Electronic Requesting

1.Place your electronic request using ICE (our electronic ordering system). This is available via the desktop computers within each hall. The ICE requesting pane will only display examinations which are available at the Nightingale Hospital.

2.Be sure to provide accurate referrer details including a phone number so we can contact you. It will not be legally possible to carry out your examination without adequate referrer details.

3. Contact either the CT or X-Ray radiographer and discuss your case to agree the following

• Indication

• Urgency

• Practicalities and Logistics

Viewing radiological examinations and reports

Use PACS Xero Viewer to see images and reports on any computer in the hospital.

If you require critical viewing, a 6-megapixel diagnostic display is located on each Radiology Base in every ward. To use this, you will need to drag the Xero browser window onto the secondary diagnostic screen and maximise the window.

Clinical Pathway

Safety

There are no known safety concerns for the use of diagnostic ultrasound at the mechanical indices the point of care machines operate at. This includes the context of scanning a pregnant patient should it arise.

The mechanical index (power setting) should be maintained at the lowest reasonable value to obtain a meaningful diagnostic image in keeping with the ALARA (as low as reasonably achievable) principles.

Indications

The indications for use are left at the discretion of the operator and are wide ranging.

Broadly speaking use cases cover

• Diagnosis and surveillance of conditions of sonographically accessible viscera, connective tissues and blood vessels throughout the body

• Guidance of percutaneous interventional procedures to improve accuracy

Standard Operating Protocol

Point of Care Ultrasound (POCUS) concerns the use of ultrasound in a clinical setting by trained medical professionals (though not usually sonographers or radiologists in this context). POCUS should only be carried out by a trained professional confident and competent in its use.

Sonographer / Radiologist Ultrasound

Ultrasound performed by Sonographer/Radiologist will only be available for investigation and diagnosis of deep vein thrombosis (DVT)

Examinations should be requested via ICE. Examinations will be performed within 2 working days. The service will only be available Mon-Fri 9am-5pm, and will be provided by an outreach service from Harrogate District Hospital.

Radiologists would however be available by telephone to offer both training sessions for Intensive Care doctors and also supervision and advice.

Staffing

Radiographers

Radiographers are on-site 24/7 to provide continuous access to plain film x-ray and CT scanning. They will be readily accessible either when working on the floor in the wards (mobile digital x-ray) or on an on-site call basis (x-ray and CT).

Radiographers will not remain in a clinical area if there is no imaging to be performed.

If you have requested any type of imaging please call either the plain film Radiographer for your hall or CT Radiographers to inform them there is an examination to undertake and to discuss the most appropriate time for this to happen.

Radiologists

On site radiology

The Radiologists are available on the telephone for advice and also to carry out hot reporting.

On-call radiologists are accessible via the Harrogate District Hospital switchboard. The night service is provided by our teleradiology partner Medica.

It is recommended that where possible, CT scans are carried out during the daytime hours. However a 24/7 on-call service is available for unavoidable emergency cases.

Clinical Pathway

Requesting an x-ray

Requests must be made electronically using ICE (our clinical orders system). It is also then important to communicate with the radiographer looking after your pod so that a discussion around clinical urgency and ideal timing / prioritisation can take place.

Requesting checklist

• Referral must be made by a registered nurse or doctor

• Adequate demographic details must be provided to meet a point of care 3-factor identity check

• The following data must be provided in the referrers data set

  • Name of the referrer (and supervising consultant)

  • Ward and pod

  • Telephone number for point of contact (usually team leader)

Viewing X-Rays

You will be able to view x-rays in a number of convenient ways

• Immediate clinical review on the machine at the bedside for safer positioning of tubes and lines

• Any computer using PACS Xero Viewer

• Large diagnostic monitor at the Radiology Base Station in each hall

Repeat Examinations

As we are using digital radiography, images will be viewable immediately on the machine after exposure. It will therefore be possible to discuss the findings with the radiographer and make a judgement whether the images are satisfactory or need repeating.

Acceptable reasons for repeating examinations

• Clearly inadequate image quality, missing key anatomical details, under or overexposing or failing to answer clinical question due to technical factors.

• Repositioning of lines / tubes

Exposures should only be repeated when the radiographer believes there is a reasonable chance of achieving better quality and there is a clear benefit from doing so when the increased radiation dose is considered.

Reporting of x-rays

Consultant Radiologists will read and report chest x-rays during the hours 09:00 - 17:00 7-days per week. Studies acquired outside of these working hours shall be reported the following morning by routine. However if a specialist opinion is required, the on-call radiologist will provide this by remote consultation.

From 20:00 this reporting service shall be provided by teleradiology by Medica by a remote consultant radiologist.

The Yorkshire Imaging Collaborative (YIC) is a regional radiology network with 28 partner hospitals connected via a common technology platform. Radiologists and radiographers throughout the network also work in co-operation through clinical special interest groups to deliver common goals with a common practice based approach.

