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Dr. P. Othieno Consultant Radiologist Knh

Role of radiology in critical care of mothers and neonates mnch symposium knh / uon 7 th February 2014. Dr. P. Othieno Consultant Radiologist Knh. objectives. Overview of the role of radiological imaging in critical care of: expectant mothers for: - Maternal causes - Foetal causes

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Dr. P. Othieno Consultant Radiologist Knh

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  1. Role of radiology in critical care of mothers and neonatesmnch symposiumknh/uon7th February 2014 Dr. P. Othieno Consultant Radiologist Knh

  2. objectives • Overview of the role of radiological imaging in critical care of: • expectant mothers for: - Maternal causes - Foetal causes • Infants - newborns • Related issues

  3. Need for medical imaging Radiological imaging is used to: • Confirm or exclude presence of disease • Determine type of disease • Determine extent of disease • Determine progress of disease • Assess presence of complications arising from the disease process Complements clinical and lab data

  4. Imaging of the critically ill For optimal patient outcome, key issues are speed and accuracy of radiodiagnosis. These depend on: • Facilities/equipment available • Their location • Skills, experience • Protocol

  5. Radiation protection of patients (RPOP – IAEA) • Pregnant women and children classified under “special groups” by IAEA • The exam must be justified, (Consider risk vs. benefit) and the procedure optimized to answer the clinical question • Reduce exposure to radiation • Applies in usage of ionizing radiation – radiography, CT (MRI) • Protection of growing foetus, gonads References: • INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION, 1990 Recommendations of the ICRP, Publication 60, Pergamon Press, Oxford (1991). • INTERNATIONAL COMISSION ON RADIOLOGICAL PROTECTION, Pregnancy and Medical Radiation, Annals of the ICRP, Publication 84, Pergamon Press, Oxford (2000)

  6. Considerations in Maternal imaging • Radiation protection of patient (mother) & foetus must be observed • The foetus and young infant are at greatest risk for radiation-induced disease • Ionising radiation – radiography, CT, fluoroscopy, interventional procedures • MRI procedures limited • Restrict use of contrast media

  7. MATERNAL CONDITIONS • APH • PPH • PIH • Thrombembolism (cerebrovascular or pulmonary) • Amniotic fluid embolism

  8. FOETAL US – FOETAL WELL-BEING Ultrasonography is safe, non-invasive • Foetal cardiac activity • BPP score • Resistive indices – UmbilicaI artery, middle cerebral artery • Gestational age, and weight

  9. CONSIDERATIONS IN NEONATAL IMAGING • Chest radiography is the most frequently done examination & the most difficult to interpret • Radiation dose reduction • Temperature control to prevent hypothermia • Sedation and monitoring • Immobilize patient with devices • Digital radiography reduces exposure errors • Limit use of contrast media - nephrotoxicity

  10. Challenges that gave rise to the Emergence of point-of-care ultrasound • Radiologists too few to fulfil the demand for imaging services • Mushrooming of ultrasonography practice by questionably qualified/trained personnel • US is Used by many, understood by few • Lack of appropriate training, standards, documentation, legislation, regulation

  11. Point-of-care imaging – ultrasound What is point-of-care US? Point-of-care ultrasound refers to the use of portable ultrasonography at a patient’s bedside for diagnostic and therapeutic purposes because of the critical nature of the patient’s condition. • http://www.diagnosticimaging.com/articles/radiologists-develop-point-care-ultrasound-training#sthash.Q0YhfcH0.dpuf

  12. Point-of-care imaging • Refers to radiological imaging performed at the patient’s bedside • Critically ill patients cannot be moved easily to radiology department • Exams performed at patient’s bedside using portable equipment • Results are obtained readily and easy to interpret • Currently at KNH portable radiography, US at labour ward

  13. Pocus – it’s role and characteristics • It is practised by non radiologists/sonographers • Answers a yes or no question - Exam is focused and goal-directed • Exam is for a well-defined purpose linked to improving patient outcomes • Exam findings are easily recognizable • The exam is easily learned • Exam is quickly performed

  14. Challenges at KNH

  15. Way forward • Analysis of root causes and obstacles giving rise to the current situation needs to be undertaken and appropriate interventions made where possible • Multidisciplinary approach in active patient management - protocol development, clinicoradiological/pathological case discussions etc. • Need for US education which is credible, of high quality • Need for US practitioners to refresh, upgrade skills • POCUS training at KNH for labour ward staff • Procurement of equipment and training, PACS

  16. conclusion • If the examination involves ionizing radiation (especially for expectant mothers) then the risk vs benefit must be considered and the examination justified • Practice radiation safety at all times • Point-of-care imaging will assist in answering urgent clinical questions • A multidisciplinary approach to managing critical ill mothers and neonates is required to optimise the clinical outcome

  17. Thank you!

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