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In the COVID-19 era, imaging subspecialties are refining techniques for obtaining exposures efficiently in high-volume, large hospital areas where preventing and eliminating transmission risk is critical. At UNC Medical Center, Cardiothoracic Imaging (CHEST) and Body CT providers have innovated technique and protocol solutions that preserve provider/patient safety, enable imaging efficiency and conserve PPE resources.

CXR taken inside (L) versus outside the scanning room – “Shooting through the Glass” (R).

CHEST radiograph [CXR] technologists and attendings innovated a technique for obtaining exposures in UNC Medical Center’s high-turnover emergency department (ED) isolation room using a portable CXR unit. Dubbed “Shooting through the Glass” (SttG), the innovative method employed a “phantom,” or specially designed object for testing, evaluating and fine-tuning imaging devices and techniques, and was developed using normal exposure techniques. A PPE-“protected” technologist first positioned and obtained CXR exposures of the phantom inside the isolation room. Marking a “#” symbol on radiograph images obtained through the isolation glass, a “clean” technologist next obtained exposures outside the room to simulate shooting CXRs of COVID-19+ and potentially exposed patients under investigation (PUI)s.

A radiologist comparing CXRs obtained inside the isolation room versus through the glass analyzed source-to-image distance (SID), image quality and exposure techniques. Concluding no image degradation using SttG, Cardiothoracic Imaging Division Chief Leon Bacchus, MD, approved the technique to obtain CXR exposures of isolated COVID-19+ patients and PUIs in the ED.

Evaluated next for ED triage, SttG proved viable for clinical use when tested with 10 COVID-19+ patients and PUIs. Radiologists interpreting SttG exposures obtained within normal range concluded no need for repeat imaging and no image degradation when compared with using standard CXR techniques.

Results for CXRs obtained inside (L) vs. outside (R) the room proved SttG a viable, patient/provider safety technique for COVID-19+ & PUI patients ED isolation care.

At UNC Health’s 13th Annual Quality Expo (virtual) in October 2020, Imaging Manager (Compliance, Accreditation, Regulatory, Education & Safety) Sonya Whitehead, RT(R), Imaging Supervisor (Diagnostic Radiology) Sheila Stokes, RT(R), and CHEST Division Chief Dr. Leon Bacchus presented the division’s innovative technique as a safety initiative well-suited to ED imaging care.

Whitehead stated: “[SttG] provides quality imaging while eliminating equipment contamination without using the portable CXR unit inside the isolation room. Using [SttG] with COVID-19+ patients and PUIs in the ED isolation room decreases bedside time per patient, permits quicker imaging and enables us to focus on protecting patients and co-workers with limited staffing resources.”

Dr. Bacchus noted: “Applying [SttG] to emergent (STAT) high-volume [CXRs] ahead of batched, non-emergent orders has reduced COVID-19+ morbidity and mortality at UNC Medical Center. It aids early COVID-19 diagnosis, treatment and control of infection spread in ED CHEST imaging services.”

Protocols designed to keep technologists caring for COVID-19+ and PUIs away from others have evolved in other radiologic subspecialties at UNC Hospitals. In Body CT, providers conducting COVID-19 preparedness/response planning designated two CT scanning suites for obtaining exposures of COVID-19+ patients and PUIs safely, without technologists having to remove PPE. An installed lead window in each of these suites, as well as “dirty tech” versus “clean tech” separated donning/doffing stations, allowed CT workflow to operate efficiently and safely.

Imaging Supervisor (Compliance, Accreditation, Regulatory, Education & Safety) Davia Silberman RT(R), stated: “The COVID-19 protocols we’ve adopted for CT scanning have worked well. Nurses monitoring COVID-19+ patients and PUIs safely and a rotating schedule of “dirty techs” have allowed us to efficiently Body CT scan these patients while preserving PPE resources and preventing repeat scans.”