Connected Trusts

• Harrogate District Foundation NHS Trust

• Leeds Teaching Hospitals NHS Trust

• Bradford Teaching Hospitals NHS Foundation Trust

• Airedale NHS Foundation Trust

• The Mid Yorkshire Hospitals NHS Trust

• Hull University Teaching Hospitals NHS Trust

• Northern Lincolnshire and Goole NHS Foundation Trust

• York Teaching Hospital NHS Foundation Trust

• Calderdale and Huddersfield NHS Foundation Trust

How this benefits Nightingale

Medical imaging records for patients transferred from any of the above hospital Trusts and the associated medical reports will be seemlessly available via Xero Viewer. This is a game changer for clinical care delivery, since this process usually requires a tedious manual process to transfer patient images between sites of care delivery.

Resilience in Service Delivery

The radiology service in Nightingale Harrogate is provided by the Harrogate District Foundation Trust radiologists. However, YIC have provisioned a technical solution to enable the rapid deployment of regionwide teleradiology in the event that additional assistance is required.

This will enable rapid access to a network of upto 240 Consultant Radiologists (including members of the YIC Chest Special Interest Group).

A further line of resilience is provided in the form of commercial teleradiology (Medica) which is currently provisioned to support night time radiology services for Nightingale.

Clinical Pathway

CT Procotols

Requesting a CT Scan

To make a CT scan request, you must initially contact the CT radiographer to discuss your requirements.

Requesting checklist

• Referral must be made by an Consultant Physician

• Adequate demographic details must be provided to meet a point of care 3-factor identity check

• The following data must be provided in the referrers data set

  • Name of the referrer (and supervising consultant)

  • Ward and pod

  • Telephone number for point of contact (usually team leader)

Transferring a patient to CT

To help you to understand the logistics around patient transfers for CT scanning, take a look at our CT scanner page 👇👇

Each hall within the clinical areas (red-zone) has a well equipped radiology area which is primarily used by the resident radiographer. It also serves a number of other functions.

• Docking station for charging and networking of the digital mobile x-ray unit

• Charging station for point of care ultrasound scanners

• First port of call to communicate with radiographer

• Paging station to contact radiographer who is outside of clinical area

• Viewing of images on large diagnostic display

GE Venue Go

Venue Go scanners are specifically designed for point of care ultrasound. They are easy to use and are familiar to many users from Emergency and Intensive Care Medicine settings. Additional training can be provided as part of the Nightingale induction process and specialist training offered by Harrogate radiologists.

Available support

• Harrogate based Application Specialist (Amy)

• Accredited intensive care ultrasound trainer (Dr Adam Culverwell - HDFT)

You can request POCUS training by filling out this form 👉 https://airtable.com/shrFFu9Amhfvld0XI

Probes

Ultrasound Machines

Siemens go.All CT scanner

Our on site CT scanning service is provided by Alliance Medical who supply trained CT staff to operate round the clock provision. The scanner is located in front of Hall M and the Royal Hall on Ripon Road.

The scanner is sufficiently large to allow an intensive care bed to wheel into the scanner via a shallow ramp. Entry to the scanner takes place through a pair of doors sufficiently wide enough to accommodate a bed. Within the scanner there is plenty of room for the ICU team to enter with the patient and arrange medical devices and place the ventilator ready for the scan.

During the scan the ICU team will be required to exit into either the control room or wait briefly outside the scanner. A CT scan is very fast, typically completed in under 5-mins once the patient is setup. The team can then rapidly re-enter and remove the patient.

Location of scanner

CT Machines

Samsung GM85 Mobile Digital X-Ray

X-Ray machines

Workforce

Examination Protocols

Standard Operating Procedures

IRMER Regulations

Local Rules

Radiation Risk Assessments

Patient Group Directives

Finding the Radiology Department

Radiology

IT

Workstation and Wifi login details can be found at the Radiology Reception.

Personal AGFA, CRIS and ICE login details are the same as those at Harrogate District Hospital.

Protocols

All Trusts using the Nightingale site will be working to the Yorkshrie Imaging Collaborative CT Protocol Book (Tolan D - February 2020 edition). A printed version of this can be found at the workstation.

Contrast

Contrast is prescribed by hand on a paper prescription chart. An example of a completed prescription chart can be found at the workstation. Omnipaque 350 volumes are determined by weight and are in the protocol book (also, see table below). Patient weight and allergy history will be taken on arrival. The up-to-date eGFR will be recorded on the printed scan request form.

Prescription Chart Checklist

• Patient identifiers (Name, DoB, NHS number)

• Allergy history

• Patient weight

• eGFR

• Prescribe volume of Omnipaque to be infused

• Prescribe normal saline flush (100ml of 0.9% NaCl)

Omnipaque 350 Volume by Body Weight

Comfort

Lunch Break

The scanner pauses for lunch break at 12:30 before resuming the afternoon session tests at 13:00 (patient on scanner for 13:15)

This leaves just enough time to make it to...

Food/Drink Ideas

All COVID-19 adjusted opening times for nearby open eateries were correct as of 04/06/2020.