How Much Does It Cost To Start A Portable X-ray Service

• Research article
• Open Access
• Published: xx August 2020

Mobile Ten-ray outside the hospital: a scoping review

• Thomas Erik Møller Christiansen¹,
• Finn Rasmussen¹,
• Camilla Palmhøj Nielsenⁱⁱ &
• Else Marie Damsgaard^three

BMC Health Services Inquiry book 20, Commodity number:767 (2020) Cite this article

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Abstract

Background

For several years mobile 10-ray equipment has been routinely used for imaging in patients too unwell within the hospital, when transportation to the radiology section was inadvisable. Now, mobile X-ray examinations are also used outside the hospital. The literature describes that fragile patients may do good from mobile X-ray, merely nosotros need to provide insights into the breadth, depth and gaps in a body of literature.

Methods

The scoping review was performed past searching PubMed, Cinahl, Embase, EconLit and Health Technology Cess.

English-, Danish-, Norwegian-, German-, Italian-, French- and Swedish-language studies, published 1.1.2009–1.5.2020 almost mobile X-ray outside the hospital were included.

Participants were patients examined using mobile X-ray as the intervention.

PRISMA was used when eligible to build upwards the review. To extract data from the selected manufactures, we used a structured summary table.

Results

We included 12 studies in this scoping review. The results were divided into four topics:1. Target population 2. Population health three. Experience of care and 4. Toll effectiveness.

The main findings are that target population could be larger for example including hospice patients for palliative care, group dwelling for people with intellectual disabilities, or psychiatric patients, population wellness may exist improved, paradigm quality seems to be practiced and mobile X-ray may be cost effective.

Limitations of linguistic communication, databases and grey literature may have resulted in studies being missed.

Conclusions

Mobile X-ray may be used outside hospital. There seems to be potential benefits to both patients and health care staff. Based on the published studies it is not possible to depict a final conclusion if mobile X-ray exam is a relevant diagnostic offer and for whom. Further studies are needed to appraise the feasibility of apply in fragile patients, also regarding staff, relatives and societal consequences and therefore the topic mobile 10-ray needs more research.

Peer Review reports

Synopsis

Questions:

Using mobile Ten-ray.

1. i.

   What are the target patient populations?

2. 2.

   What are the improvements of population health?

3. 3.

   What are the experiences of care?

4. 4.

   Is mobile X-ray a toll-effective intervention compared to 10-ray at hospital?

Findings: In this scoping review nosotros found that the target populations in the studies were fragile elderly, homeless, drug users, asylum seekers, patients with multiple co-morbidities, residents in care facilities outside a hospital setting, target screening for hard to reach populations and nursing home residents. The literature points at many potential outcomes, but without clear conclusions almost the effect on population health, experiences of care, quality and cost effectiveness.

Significant: In general, all studies fulfilled their aims, only claimed that further studies are needed to certificate the effect of mobile X-ray outside hospital.

Groundwork

Rationale

For several years mobile X-ray has been used routinely for imaging patients too unwell to exist transported to the radiology department for examination within the infirmary for making diagnostic decisions [1]. Still it is used, when patients are as well fragile to be transported to the radiology department [2,three,iv]. Also mobile examinations have shown to be cost effective in the difficult to achieve populations for instance when screening for tuberculosis or in low or middle income countries [5,6,seven].

In frail patients due east.m. nursing dwelling residents, the environmental change from abode to hospital for exam may result in cerebral difficulties [four, viii]. The patients feel illness deterioration, a need for increased intendance and medication for several days after the admission to the hospital [4, 8, ix]. In fragile patients, examination at the hospital can exist a claiming due to transport to the hospital, long waiting times, and a need to be accompanied [x]. These patients also crave actress care before, during and after the exam [ten]. Image quality is a central aspect in X-ray imagining for right diagnose of patients. A review published in 2017 [11] indicated that mobile X-ray for nursing home residents in loftier income countries is of comparable image quality to X-ray examinations at the hospital and accept potential benefits, as mobile X-ray reduced transfers to and from infirmary, increased the number of examinations carried out, and facilitated timely diagnosis and admission to treatments. But they concluded that further research was needed to evaluate potential improvements in care quality and toll-effectiveness. Furthermore, the written report population only included nursing home residents [11].

