Thus, it has undeniably become an integral part of healthcare diagnostics and delivery and this is evidenced by the fact that there is a full-fledged radiology department in almost all the major multi-speciality hospitals today. So, In Imaging, the specialist magazine from ‘The Indian Express’ group, which chronicles all the major developments and happenings radiology, brings its readers a new segment – an overview of the departments of radiology across different hospitals in the country. We intend to look at five aspects of the radiology departments, i.e. infrastructure, costing, technology, personnel and safety. The objective of the whole endeavour is to offer learning lessons in radiology and its management with different hospitals serving as case-in-point.
The first chapter of this series begins with the department of radiology at Kohinoor Hospital, a 150-bed multi-speciality hospital in Mumbai. Established in 2009, it is spread over an area of approximately two lakh sq ft, five floors and two basements. Apart from a team of qualified and skilled personnel, hi-tech infrastructure and several medical specialities, this hospital also boasts of being the first Platinum LEED-certified Green hospital in the country.
Kohinoor Hospital has a functional radiology department right from the time it began operations in 2009. Since then it provides comprehensive radiology services to out-patients as well indoor patients. Besides this, the imaging services offered are important to the hospital from the revenue-generation perspective as well.
Infrastructure
The infrastructure of the radiology department is of paramount importance since without proper planning, designing, pre-requisite equipment and technology, radiology as a speciality cannot make an impact to healthcare delivery. Kohinoor Hospital’s radiology department is situated on the ground floor and planned in such a way that it is very easily accessible from the casualty department. Explaining the rationale behind this layout, Dr Priya Chudgar, Senior Consultant at Kohinoor Hospital informs that since it is the casualty department which more often than not needs to use the radiology department on an emergency basis, it is better to have both departments at easily accessible locations from each other. She also informs that to a great extent, the department’s layout depends on the way processes in the department are aligned and take place. The major functional areas of the radiology department at Kohinoor Hospital are:
- Reception and Waiting area
- Change room (for patients)
- X-ray rooms
- Processing room (Dark room)
- Mammography room
- Ultrasonography room
- MRI room with console room
- CT room with console room
- Storage space
- Report preparation area
- Radiologist’s office
Investment and returns
While Kohinoor Hospital’s radiology department has been operational from the day the hospital began functioning, Dr Chudgar informs that the estimate cost of setting up a radiology department is approximately Rs 6-7 crores for a unit catering to 300-400 patients. Dr Chudgar reveals that the radiology department is highly capital-intensive and hence needs very high maintenance as well to keep it functioning smoothly. “Our department has not reached break even for the investment in the last two years. But it is growing by leaps and bounds, and soon it should be making great profits,” informs Dr Chudgar. She also discloses that a well-established radiology department can be an excellent source of indirect income, by bringing more patients, since clinicians feel safe to admit their patients in a hospital which has well established radiology services.
Equipment & technology
The success and effectiveness of a radiology department is dependent on the equipment and technology it uses on a daily basis. If put to good use, they can be instrumental in helping to reduce time, effort and errors in a big way. Kohinoor’s radiology department boasts of a 500 MA X-ray Unit and a 100 MA Portable X-Ray unit from Siemens (one for routine test and one for fluroscopy); an USG instrument and a Colour Doppler from GE Healthcare as well as a CT scanner and a MRI machine from Siemens. These machines have been chosen for the variety of features that they offer since they help in enhancing the services for the benefit of the patients.
The department is also equipped with PACS, where images of all modalities can be archived for future use. It also enables viewing of images at multiple stations, without any delay. This system is integrated with HMIS, hence it is very easy to trace patient data from the system. Thus, technology has been deployed effectively at Kohinoor Hospital’s radiology department to enhance the efficiency and effectiveness of its operations.
Personnel
Any department’s true strength is the people who run it. The radiology department is no exception. It requires highly skilled personnel round-the-clock as the services of this department may be required in emergency. Kohinoor’s radiology department has around 8-10 people working in shifts. Instead of a single department head, the department has a couple of senior radiologists, a couple of junior radiologists, technicians, nursing assistants, a receptionist and an attendant. However, the total manpower strength for a department catering 300-400 patients is approximately 18-20 personnel. Addressing this short staffing issue, Dr Chudgar explains that the hospital is gradually enhancing and building its radiology team. However, she assures that the functioning of the department is very effectively managed by the existing staff since they work in eight-hour shifts and the staff are always present to handle any emergence situation. Moreover, she also points out that the senior radiologists, even when they are off-duty are accessible and can be consulted about any case through their very effective PACS system.
Safety
Last, but definitely not the least are the safety measures incorporated at the radiology department. They are crucial since, if not properly handled, both the patients and the staff can be at risk. There are several approvals that are needed, many radiation protection measures have to be enforced, compliance with AERB regulations have to adhered etc. Kohinoor Hospital’s safety measures for the radiology department includes the following:
Protective measures
- Radiographers use 0.5 mm lead aprons while conducting portable and Fluroscopy examination. Each unit has a sufficient number of lead aprons.
- 0.5 to 1.5 mm lead protective barriers (shielding) are present at all the xray units, which helps to stop scatter radation.
- 0.5 mm lead thyroid and 0.5 mm lead gonald sheilds are used by the radiology, Cathlab and OT staff during Fluroscopy examination.
- 0.5 mm lead glass in CT Scan/CathLab console
- All the radiation source areas consists of 2.0 mm lead lined doors to prevent radiation from moving beyond the consoles.
- The consoles have 230 mm thick brick walls and the units are located in such a way that that the primary rays would be kept away from the public
- The average ceiling height of all the radiology rooms are 11 feet as per AERB norms
- Lead gloves and goggles are used by the technicians and radiographers while working with the equipment.
Suitable warnings
- A suitable warning signal in the form of a red light has been provided at a conspicuous place outside the X-ray rooms and it is kept “ON” when the units are in use to warn and prevent other patients and people, who are not connected with the particular examination, from entering the room. An appropriate warning placard has been posted outside the X-ray rooms.
- Notice in the local language is displayed at a conspicuous place in the X-ray department, wherein every female patient is asked to inform the radiographer or radiologist whether she is likely to be pregnant. Examination of women known to be pregnant are given special consideration.
Adherence with the PNDT Act
- It is an Act “to provide for the prohibition of sex selection, before or after conception, and for regulation of prenatal diagnostic techniques for the purposes of detecting genetic abnormalities or metabolic disorders or chromosomal abnormalities or certain congenital malformations or sex-linked disorders and for the prevention of their misuse for sex determination leading to female foeticide; and, for matters connected therewith or incidental there to.”
- The Kohinoor Hospital is registered under the PC/PNDT act which forbids pre-natal ultrasound for sex-determination. A poster has been placed outside the ultrasound room stating the same and also discloses the fine and punshment for such an offence.
- Every patient is given a form ‘F’ to be filled with the signs of both the sonologist as well as the patient.
- All records, charts, forms, reports, consent letters and other documents are maintained under this Act and the rules are preserved for a period of two years or for such period as may be prescribed,
- All such records, at all reasonable times, will be made available for inspection of the appropriate authority or to any other person authorised by the appropriate authority on his behalf
Thus, a host of safety measures have been put into place at Kohinoor for the protection of the patients as well as the staff involved in the operations at the radiology department.
Conclusion
Overall, the hospital has made a concerted to put together a good radiology set-up which would help to serve a variety of purposes. While there is always scope for improvement, for e.g. in the number of staff, a couple more advanced equipment etc, one has to admit that the current radiology department at Kohinoor Hospital quite adequate and self-sufficient.