DrBaboon
10-26-05, 19:56
I don't know that you'd consider the home healthcare or nursing home world to be "austere," but in a sense it is compared to the hospital or the ER.
It also gives a preview of what x-ray might be under austere circumstances if you were lucky enough to have any x-ray equipment in the first place.
The nursing home regulations in the US generally result in any x-ray services done in the facilities be rendered by a visiting service - rather than using equipment based in the facility.
The appearance of the equipment is often different enough that if I have a resident with me at a nursing home, and the x-ray goes down the hall, I'll ask the resident what it is. They *rarely* correctly guess that it's an x-ray machine.
Typically, what I've seen is the tech pushing some kind of stand down the hallway (often looks like an IV pole on steroids), while lugging/dragging a big suitcase.
http://www.pnwx.com/Equipment/MedXray/MinXray/HF100H/
It turns out that this is one of the models I have often seen brought in.
Even though the pictures on that page show a wheeled cart that unfolds to be the framework supporting the x-ray, I have not seen that cart in use.
Instead, I've generally seen either this
http://www.pnwx.com/Equipment/MedXray/MinXray/Accessories/XGS%20MKIII%20LW_3.jpg
stand or this other one in use
http://www.pnwx.com/Equipment/MedXray/MinXray/Accessories/XGS%20MKIII%20LW_4.jpg
How well has it worked in terms of clinical results?
Well, I guess it depends on what you're trying to do with it.
Keep in mind that while many of us see portable Chest X-rays done AP, and are aware of the differences in how things look compared to an installed CXR unit doing PA films, most of us *don't* have films done with portable technique on other areas of the body. Well - OK - we get portable KUBs in a hospital setting once in a while. But we don't get knee films or hand films or whatever with portable equipment.
IOW - if you haven't lived with portable films on various areas of the body - you'll be in for a treat. There is of course *magnification* like you often see comparing a AP portable CXR to a PA film done on an installed unit. Basically, you don't have any of the colimating devices or other things available to you to make the rays parellel and non-divergent. There are no Bucky diaphragms in this type of work. So it's like casting a shadow on the wall, and magnification is typical. And as in AP portable chest x-rays, you get less magnification of the body parts that are right on top of the film cassette, and more magnification of body parts further from the casette.
You also don't have all the usual means of positioning the patient or aligning the x-ray source and the casette that you have with an installed x-ray unit. So distortion, having films shot at off-angles, etc. is the norm. The x-ray source is also often much closer to the patient and the casette than even with hospital portable CXRs, which adds another dimension to reading this kind of portable film.
In spite of all of that, I've gotten useable x-ray information in nursing homes with films shot by visiting services.
It's also given me some principles for deciding whether or not to order an x-ray in the nursing home, skip the x-ray, send the person out for another imaging study of some kind, or perhaps send them to the ER even for conventional x-rays.
Aside from being not very helpful period - you can't get decent skull films this way. Mandible films can be done, but it's going to be mostly bilateral views (I order more mandible films in the NH for sialolithiasis than trauma -seems to affect my population). Forget sinus films - you can't properly align things. Chest x-rays are more challenging than regular portable AP films in the hospital, but are usually good enough to be useful. KUB's are OK. Of course, things like confirming feeding tube tip locations, or even squirting some gastrograffin into a tube when there is ambiguity can be done if the doc is there when the tech is there. I have been able to get GI contrast from some of the pharmacies with 24 hour advance notice.
Limb films, pelvis films are OK - with distortion/alignment/magnification problems. I don't do hip films on people I think have hip fractures - they go to the ER. I sometimes order hip films or pelvis films on people I *don't think* have hip fractures to add evidence to the existing clinical impression of *no fracture*. The delay before the portable service comes, takes the film, and later reports it, and then having to go to the hospital if there is a hip fracture results in more delay than is usually acceptable before surgically addressing the hip fracture.
Spine films don't work out too well on this kind of portable equipment. I have been known to look at lumbar vertebrae for signs of compression on a KUB in someone with back pain. As far as I can tell, I rely less on the phone reports from the service, and ask to see far more actual films than my local colleagues. There is often stuff which interests me that is not commented on in the report, and I often want to correlate what I see clinically with the film.
If you could either come up with digital imaging to substitute for the casette, or manage a way to have your film developer set-up and operating, I bet this type of x-ray would have it's uses in some parts of austere care. Of course, there is also the problem of needing consumable x-ray film and chemicals for the developer.
It's also an area where I could see a return to old "special procedures" techniques - if they were done at all (if supplies were avaiable, could be conjured up, etc.).
For example - hand injecting contrast for venograms (another good reason for having a pocket doppler available, I think - I'd rather do the doppler). If you're injecting an arteriorgram for limb viability, I'd bet the limb is already lost, and you'd probably get good enough information from pocket doppler to supplement your clinical assessment.
Unless you've got an abdominal ultrasound (possible) - I could see going back to oral cholecystograms (I haven't ordered an OCG since intership!). Nuclear medicine is off-line in the absense of radio-pharmaceuticals, even if you had the equipment.
IVP's aren't that hard to do if you have any x-ray, as long as you have some IV contrast. I don't think tomograms are essential. Ultrasound would again be a good alternative - and re-useable.
Basically - I'd bet that *if* we have any kind of x-ray available - it would be something like this. And we'd have to adjust our use of them, as well as how we interpret them. These kinds of portable films really do look different.
