If you are sure of the exam to be requested, please specify clearly. If you are not sure, consult with the appropriate Radiology Section before ordering on Sunrise.
      
      When telephoning requests for radiological procedures, the following information is needed:
      
      1. full name of patient
      
      
      2. HUP ten digit history number
      
      
      3. date of birth
      
      
      4. reason for procedure
      
      
      5. patient location
      
      
      6. insurance information.
         
         
   3. For examinations requiring preparations, a separate order must be written in Sunrise for proper preparation. Unless contraindicated, the standard preparations should be used, as described in this handbook and in the standing radiology sheet attached to the order book.
      
      
   4. If scheduling after 6 P.M., unless the current date is requested, STAT CODE BLUE, URGENT, or STAT, it will be assumed that the examination is to be performed the following day. When an examination cannot be performed on a requested date (for example, when preparation procedures dictate time availability), the scheduler will inform the floor. PLEASE NOTE, that the floor is responsible for informing the physician.
   
   
   5. For exams scheduled nights and weekends, (after 6 P.M. weekdays, after noon Saturdays, and all day Sundays), only the following examinations will be routinely performed:
      
      
      1. Emergency studies or exams required for urgent medical needs or concerns.
      
      
      2. Pre-operative examinations for surgery the same day or next morning (on OR schedule).
      
      
      3. Pre-myelogram spinal examinations for myelograms scheduled the next morning.
      
      
      4. Portable examinations for intensive care units and OR.
         
         
      Any other examinations requested must be approved by the Radiology resident on duty.
      
      
3. Outpatient Scheduling: Requests must be made using the Radiology outpatient request form. If you are sure of the exam to be requested, please specify clearly. If you are not sure, consult with the appropriate Radiology Section before filling out the request slip. Patients should arrive 30 minutes before the examination is scheduled to be performed. They should bring insurance information, but leave at home valuables or money they will not need.
   
   When an appointment is made by telephone, name, DOB, Hx, reason for exam, local address, insurance and patient's telephone number should be supplied. Insurance authorization if applicable.
   
   Cancellations and changes in a patient's status (transportation, condition, etc.) should be reported as soon as possible by calling 662-3000.
   
   
4. Pregnant Patients: Referring physicians should determine, whenever possible, if a female patient is pregnant. If she is, consult with a radiologist before ordering x-rays, MRI, or Nuclear Medicine examinations.

Back to Top

CONSENT FORMS

 

If a signed consent form is required for an examination, it is indicated per exam (consents are individualized for each procedure). Consent forms are to be signed only after an oral explanation by the radiologist involved and after ample time has been allowed for the patient to read the form.

Someone other than the physician must witness each form, preferably, and the date must be clearly indicated on the form in addition to the patient’s name clearly printed on the top. If the patient is a minor, unconscious, or is otherwise not competent to give consent, a member of the family is permitted to sign the consent form with the relationship to the patient indicated.

Back to Top

CRITICALLY ILL PATIENTS

 

Notify Radiology in advance if a critically ill patient will be arriving for an examination. A physician, nurse or teletransporter must accompany the patient; this is HUP policy for ICU patients. Escort services should be called to assist, but they should never have sole responsibility for a critically ill patient.

When available, a nurse in Radiology will stay with the patient. A full, accurate report of the patient's needs and condition must be given to the nurse. If a Radiology nurse is not available, a member of the patient's medical team must remain with the patient.

Back to Top

PATIENT HOLDING/RESTRAINT PROCEDURES

 

If necessary, Radiographers will use restraints to position patients during examinations. Because of the close proximity to radiation, Radiographers are not permitted to remain in the room with the patient during their examination. In some instances, staff members (physicians, nurses, etc., not pregnant and protected with lead garments) will be asked to hold patients.

Back to Top

ADVICE ON ORDERING EXAMS FOR TRAUMA PATIENTS

 

Lumbar Spine Films: These involve considerable exposure to the gonads and should be ordered very selectively. The yield of these films for "low back pain" is low. They are useful for trauma (auto accident), infection and metastatic disease.

