Ebola and Radiologists, Technologists

Radiology departments need to develop new protocols when obtaining images for patients who are contagious with potentially lethal infectious diseases, such as Ebola virus, according to an article published in the journal American Journal of Roentgenology.

Physicians from Emory University authored an article reviewing the protocols used at their facility in order to successfully acquire chest X-rays of patients who were infected with the Ebola virus.

"Clear and frequent communication with the healthcare staff is essential during this time of heightened public concern and understandable caution," said report co-author Carolyn C. Meltzer, MD, departments of radiology and imaging sciences, psychiatry and behavioral sciences, and neurology, Emory University School of Medicine in a release. "For example, at Emory University Hospital, open Town Hall information sessions, the wide dissemination of standardized screening protocols, and close intra- and interdepartmental communication have supported a safe environment in caring for patients with Ebola virus."

Chest radiographs are not used to diagnose Ebola virus disease, however patients presenting to the emergency department are likely to require imaging, the authors noted. Given the nature of the disease, patients with Ebola virus must be cared for within a specialized isolation unit.

At Emory, radiology staff received in-depth information and education on the Ebola virus and required isolation unit procedures. "Radiology staff directly involved in the care of patients with Ebola virus disease need to be identified and educated regarding procedures of the isolation unit and regarding appropriate donning and doffing of correctly-sized personal protective equipment," co-author, David A. Bluemke, MD, PhD, director, department of radiology and imaging sciences, NIH Clinical Center, said in the release. "Open and frequent communications are essential."

While each patient unit may be unique, depending on its equipment and how it is connected (wired versus wireless), radiology departments must develop standard operating procedures that can be adapted according to each situation. Every attempt should be made to perform imaging in the patient’s room with portable equipment, limiting transportation to a central imaging area.

One strategy that could be used is the hot room/warm room approach. According to the authors, the patient’s room is called the hot room and the anteroom is the warm room. The radiologists do not go beyond the warm room. From the warm room, they relay verbal instructions to the nurses and physicians in the hot room, minimizing the number of people exposed to the patient.

A second strategy is used when the equipment is more complex and may need more hands on by the radiologic technologist. The technologist then does enter the hot room in order to operate the equipment.

Hot room preparation for imaging is essential. The room must have all necessary supplies, including lead aprons, disinfectant, and equipment covers. Batteries for portable equipment must be kept fully charged. The X-ray detector is then double bagged and each bag is separately zip-locked prior to entering the patient's room, the authors explained.

The physical layout of the room should also be taken into consideration. For example, a dirty box area (hot room) and clean box area (warm room) will be marked. In the hot room, the patient’s bed should face the door, in the direction of the dirty box.

If transportation to a central imaging location is required, additional precautions are needed, such as coordinating the patient’s route to and from the location with the infection control team.

Disinfection of radiology procedure rooms requires many hours and may prohibit diagnostic treatment of other patients in the facility. CT and MRI equipment are not designed for imaging of patients with Ebola or other highly contagious diseases. Small crevices in the gantry table and moving parts are extremely difficult to protect with plastic covers, and bodily fluids can accumulate in narrow recesses that are inaccessible to surface cleaning.

The imaging protocols presented by the authors were developed by the infectious disease specialists and the radiology department. “There is an opportunity for radiologists to collaborate with clinicians in improving these protocols and developing safe protocols for other modalities. In particular, radiology departments and hospitals should consider investing in digital radiography machines to be placed within these isolation wards,” the authors concluded.