Center for Health & Healing- Radiology Department
CHH Day Shift Radiologist Responsibilities:
- CHH GI studies
- CHH adult ultrasound are now read by the body radiology section (peds: tech calls to check case with pediatric radiology)
- Contrast reaction issues on 3rd floor CT/MR, and 9th floor CT (in conjunction with cardiology). Please familiarize yourself with the 9th floor location (if you walk down the back hallway, CT is on the left, down the first hallway past service elevators).
- 8:15am – 5:00 pm presence in the building to cover CT/MR contrast issues
If you need to call in sick, please talk directly to someone who can arrange coverage to minimize disruption to scheduled appointments (ie Drs. Riccelli, Primack, Anderson)
If an emergency causes you to be late, please call Brad Frish, CHH imaging supervisor, at pager 12872 or office 4-7980.
- Read other worklists as assigned on the schedule
- Facilitate any calls from clinicians. Radiologist are not expected to read outside their area of expertise, but please help clinicians find the correct person, or refer to radiology operator 4-5369. Add-on studies go through Brad Frish or technologist.
Contrast reaction kits:
CT/MR control room; GI fluoro room; 9th floor scanner control room. All have epi pens (adult - yellow and peds - green), albuterol, benedryl among other standard items. AED in 3rd floor patient prep area and in back conference center hallway.
9th floor code cart: in hallway behind CT scanner room.
In general, patients with prior contrast reactions are supposed to be screened out by the schedulers and scanned on the hill, however some may end up at CHH. We generally will scan patients with significant prior contrast reactions on the hill.
9th floor CT contrast reactions:
Protocol is the same regardless of whether it is a "cardiac" study or general radiology study. In severe reactions, 9th floor cardiologists, if present and available, can help, but we ultimately need to be available. If a tech calls you, it is because they need your help in some way. Please respond promptly by triaging the situation over the phone if you are in the middle of something such as a GI fluoro exam, and then deciding if you can finish what you are doing or need to respond immediately.
Useful PACS worklists:
*CHH US Today: (all CHH ultrasound studies read or unread)
*CHH GI (plus others): CHH GI, but includes other non-CHH studies
There should be a paper schedule left at the workstation each morning for you. The GI schedule can also be accessed thru EPIC. (to set up, go to Schedule, right click "my schedule" – create schedule – give it a name like CHH RF, click configuration tab, click search by department, click resource, put RAD GENERAL CHH in Dept field, then select RAD CHRF1, click add. Click accept.)
An MR schedule can be made similarly - the Dept is RAD MRI CHH, and the two MR's listed are the CHH ones. add both.
GI Fluorocopy Studies:
Primarily, we do barium GI studies: modified barium swallow with speech pathologists, esophagram, upper GI, occasional small bowel follow through, enemas (rarely screening unless CT colonoscopy is denied by insurance; mostly gastrograffin post ostomy). Rarely, adult cystograms and other GU. We do not have tomogram capabilities at CHH. We can do IVP without tomograms, or CT urography. We do not do pediatric fluoro (GI/GU) studies at CHH - they are done at Doernbecher. CT enterography and CT colonoscopy can be done in place of traditional fluoro studies when appropriate, with approval by the referring clinician and if insurance will cover (can be a problem for CT colonoscopy if no prior colonoscopy attempt). We have a specific protocol for same day add on CT colonoscopy after same day incomplete colonoscopy. Prep starts at CHH. Discuss with Brad Frish or CT technologists to facilitate if this is requested.
Modified Barium Swallows
Unlike on the hill, at CHH these must be manually "recorded" by the radiologist by holding the fluoro save/screen capture button down while doing the cine. Try not to save excessive images before and after contrast images (you may fluoro for a little longer than what you save if waiting for swallow initiation or checking for what happens to residual contrast). There is a limit of about 4000 images that can be recorded in one session, which is generally plenty, but if this needs to be exceeded the technologist can save that batch and reset the machine to take additional images.
For billing purposes, esophagrams are all billed essentially the same, but upper GI and/or SBFT need at least the following items specified: What anatomy is studied (esophagram vs upper GI vs Upper GI with SBFT, vs only SBFT) Single contrast, or air contrast with high density barium (don't use the term "double contrast", but you can say air contrast or with effervescent granules.) KUB (scout) if done. Please confer with the tech or check the exam order in pacs on each study to make sure that the hospital bill and your report (our bill) are congruent, or you may get a red folder.
Routine pediatric and adult ultrasound is performed. No ultrasound needle procedures are done at CHH. Pediatric studies can be scanned at CHH but are read by pediatric radiologists. Technologists call pediatric radiologists directly.
CHH Radiology Manager:
Brad Frish is the CHH radiology manager and can help with tech related and logistical issues of all studies, equipment and building related issues.
Other potentially useful information:
- CHMR1(open scanner) bed undocks and can be pulled out of the room if needed. But it is very heavy.
- Equipment in the holding area is labeled as to whether it is "MR Safe" or "MR Unsafe". Check for "MR Safe" before taking anything into scanner room.
- All O2 tanks and holders in the department are supposed to be non-ferrous (aluminum finish on outside) and can be taken into the MR scanners. O2 holders are labeled "MR Safe" so check for that.
- Suction for MR is attached to one of the O2 tanks (suction unit on top of code cart cannot go in the scanner).
- One stretcher is non-ferrous and can be taken into MR scanners (double check labels that you have the right one before use).
- Non ferrous wheelchair is located inside CHMR1, in the corner, behind the curtain.
- Stethoscopes can be found in each room, one in each file cabinet in the tech area, and one on the vitals machine in the holding area.
Transfers to ED:
Call 4-4444 (public safety) for ambulance or security: In general, if a patient needs urgent medical help (severe contrast reaction, fall, seizure, altered consciousness, etc) the radiologist will perform initial assessment, and if further medical care is necessary, it will be recommended that the patient go to the OHSU ER by ambulance. Notify Brad Frish or covering manager as soon as possible, and before patient leaves the department if possible. You can contact the referring clinician as a courtesy if time and the situation permits, but unless the problem is the specific reason for being seen for a same day appointment, the patient will probably need to be referred to the ED. Please also call the ER with the basic information (4-7551). RN and Brad Frish can facilitate transfers.
CHH Tenant Handbook see Emergencies - Medical Emergency and Injury
Evening Shift Responsibilities:
Provide on site physician coverage beginning at 5pm primarily for contrast reactions, but also for any other issues that arise requiring physician input. Physician must remain on site until last patient with a contrast enhanced exam has left the department. A formal orientation is required prior to first shift.