Rib Films: Rib fractures are less important than their complications: pneumothorax, pulmonary contusion, hemothorax. These are best evaluated on simple PA and lateral chest films. However, the lower ribs may not be seen on a chest film.

Head Trauma: Skull films may not visualize facial fractures. If facial fractures are of concern, facial films will be the better exam.

Cervical Spine Trauma: If a fractured or dislocated C-spine is suspected, order a portable lateral C-spine film. The purpose of this film is to visualize all 7 cervical vertebral bodies and rule out instability. If no such injury is seen, then the patient can be moved for a complete film series. A normal portable film does NOT exclude a C-spine fracture.

Extremity Trauma: Point tenderness and swelling are best indicators of which films, if any, to obtain. Fractures are unlikely if these signs are absent.

NOTE: Feel free to ask the radiologist for advice regarding the best films to evaluate a problem.

Back to Top

THE PORTABLE X-RAY EXAMINATION

 

Portables are done 24 hours a day, 7 days a week. A portable x-ray examination is one in which the x-ray unit is brought to the patient's bedside, rather than having the patient transported to the department. Certain disadvantages are inherent in this system. The portable x-ray unit is less powerful than a stationary machine. Longer times are thus required to make each exposure, and exposures of thick and dense parts of the body, such as the abdomen, may be impossible in large patients.

Other problems occur which make the portable x-ray examination less than optimal. Because the tube and film are not fixed installations, distance and angulation can vary, leading to distorted, overexposed, or underexposed radiographs. Patients who require portable examinations are often unable to cooperate and often are not able to remain motionless or suspend their respiration for the time required to make an exposure. This will yield radiographs of poor quality.

Despite the limitations of the portable technique, it remains a very important and useful tool in the care of the critically ill patient.

Who should have a portable examination?

Only those patients who are too ill to come to the Radiology Department or who are absolutely restricted to their room by life support equipment or orthopedic appliances should be examined by portable techniques. In addition, the information sought should be relatively gross, since the limitations of the examination do not generally yield the fine details, which can be obtained in more permanent installations.

What portable examinations are useful?

Chest X-Rays: The portable chest examination is the most common portable examination ordered. The cardiopulmonary system is frequently involved in the critically ill patient. The portable chest x-ray can often provide information about the etiology of the problem and it is useful in following the course of a known cardiac or pulmonary problem. The portable chest x-ray is necessary to evaluate the placement of tubes and catheters in the chest and the complications, which might result from those catheters. The portable chest x-ray examination is generally done in the AP projection only.

Lateral films and decubitus films may be attempted when deemed essential, but these are frequently difficult to obtain on the critically ill patient.

The information obtained from the portable chest x-ray is gross. Pneumothorax, atelectasis, and pleural effusions of any major degree are generally recognized. Cardiac size and congestive failure often can be evaluated. Pneumonia, aspiration, and pulmonary edema can all be detected but may look very much alike in an individual and it may be difficult to distinguish which of these problems is present.

Abdomen: The portable x-ray examination is not very useful in evaluating the abdomen. It can determine the placement of a feeding tube, and it can sometime be helpful in detecting bowel obstruction. Because one is generally limited to a supine AP film, it may be difficult to determine the location of intestinal gas and thus whether there is a dynamic ileus or obstruction. If a perforation is suspected, a decubitus or horizontal lateral film is usually the film of choice since the patient usually cannot stand erect. Either film may show the presence of free air. In very large patients, adequate abdominal radiographs may be impossible when completed portable.

Extremities and Spine: A portable examination may be useful in detecting gross fractures of the extremities or, occasionally, of the spine or in assessing position of known fractures which are being treated with traction.

Skull: A portable skull examination is essentially useless, unless one is looking for extremely gross findings. A major fracture, particularly a depressed fracture, may be identified. A major pineal shift may also be recognized. If the patient's clinical status clearly indicates that the patient should have skull films, it is almost mandatory that the patient be brought to the Radiology Department where technically good films can be obtained.

Contrast studies: Portable contrast studies are generally poor. However, where gross information is required, they can be useful. For example, in a surgical patient who is being considered for a nephrectomy because of severe trauma, it is important to establish the presence of a second kidney. This can be easily accomplished by administering intravenous contrast material and making a portable abdominal film.

