36 ray. The literature supports the need to address increased point of care in the residential environment for a range of services including Medical Imaging. (Codde and Frankel, 2010)1, Lowthian et al, 2011)2. To improver the patient experience and Emergency Department workflow and alternative model of care was piloted for 18 months. The Northern Beaches Health Service (Sydney) is the first public health facility in Australia to provide a Mobile X-Ray Service to immobile, aged and disabled patients in their own environment. This service has successfully reduced Emergency Department (ED) presentations and patient hospital times for simple x-ray procedures. Baseline data identified 80 patients a month could be imaged in their residence. With the assistance of a MTEC (Ministerial Taskforce on Emergency Care) grant, a digital mobile x-ray unit, van, two staff and protocols were established to provide an imaging service for patients referred by local GPs. A 23.2 % reduction of Aged Care Facility (ACF) patients presenting to ED departments has been demonstrated with 87.5 % of these van patients not presenting later to the Mona Vale and Manly Emergency Departments. Methods: A Clinical Practice Improvement (CPI) process was adopted incorporating Diagnostic Phase, Project Phase, Implementation Phase, and a Post-implementation Phase (including a sustainability review). Results: i. ED post-implementation audit of referrals, (March 2013), demonstrated 23.3 % reduction in ED presentations (target 10%). ii. A post-implementation mobile service audit was conducted to determine the actual number of patients who avoided ED admission through direct referral to the Aged Care Mobile X-ray Service. The results show 87.5 % of these cases did not present to local ED departments in a 2 week period post imaging. Outcomes: Emergency department avoidance savings are significant. 10.15. Radiographers view on task shifting towards radiologists, a qualitative study Presenter: Håkon Hjemly, The Norwegian Society of Radiographers Authors: Håkon Hjemly, Aud Mette Myklebust, Erling Stranden, Philos - Faculty of Healt Sciences Background: Imaging departments in Norway experience increasing demand for diagnostic examinations done in a timely manner, in a rapidly expanding field of imaging techniques and possibilities. Research evidence show that implementation ofadvanced and consultant radiographer practice has led to effective, timely clinicalimaging services improvements for patients and referring clinicians. Task shifting is being addressed by political leadership in Norway, as a necessary tool to meet the future demands in service delivery. The aim of the study: To explore and provide insight about radiographer opinions in general, and identify influential factors, regarding task shifting towards radiologists. And by doing so, provide valuable knowledge for further research and work with radiographers role development in to advanced practice. Methods: Qualitative methods based on focus group discussions with 11 radiographers from a medium-large sized hospital in the health region south-east of Norway. An inductive data analysis was done with a hermeneutic approach in five stages. Results are seen in relation to previous research and the researchers own experience related to task shifting for radiographers in Norway. Results: The radiographers in the study express that the most limiting factor for task shift into advanced practice is resistance amongst the radiologists. The radiographers believe that by relieving some advanced diagnostic responsibilities from the radiologists, they can lead to service improvements. However, in spite the negative attitude amongst radiologists towards radiographers taking on diagnostic responsibilities, and the lack of formal support from the department, the radiographers do take decisions regarding justification and clinical follow up when they feel they have to so in the best interest for their patients. Conclusion: The radiographers in the study are motivated for task shift towards radiologists, but experience strong resistance in term of negative attitudes. The study provides knowledge that may be of value in future research and planning of role development processes for radiographers and team work in clinical imaging. The study also indicates need for investigation of scope and impact of informal advanced radiographer practice. 11. MRI 11.1. A Study on the Electrical Axis of Heart in Cardiac Magnetic Resonance Imaging Presenter: Ho NamKoong, Seoul National University Hospital, South Korea Authors: Ho NamKoong, Dong-Jin Choi, Dong-Sung Kim Purpose: The signal of electrocardiogram from patients can be changed and distorted by the position of electrodes on the chest that is necessary for high quality of Cardiac Magnetic Resonance Imaging (CMR). It is essential for the electrodes to align with the electrical axis of the heart that is various in the patients. We investigated the angle of the electrical axis of the heart on the CMR clinically. Materials and Methods: We investigated the angles from 335 patients (male 237, female 99, mean age 63.2 ± 2.5 years old) for 5 years (January 2008 – December 2012) on 1.5T (Sonata, Siemens) or 3.0T (Trio, Siemens). The electrical axis is the direction from left atrium through mitral valve to apex of heart and has been divided into two angles on the CMR scout images to know how much it changed. The two angles were measured from medial sagittal line to the electrical axis on axial and coronal images respectively. The correlation between angles, sex, and diseases were evaluated by Pearson Correlation Value (IPSS v22.0). We compared the electrode position according to electrical axis from the patients with that of the manufacturer recommended. Results: The angles of electrical axis on axial and coronal images were 112.26 ± 6.05°, 42.43 ± 8.77° respectively. It showed significant correlation between the angles (p>0.996). However, it was not correlation between angles and sex (p<-0.133). Most cardiac diseases of the patients were myocardial infraction (40%), angina pectoris (9%), cardiomyopathy (9%), aortic stenosis (8%), congenital heart (6%) and etc. (28%). The electrode attached locations were different between in aligned with electrical axis and manufacturer recommended. Conclusion: Cardiac electrical axis varies and changes toward inferior and lateral in various patient conditions clinically. The positioning of the electrodes needs to be adjusted to the electrical axis to get the high quality ECG signal and it should be considered clinically comparing the manufacturer recommended methods. 11.2. MRI with cardiac pacing devices – Safety in clinical practice Presenter: Touko Kaasalainen, HUS Medical Imaging Center, Finland Authors: Touko Kaasalainen, Sami Pakarinen, Sari Kivistö, Outi Sipilä Introduction: Until recently, cardiac pacing device manufacturers have strictly restricted the magnetic resonance imaging (MRI) examinations of patients with cardiac pacing systems. However, with the high incidence of clinical indications for MRI, pacemaker (PM) manufacturers have recently developed MR-conditional PMs and implantable cardiac defibrillators (ICDs) that can be scanned in MRI under certain imaging conditions. Additionally, many centres have recently performed MRI scans also for patients with MR-unsafe pacing systems. Our aim is to introduce our safety protocol, which was developed in close co-operation between the Departments of Cardiology and Radiology, of performing MRI scans in patients with cardiac pacing systems and to summarize our experiences of these studies. The step-by-step protocol doesn’t have any restrictions in a scanned body region, and includes methodologies for both MR-conditional and MR-unsafe pacing systems as well as for both PM-dependent and nondependent patients. Methods: So far, 140 patients with cardiac pacing devices have been scanned with a 1.5T MRI scanner using a dedicated safety protocol. The function of pacing devices has been checked prior to, immediately after and approximately one month after the MRI. Results: All MRI examinations have been completed safely. We haven’t observed any significant changes in the programmed parameters of the devices. Neither we have found differences in the variable changes between MR-conditional and MR-unsafe pacing systems nor between scans of thorax area and other areas. We conclude, MRI in PM patients can be performed safely under certain condition with a proper patient monitoring and device programming, when there are no alternative imaging modalities for diagnosis.
ISRRT | Book Of Abstracts
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