At Children's Healthcare of Atlanta, the ultrasound department realizes that its staff makes a difference in a child's life every day. One way is by utlilizing emergent ultrasounds. The thin body habitus of a child is especially suited to ultrasound evaluation. What emergent ultrasound exams are done on the pediatric patient? The most common is to evaluate for the acute abdominal condition. Abdominal studies look for obstructions such as intusseption and pyloric stenosis. Abdominal ultrasound also evaluates the abdomen for gallstones, kidney stones or abscess or fluid collections. Pelvic ultrasounds are performed for ovarian torsion, hemorrhagic ovarian cysts, or fluid collections and abscesses. Scrotal ultrasounds are used to diagnose testicular torsion. Children's performs everything from deep vein thrombosis Doppler studies to hip ultrasound for effusions. Superficial foreign bodies can be seen on ultrasound that may not be seen by diagnostic radiography. More and more, the emergency department requests ultrasound studies. Ultrasound in the acute situation is very dependent on the skill and expertise of the sonographer. Children's has a dedicated team of sonographers that are the best of the best. They are all very passionate about their work and extremely proud of the work they do. The ultrasound department at Children's is a wonderful place to work.

Alice Spinks, Radiology Team Leader, Children's Healthcare of Atlanta at Scottish Rite

The importance of image quality is recognized at Children's Healthcare of Atlanta by radiology leadership. A high standard of image quality is required to assure the radiologist accurate reading of images. This assists the attending physician in making a diagnosis and safety treat the patient. The Children's quality team has developed a system called Z-coding where the radiologist will attach a letter code to their dictation. Some examples of the factors coded are positioning, collimation, shielding, rotation, motion, unacceptable and excellent. This Z-coding system enables us to maintain on-going education for technologists that may need assistance in those areas. In addition, we are able to monitor trends that would indicate areas for improvement. - Susan Freeman RT(R) Education Analyst Children's Healthcare of Atlanta Egelston

As Team Leader for the CT Department at a large pediatric hospital, I know the importance of dose reduction and shielding when scanning patients. Children are not "little adults" and can not be treated as such. Because their cells regenerate at a much faster rate than adult cells, it's very important that we protect them as much as possible. The two best ways to protect pediatric patients in CT are shielding and dose reduction. We use two types of shielding. First, to shield an area outside of the scan field, we use lead shielding. Secondly, to further shield our patients, we use bismuth shields. Bismuth shields can be used within the scan field without obscuring the image. There are various bismuth shields; eye, thyroid and on female patients, breast shields to name a few. Bismuth shields on average reduce radiation by approximately 25 percent. Dose reduction is the other way to reduce the amount of radiation a child receives. We are constantly reviewing our protocols to see where we can make adjustments that will reduce the amount of radiation without affecting image quality. Our scanners and our scanning protocols are certified and approved by the American College of Radiology (ACR).

- Bonnie Johnson RT(R)(CT)

This week I have been reminded about how blessed we are in the United States. In looking at the scenes of devastation in Haiti, the poorest nation in the southern hemisphere, I am thankful for the lifestyle afforded to me in the United States. In 1995, I was a volunteer healthcare worker in Cape Haitian, Haiti and witnessed first-hand the lack of medical care available to the people of that country. The clinical and hospital facilities were void of supplies and had basic equipment. At the local hospital, the autoclave (a system that sterilizes surgical instruments) was from the 1940s (wow!) and the X-ray system was a U.S. military system used in the Korean War. Now, in this time of great suffering I wonder how the medical infrastructure is going to be able to assist everyone in need. I worry for the friends I made when I was in Haiti and the American Medical Staff that is still working diligently to assist these people. I am pleased to see medical missions and supplies are finally getting to the people in Port-au-Prince and I hope that the city can rebuild. In this time of insurance legislation and debates about medical care in the United States I feel we can all learn a lot from examining the medical care in countries like Haiti and take time to step back and truly be thankful for our medical systems--they are not perfect but they are (really) the best anywhere.