Objectives

For reasons described to a higher place, mobile X-ray examinations are already used exterior the hospital [12,13,14]. Our aim of this scoping review was to disclose published noesis about the use of mobile 10-ray and to provide insights into the breadth, depth and gaps in a body of literature.

For that reason, we asked four study questions:

Using mobile X-ray.

i. What is the target patient population?

2. What are the improvements of population health?

3. What are the experiences of care?

4. Is mobile Ten-ray a cost-effective intervention compared to X-ray at infirmary?

Methods

Protocol and registrations:

We used PICO (patient, intervention, comparison and outcome) and part of the PRISMA model to report the literature in this review studies [15]. This is because, this is a scoping reviews with the aim of disclosing published literature virtually the utilize of mobile 10-ray and non a metaanalysis or effectiveness review. A protocol of the present study is available upon request.

Inclusion criteria

Report design: Randomized controlled trials (RCT), non-randomized trials, cohort studies, example-control studies, cross – sectional studies, qualitative studies, case reports and series.

Countries: Commonwealth of australia, USA, Canada and Europe. Nosotros only considered these countries as comparable concerning 10-ray equipment, patient facilities, transporting, environs, nursing staff and the purpose of using mobile X-ray.

Time period: 1.1.2009–1.five. 2020.

Language: Abstracts and/or articles published in the English, Danish, Norwegian, French, German, Italian and Swedish languages.

Exclusion criteria

Study pattern: Ideas, editorials, personal opinions, messages, written report plans, paper articles, protocols, posters, animal inquiry studies, reviews and metaanalysis.

Intervention: Mobile Ten-ray used outside a hospital setting.

Information sources

The following databases were searched: PubMed, Cinahl, Embase, EconLit and Wellness Engineering science Cess. We chose these databases, because we considered that those databases would encompass our study questions.

The search strategy and option of databases were developed in cooperation with a librarian, expert in wellness-related literature search. The search strategy was developed in PubMed and was adapted to the other databases. In Table 1 the completed search strategy used is shown.

Table 1 Search strategy in PubMed, Cinahl and Embase for mobile X-ray

Full size tabular array

The search was carried out in December 2018, Apr 2019 and May 2020. If any new literature in the same search was published, the author received an e-postal service. Supplementary search for prototype quality and toll effectiveness was carried out in May 2020.

In a search for paradigm quality in Dec 2018, we identified 246 records, of which we concluded up with 4 total text articles already institute in the first literature search. The search strategy is shown in Tabular array 2.

Table 2 Search strategy in PubMed for image quality

Full size table

In a supplementary search in May 2020 in EconLit nearly mobile X-ray and price effectiveness, nosotros identified 12 records, of which no 1 could exist included, because the literature did not fulfil our inclusion criteria. The search strategy is shown in Tabular array iii. Nosotros too searched Health Technology Assessment using the aforementioned method as in Table 3, but we did not notice whatever reports studying mobile X-ray.

Tabular array 3 Search strategy in EconLit for mobile X-ray and cost effectiveness

Full size table

Search

Study selection

The records were archived and assessed using the computer program 'Covidence'. In Covidence when screening the literature, in the option y'all choose between 'aye', 'no' and 'maybe'. All literature selected was double-checked past Co-author CPN. Reference lists in the included studies were screened and included if eligible and published inside the fourth dimension period.

Summary measures

To extract data from the selected manufactures, we were inspired by Peters to use a structured summary tabular array for scoping reviews [16]. We included the post-obit information for summarizing the data in the articles: Author and twelvemonth, source origin, aim/purpose, report population, pattern/concept, intervention blazon, setting, system, elapsing of the intervention, how outcomes are measured, key findings and limitations (see Table 3).

Results

Study choice

In the literature search we identified 1.615 items. Subsequently removing duplicates, we had 1.480 records to appraise. Of these, 233 were selected for abstract screening after screening of titles. Subsequently reading the 233 abstracts, 27 total text articles were left to appraise. In Fig. 1 an overview of the included and excluded studies and reasons for exclusion is presented from the searched in PubMed, Cinahl and Embase.

