Consider logistics fully and MSCT will thrive

Multislice CT systems are capable of dramatically improving image quality and patient throughput, and they are proving popular with referring doctors. But these systems also impose new workload and space demands on radiology departments. To ensure a successful installation, it is essential to consider the logistical implications and prepare with care.

Newer, faster machines drive up demand and boost throughput, but they are not always matched with new staff, and radiographers and radiologists may find themselves with heavier workloads.

The addition of a 64-slice MSCT machine at Addenbrooke's Hospital (Cambridge University Teaching Hospitals Trust) in the U.K. in late 2004 cut examination times from nearly 30 minutes to around 10 to 15 minutes. It made clinicians much more aware of CT and led to a department redesign to cope with changes in workload. Image quality is so good that clinicians want CT for almost everything. Many departments are trying hard to keep up with the workflow, and they are operating for extended hours to use the expensive machines at maximum capacity.

Requests for imaging of pulmonary embolism and acute abdomen are growing fast, and CT is on its way to becoming the first port of call for people with chest pain. CT is appropriate for victims of road traffic injuries, as well as very sick patients for whom MR is difficult to tolerate. CT has replaced intravenous urography, and CT colonography is replacing barium enemas.

Although the machine is important, even more crucial is the team of people who run it. Staff who have an impact on a CT unit include clerical workers, radiographers, radiographic helpers, nurses, and porters. If any of these groups are absent, the entire system will fail completely.

Streamlining of work processes should reflect a cooperative effort between radiologists, radiographers, and managers. The single most important factor in the smooth running of a CT unit is mutual respect between radiologists and radiographers.

Faster throughput leaves little time for thinking while the patient is in the CT unit, making protocols essential. Organization and efficient scheduling are also crucial. One option is to have "ringfenced slots," grouping together patients with the same clinical problem (e.g., renal cholic).

Redesigning the department is often necessary before throughput can improve. It is easy to run out of space because patients are handled so quickly. A possible solution is to set up a recovery room for patients, especially those who have just undergone an interventional procedure (e.g., CT-guided biopsy). Some procedures related to CT, such as needle insertions for intravenous lines, can be performed by radiographers in a side room.

At Addenbrooke's, we set aside a room for handling ventilated patients and for giving general anesthesia. On an average day, six ventilated patients from the critical care unit are examined. Another room is used by children, and a reporting room is available for radiologists and for radiographers to do advanced postprocessing, which is an important part of MSCT. Different units for outpatients and inpatients are useful for separating critically ill patients from ambulatory outpatients.

Having sufficient workstations is critical to throughput. Each CT system should have at least one operating platform and two workstations. Assigning two or three radiographers to each machine is necessary to maintain throughput.

On two CT systems at Addenbrooke's, staff examine about 45 patients per day during normal working hours, excluding neuroradiological and emergency examinations. Radiologists must know the clinicians making the requests. Investigations should be carried out as agreed during clinicoradiological meetings and the findings discussed with clinicians. Under the Ionizing Regulations and Euratom Directive, it is important to vet each request to make sure the examination is appropriate.

Maximizing throughput is not everything, however. Patients are human beings who should be treated with care and respect. Despite pressure to increase throughput, the department should not become a factory production line.

Image storage is another concern. More images are produced on the new machines, and questions arise as to how many should find their way to a PACS.

An infinite amount of material could be stored, so you have to make hard decisions about how much you store and where you store it. Most likely, it will be necessary to set protocols for the whole department for image capture and storage.

PROF. DIXON is head of the university department of radiology at Addenbrooke's Hospital in Cambridge, U.K. His radiographer colleague, Barbara Housden, contributed to this presentation.

This column is based on a presentation by Prof. Dixon at ECR 2005.