The placement of various tubes can be ascertained by injecting into the tube with contrast material and making a portable radiograph. This is generally necessary only if the tube is thought to be outside the appropriate viscus or if a perforation is suspected. Fistulae and visceral perforation can sometimes be demonstrated by injecting a fistula with contrast material or by filling the appropriate viscus with contrast material (barium swallow, tube injection, etc.).

Back to Top

OWNERSHIP OF RADIOGRAPHS

 

Radiographs are the Hospital's property and are maintained and stored by the Radiology Department Film Library. Storage, retrieval and loan of radiographs should be in the best interest of the patient.

Back to Top

FILM LOANS

 

TO HUP PHYSICIANS

The Film Library is open Mon-Fri 8:00 am – 7:00 pm. Call 662-7994 for information.

Master film folders cannot leave the Radiology Department. Films that are loaned must be in a film loan jacket. CD can be provided for the patient to keep. For the 2nd CD there is a charge of $75.00.

Physicians can submit their request by the following procedures:

1. Call ahead (662-7994) or go to the loan window in the Film Library
   
   
2. Provide the patient's name, medical record number and examination needed. Patient’s birth dates are acceptable if history numbers are not known by FAX to 662-3099.

Requests for more than three patients' films/CD must be made in writing.

Conference Lists: Due to the tremendous volume of conferences submitted to the Film Library, conference lists should be submitted to the Film Library 12 hours prior to scheduled conference time.

A conference form must be filled out containing CD/films, patient's name, medical record number, exam date, time and physician's name (beeper number). The requests can be picked up at the loan window in the Film Library.

TO OUTSIDE PHYSICIANS

If the referring physician, or the patient on the physician's behalf, wishes to take films out of the Hospital, it should be clearly understood that the films are on loan and are to be returned. Patients should understand that the payment for their examination was for procedure, interpretation, and professional services, not only for the films themselves.

The physician or the patient must provide a written request authorizing the release of film/CD; forms are available in the Film Library. The request can be mailed or hand-delivered. The patient, or a family member with authorization from the patient, may pick up the films for loan or CD to keep.

Patients who request copies of their reports will be encouraged to obtain them from their referring physician, who can best help them interpret and understand the information.

Back to Top

REPORT AVAILABILITY

 

Preliminary and final reports can be reviewed on the TDS, Medview, and EPIC computer terminals on the floors. Inpatient reports are printed on the floor from TDS. Outpatient reports are printed in radiology and sent to the referring physician via mail services. Reports can also be sent via e-mail by upon request to help@rad.upenn.edu.

The system does include reports that have not yet been edited and signed by a staff radiologist; "Unapproved Report", resident reading not yet checked by staff. All reports that go to medical records are signed by a staff radiologist.

Verbal reports are also available from the Radiology Voice Access System. You may gain access to this system from any telephone, and access the verbal dictation of a patient examination immediately following the Radiologists' dictation. Instructions for access to the system are available on in-patient floors and Referring Physician Offices. A demonstration may be arranged by calling 662-3067.

It is permissible to release x-ray reports if authorized by the patient.

Patients who request copies of their reports will be encouraged to obtain them from their referring physician, who can best help them interpret and understand the information.

When radiographic studies are reported that contain potentially life-threatening conditions, the Radiologist will attempt to contact referring physician. It can be difficult to reach referring physicians in a timely manner; consequently, it is strongly recommended that all examinations be reviewed in Radiology with a Radiologist.

Back to Top

REVIEW OF OUTSIDE FILMS

 

Radiology examinations performed outside of HUP may be reviewed with a HUP radiologist by requesting a written consultation report. Outside films can be deposited at the Main Reception Area on Ground Dulles. All requests must be accompanied with the following:

1. The original interpretation (report) for each case.


2. A written request for review patient name, hx#, reason for review, ICD9 code, location, DOB, and insurance.


3. Only the specific films to be reviewed.

If these criteria are not met, the request cannot be accepted nor will the films be reviewed.
All written requests (standard request form) must include the following data:

1. Patient's name.


2. HUP medical record number or patient's date of birth.


3. Clinician's signature (also printed for clarity).


4. Pertinent clinical data for reviewing the cases.


5. List of examinations needing review.


6. Indication if films are to be returned to clinician or filed in Radiology Master folder after review.

Back to Top

HOW TO INTERPRET "FLASH CARD" READINGS:

 

NAS: No abnormality seen.

