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2. Problems related to Radiology

Radiology has an important role in imaging patients with SARS but stringent infection control measures have to be implemented to stop infection of staff. In addition some hospitals may find themselves in the extremely difficult position of having to treat patients with SARS at the same time as trying to continue their service for the non-SARS population. This causes major problems for a radiology department which will have to offer a service to all these patients, sometimes using the same equipment, in the same room, by the same staff. In these circumstances the goal is not only to reduce the risk of infection to staff but also to reduce the risk of cross infection among patients. To provide a service patients must be segregated according to their percieved relative risk.

Designation of patient risk

As our hospital has a high patient throughput and a variable case mix, we decided that all staff performing radiological examinations, for both in-patients and out-patients, should take the highest personal infection control measures irrespective of the patient risk group. This means wearing isolation gowns, caps, gloves, N95 masks with goggles and visors or facial shields.

However, when it comes to re-organising the department and assigning infection control measures with respect to aspects such as cleaning and protective apparel worn by patients, the risk category of patients has to be taken into account. For practical purposes there are four categories of patients attending a radiology department:

These four groups of patients should be segregated.

The highest infection control measures must be taken for category (2) and (4) while lower precautions can be taken for category (1).

Category (3) patients cause the most difficulty when trying to assign relative risk. These in-patients may have a provisional diagnosis of a non-SARS related disease that also causes symptoms in common with SARS, in addition in-patients are at a risk of cross infection. Therefore we believe that the highest infection control measures should be taken for all in-patients attending the radiology department. The risk is not only dependant on the patient but also on the procedure. Some modalities such as ultrasound, interventional radiology, angiography and fluoroscopic contrast examinations including barium enema, carrying a higher risk because of prolonged periods of contact with a patient at close quarters and/or exposure to bodily fluids.

Segregation of patients

There are two ways patients can be segregated, location or time.

(a) Location

Try to site as many of the modalities for SARs patients outside the main department, i.e. mobile X-ray units, ultrasound on ITU etc. However, some modalities are not mobile (CT, MR, Fluoroscopy, Nuclear medicine). If you have two units try to designate one for SARS and one for non SARS patients, or hire additional equipment such as a portable CT. Waiting areas and patient access will have to be segregated also.

(b) Time

Most departments will be constrained by the amount of equipment and layout of the department. The only way to segregate some patients will be by time, for example dedicate the mornings to outpatients, early afternoons to in-patients without SARS, and late afternoons/evenings to SARS patients. Unfortunately, in practice this is very difficult to implement because the clinical condition of the patient often dictates the timing of the examination.