- Melinda Dobbs, Manager of Radiology at Children's Healthcare of Atlanta at Egleston

Patient safety and quality care continue to be important issues for hospitals and imaging centers. In mid-2009, the AHRA (The Association for Medical Imaging Management) announced the second year of its Putting Patients First grant program. Putting Patients First grants further efforts by health care facilities to improve imaging quality and safety for patients. In early 2009 the program was expanded to include imaging centers and will award three additional grants specifically for pediatric programs. Children's Healthcare of Atlanta submitted a grant to the Putting Patients First program back in October and was recently notified that we were awarded this grant to further improve radiation dose reduction in Pediatrics. We are very excited about this opportunity for our patients and staff and look forward to sharing our progress and knowledge with other pediatric imaging sites.

Melinda C. Dobbs, Manager Radiology, Children's Healthcare of Atlanta at Egleston

The week of November 8th was National Radiology Week and Children's Healthcare of Atlanta celebrated the accomplishments of all imaging modalities within Radiology. In celebrating our accomplishments we focused on volumes and new equipment acquisitions but, most importantly, on the great service we give our patients and families. Our team of dedicated imaging professionals "talk the talk and walk the walk" when it comes to customer service. That is what sets us apart from adult facilities and that is what keeps patients and families coming back. In November, near Thanksgiving, I am thankful to have a dedicated team of imaging professionals who value patient and family education, teamwork, and compassion. Thanks to my team for all that they do!

Melinda C. Dobbs, Manager Radiology, Children's Healthcare of Atlanta at Egleston

According to the journal Injury, 51 percent of all upper limb and 21 percent of all lower limb Emergency Department admissions in the United States are due to some type of fracture. Children's Healthcare of Atlanta recently launched the Fracture Care Program, which offers a comprehensive approach to fracture care for all types of pediatric and adolescent fractures.

The Fracture Care Program is located within Children's Immediate Care Centers and the Children's at Egleston and Children's at Scottish Rite Emergency Departments, making the diagnosis and treatment of fractures, sprains and strains in children and teens more convenient for families. "This program offers coordinated care--from the initial evaluation in the emergency room or urgent care center to final follow-up and return to activities--for pediatric and adolescent patients with fractures," said Michael Schmitz, M.D., Chief of Orthopaedics at Children's. "The goal is to have the patient receive the right care, in the right place, with the right physician, all in a coordinated and timely manner."

The Children's Fracture Care program features a collaborative, child- and teen-friendly environment that covers both the physical and emotional aspects of treatment. Fellowship-trained pediatric orthopaedic surgeons provide access to the best possible medical care and offer clinical oversight so onsite caregivers have the timeliest medical advice available. Onsite digital radiography at all fracture care locations allows surgeons to view images and provide fracture oversight and care coordination from remote locations. Additionally, skilled pediatric physicians and specialists are available to take care of complex fractures requiring sedation services and/or surgery.

For more information, please visit www.choa.org/fracture.

Nuclear Medicine is a modality that is vital to the care of many patients; however, there has been a decline in the use of Nuclear Medicine services in many hospitals around the country. Nuclear Medicine Technologist offerings at hospitals have also declined, a victim of the declining use of this service. Many hospitals are opting to cross-train Nuclear Medicine Technologists in other modalities to ensure Nuclear Medicine positions are protected from layoff and some facilities are looking at other Nuclear Medicine options such as PET/CT or Nuclear Cardiology. If you are considering a position in Nuclear Medicine then you may want to consider the trends in the marketplace and ensure that you receive experience in other modalities like x-ray or CT or you receive PET training while in school.