NAD: No active disease. A patient with stable TB scarring enlarged heart, stable interstitial lung disease, or a tortuous aorta will receive a reading of NAD.

NEG: Means the same as NAD or NAS.

No Fracture: Although there is no fracture, there can still be significant ligamentous injury if there is soft tissue swelling.

STS: Soft tissue swelling.

Back to Top

RADIATION RISK FROM DIAGNOSTIC EXPOSURE

 

It has not been shown that radiation exposure from diagnostic radiological examinations increases the risk of cancer. However, it is well known that at much higher exposure levels, there is an increased risk of developing some cancers. Therefore, it is common practice to carefully monitor radiation doses from all procedures that use ionizing radiation, however small the dose. Only by continuously monitoring patient doses can we be sure that the risk of injury is minimal.

In addition to cancer, another type of injury that is associated with radiation exposure is skin response (erythema, epilation) or eye injury (cataracts). These types of effects are associated with moderate doses of radiation delivered acutely. Although rare, these injuries are a possible result of diagnostic or interventional procedures that involve the use of long fluoroscopy times, high fluoroscopic dose rates, continuous fluoroscopic exposure to a specific region of skin, or a combination of these factors. Examples of procedures that carry a higher risk of this type of injury are radio frequency cardiac catheter ablation, percutaneous transluminal angioplasty, vascular embolization, and transjugular intrahepatic portosystemic shunt. Fluorographic exposures such as cinefluorography and digital angiography also contribute to the radiation risk. To minimize the risk of these injuries, a Fluoroscopic Credentialing Program has been implemented in February 2000 for all Non-Radiologist physicians. The program is a didactic lecture on the use of fluoroscopes to enhance image quality, knowledge of radiation risks, and reduce patient and personnel exposures. In addition, annual radiation safety in-services are given to every nurse and technologists using radiation-producing equipment. The fluoroscopic exposure rates are measured annually and the scattered radiation from all hospital fluoroscope equipment is measured at the time of installation. Fluoroscopy times are recorded.

The following table lists approximate patient doses (given as entrance skin exposures in milliRoentgens, mean bone marrow dose in millirads, and mean gonad dose in millirads) for the most common radiographic exams. Fluoroscopy doses are not included in this list due to their wide variability. The entrance skin exposure rates for all fluoroscopes at HUP are typically 1-2 Roentgens per minute for average-sized patients, and do not exceed 10 Roentgens per minute.

Back to Top

RADIOLOGY QUALITY IMPROVEMENT

 

The Radiology Quality Improvement program is designed to identify and solve problems within both the Department of Radiology and with our interactions with the other Departments of the Hospital.

The program consists of several components:

1. The Operational/technological QI program centers on a monthly Supervisor’s meeting, the Patient Care Committee, chaired by Dr. Rubesin, one of the Quality Improvement officers.


2. The Professional QI structure revolves around the Quality Improvement Committee chaired by Dr. Trerotola, another Quality Improvement officer.

A number of other committees meet regularly and report their functions and problems directly to the QI committees, including the Nuclear Medicine Quality Control Committee.

Radiation Safety and Equipment quality control and Mammography and MQSA issues are discussed by the Image Quality Control Committee chaired by Michael O’Shea, a member of the Physics Section.

We encourage feedback from the medical community we serve. We encourage members of the medical community to contact any of the above individuals or committees if there are comments, problems or suggestions regarding our service.

Back to Top

About UPHS   Contact Us   Site Map   Privacy Statement   Legal Disclaimer   Terms of Use

The University of Pennsylvania Health System, Philadelphia, PA © 2006,
The Trustees of the University of Pennsylvania