It also gives a preview of what x-ray might be under austere circumstances if you were lucky enough to have any x-ray equipment in the first place.
The nursing home regulations in the US generally result in any x-ray services done in the facilities be rendered by a visiting service - rather than using equipment based in the facility.
The appearance of the equipment is often different enough that if I have a resident with me at a nursing home, and the x-ray goes down the hall, I'll ask the resident what it is. They *rarely* correctly guess that it's an x-ray machine.
Typically, what I've seen is the tech pushing some kind of stand down the hallway (often looks like an IV pole on steroids), while lugging/dragging a big suitcase.
http://www.pnwx.com/Equipment/MedXray/MinXray/HF100H/
It turns out that this is one of the models I have often seen brought in.
Even though the pictures on that page show a wheeled cart that unfolds to be the framework supporting the x-ray, I have not seen that cart in use.
Instead, I've generally seen either this
http://www.pnwx.com/Equipment/MedXray/MinXray/Accessories/XGS%20MKIII%20LW_3.jpg
stand or this other one in use
http://www.pnwx.com/Equipment/MedXray/MinXray/Accessories/XGS%20MKIII%20LW_4.jpg
How well has it worked in terms of clinical results?
Well, I guess it depends on what you're trying to do with it.
Keep in mind that while many of us see portable Chest X-rays done AP, and are aware of the differences in how things look compared to an installed CXR unit doing PA films, most of us *don't* have films done with portable technique on other areas of the body. Well - OK - we get portable KUBs in a hospital setting once in a while. But we don't get knee films or hand films or whatever with portable equipment.
IOW - if you haven't lived with portable films on various areas of the body - you'll be in for a treat. There is of course *magnification* like you often see comparing a AP portable CXR to a PA film done on an installed unit. Basically, you don't have any of the colimating devices or other things available to you to make the rays parellel and non-divergent. There are no Bucky diaphragms in this type of work. So it's like casting a shadow on the wall, and magnification is typical. And as in AP portable chest x-rays, you get less magnification of the body parts that are right on top of the film cassette, and more magnification of body parts further from the casette.
You also don't have all the usual means of positioning the patient or aligning the x-ray source and the casette that you have with an installed x-ray unit. So distortion, having films shot at off-angles, etc. is the norm. The x-ray source is also often much closer to the patient and the casette than even with hospital portable CXRs, which adds another dimension to reading this kind of portable film.
In spite of all of that, I've gotten useable x-ray information in nursing homes with films shot by visiting services.
It's also given me some principles for deciding whether or not to order an x-ray in the nursing home, skip the x-ray, send the person out for another imaging study of some kind, or perhaps send them to the ER even for conventional x-rays.
Aside from being not very helpful period - you can't get decent skull films this way. Mandible films can be done, but it's going to be mostly bilateral views (I order more mandible films in the NH for sialolithiasis than trauma -seems to affect my population). Forget sinus films - you can't properly align things. Chest x-rays are more challenging than regular portable AP films in the hospital, but are usually good enough to be useful. KUB's are OK. Of course, things like confirming feeding tube tip locations, or even squirting some gastrograffin into a tube when there is ambiguity can be done if the doc is there when the tech is there. I have been able to get GI contrast from some of the pharmacies with 24 hour advance notice.
Limb films, pelvis films are OK - with distortion/alignment/magnification problems. I don't do hip films on people I think have hip fractures - they go to the ER. I sometimes order hip films or pelvis films on people I *don't think* have hip fractures to add evidence to the existing clinical impression of *no fracture*. The delay before the portable service comes, takes the film, and later reports it, and then having to go to the hospital if there is a hip fracture results in more delay than is usually acceptable before surgically addressing the hip fracture.
Spine films don't work out too well on this kind of portable equipment. I have been known to look at lumbar vertebrae for signs of compression on a KUB in someone with back pain. As far as I can tell, I rely less on the phone reports from the service, and ask to see far more actual films than my local colleagues. There is often stuff which interests me that is not commented on in the report, and I often want to correlate what I see clinically with the film.
If you could either come up with digital imaging to substitute for the casette, or manage a way to have your film developer set-up and operating, I bet this type of x-ray would have it's uses in some parts of austere care. Of course, there is also the problem of needing consumable x-ray film and chemicals for the developer.
It's also an area where I could see a return to old "special procedures" techniques - if they were done at all (if supplies were avaiable, could be conjured up, etc.).
For example - hand injecting contrast for venograms (another good reason for having a pocket doppler available, I think - I'd rather do the doppler). If you're injecting an arteriorgram for limb viability, I'd bet the limb is already lost, and you'd probably get good enough information from pocket doppler to supplement your clinical assessment.
Unless you've got an abdominal ultrasound (possible) - I could see going back to oral cholecystograms (I haven't ordered an OCG since intership!). Nuclear medicine is off-line in the absense of radio-pharmaceuticals, even if you had the equipment.
IVP's aren't that hard to do if you have any x-ray, as long as you have some IV contrast. I don't think tomograms are essential. Ultrasound would again be a good alternative - and re-useable.
Basically - I'd bet that *if* we have any kind of x-ray available - it would be something like this. And we'd have to adjust our use of them, as well as how we interpret them. These kinds of portable films really do look different.