Melinda Dobbs, Manager of Radiology at Children's Healthcare of Atlanta at Egleston

I have to admit, over the past few weeks I have been watching "America's Got Talent" - my guilty pleasure. It is my way to rewind and take the stress of the day away. I often think that we don't recognize talent in our healthcare system enough. These days we hear about the cost of healthcare--namely, how expensive healthcare has become in the U.S. However, where are the stories that focus on the miracles I see daily (even the small ones)? Yes, the costs are high and cost reform may be useful, but I feel the discussions about reform only tell part of the story. There are thousands of dedicated healthcare workers--nurses, radiology technologists, physicians, patient care technicians, healthcare administrators--who devote numerous hours to ensure that all patients receive the best care possible. I am proud to say that I have devoted my career to our little patients at Children's Healthcare of Atlanta and will continue to share the miracles I see every day with as many people as possible.

-Melinda Dobbs, manager of radiology at Children's Healthcare of Atlanta at Egleston

To what extent is there a risk of infection or contamination in MRI suites?

Most patients with serious infections typically have some type of imaging procedure performed during the course of their treatment /hospital stay. MRI suites often lack basic safeguards against infection due to its unique environment; it is challenging to implement and maintain an effective infection prevention regimen while adhering to MRI Safety standards. Because of the dangers from extremely strong magnetic fields, housekeeping staff and most cleaning equipment are globally prohibited from entering the MRI suite. The resultant lack of thorough cleaning was clearly demonstrated in a recent study from Ireland that cultured infectious organisms on the MRI scanner.

What are some of the reasons that such a risk exists?

See above about the limitations re: cleaning equipment and non-MRI trained staff.

Additionally, hospitalized children have some type of intravenous device such as a central line or peripheral catheter which adds more risk due to the invasive nature of the devices. MRI staff must understand these risks and safeguard the device and the equipment utilized to maintain that device, such as infusion pumps.

Can you provide a description of the size of the MRI suite at Children's Healthcare (e.g., the number of MRI units, whether they are closed-bore or open)?

Children's Healthcare of Atlanta has 6 MRI suites located at three sites around Atlanta. All 6 units are state-of-the-art closed-bore systems. Each MRI suite is quite large, ranging in size from 17 feet by 14 feet to 25 feet by 18 feet.

What steps does Children's Healthcare take to minimize/eliminate the risk of infection or contamination in its MRI suite?

Children's has developed numerous infection control processes to minimize/eliminate the risk of infection in the MRI Suites. These processes include:

· Hand hygiene

· Blood borne pathogen standards

· Contaminated Sharp Disposal

· Daily floor cleaning by Environmental Services under the supervision of MRI staff

· Daily through cleaning of counters, cabinets and refrigerators and other flat surfaces

· Cleaning of diagnostic tables (MRI tables), stretchers, pads, positioning aids with hospital approved disinfectant after each patient use

· Use of an approved disinfectant with a short "kill" time to pediatric significant diseases such as RSV, MRSA, and Rotavirus

· Covering positioning aids with a protective covering

· MRI coils are cleaned after each patient use with a hospital approved disinfectant

· The inside of the MRI bore is cleaned daily by the technologist using a hospital grade Quaternary Ammonium solution and a cleaning rod to reach deep inside the bore

· Daily visual inspection of the scanning table pad and Velcro immobilizing devices

· All damaged/split pads are replaced

· Documentation of all cleaning and inspections

For how long have these measures been in place?

Most measures have been in place for many years. Recently, a new Quaternary Ammonium product was developed to appropriately, thoroughly and safely clean the bore. Children's adopted this practice in 2009 as soon as the product became commercially available.

Does Children's Healthcare have a written infection control policy specifically for its MRI suite? If not, why not? If there is one, what does it say, and how is it communicated to staff?

Yes, the radiology department has an infection control policy specific to the MRI suite which includes sections regarding the prevention of infection in MRI.

Melinda Dobbs, RN, BSN, CCRC; Manager Radiology, Children's Healthcare of Atlanta at Egleston and

J. Renee Watson, RN, CIC, Manager-Infection Control / Occupational Health, Children's Healthcare of Atlanta