Fig. one

Flowchart of the selection procedure for literature search

Full size epitome

In Table 4 the information extraction of the 12 included studies is shown. 1 of the included studies was randomized [17], i written report was cluster randomized [eighteen] and one study was a randomized pilot study [xix], while the rest is non-randomized or non ranging loftier in the evidence hierarchy. There was a variance in study design, ability calculations and the number of patients (north = 69–1.192), merely mobile X-ray was compared to infirmary X-ray in all studies. The interventions were mobile 10-ray and mobile X-ray combined with hospital 10-ray [17,xviii,nineteen,20,21,22,23,24, 26,27,28,29]. The almost common 10-ray examinations were of chest [17, xx,20,21,22, 26,27,28,29], hip and pelvis spine [17, 20,20,21,22, 26,27,28,29] and abdomen [17, 20,20,21,22, 26,27,28,29]. Some studies but included chest X-rays [19, 21].

Table iv show the results of the included literature

Full size table

What is the target patient population?

As shown in Tabular array 4 the study populations in the included literature were fragile elderly [19, 22], dementia patients [nineteen], homeless [xviii, 23], drug users [23], aviary seekers [23], and nursing dwelling residents [17, twenty,twenty,21,22, 26,27,28,29].

What are the improvements of population health?

Improvements of population health are measured by several unlike outcomes that by proxy may betoken if health status is improved. The outcomes of the 12 studies were delirium measured by confusion assessment method [nineteen], sensitivity and specificity of mobile X-ray to observe tuberculosis [eighteen], patient and wellness care satisfaction measured by qualitative interviews [24, 28] and questionnaires [19,twenty,21, 27], epitome quality and costs [eighteen,19,20,21,22,23,24,25,26,27,28].

In one report the authors suggest that mobile X-ray seems to increase the certainty of presumed diagnoses, and then that treatment could exist avoided in many cases [27]. Examination using mobile X-ray could also preclude patients from being treated at the hospital [22]. Fewer patients may need transportation to the hospital, and probably fewer patients would become delirious [xix, 21, 22, 27]. The literature besides describes places to use mobile X-ray outside the hospital for instance in nursing homes [17, 20,21,22] and shelters [18, 23].

For nursing home residents mobile X-ray was considered a reasonable culling to hospital X-ray examination, because they could exist treated at home [21]. Treating patients at home reduced the incidence of delirium [19]. Less transfer to the hospital was a positive outcome, since transportation of patients from their homes to the hospital may worsen the condition of demented or disorientated patients [19, 21, 22, 27]. Test in the familiar surround may calm the patients, as insecurity during transportation to infirmary is experienced every bit pain or confusion [19, 22, 23, 25, 27, 28].

What are the experiences of care?

The five included studies explored the quality, usefulness, knowledge, barriers, success criteria's and expectations of mobile 10-ray offered to nursing habitation residents [17, 21, 24, 27, 28]. In 5 studies patients, healthcare staff, nurses and referring doctors were asked using both qualitative [24, 28] and quantitative methods [17, 21, 27]. The literature plant that the principal function of patients and health care staff was satisfied with mobile X-ray exam and the benefits that mobile X-ray had for both patients and staff [19, 21, 24,25,26,27,28]. Results showed high patient acceptance of mobile 10-ray as the patients were happy not having to get away for several hours, felt safe and that it was much amend than going to the hospital for examination [21, 24, 28]. In none of the studies the patients had a negative opinion of the procedure. Nursing dwelling staffs pointed out beneficial factors such equally the security and comfort for the patients, who could remain in their usual environment, no need for transportation, and no demand for staff to be absent from the nursing homes while accompanying the patient to the infirmary [19, 21, 27]. Barriers to implement mobile X-ray were identified as organizational changes, financial barriers and structural changes for the staff [28]. Thus implementing mobile X-ray needs skilful relations betwixt the nursing home and the organization providing mobile X-ray [28].

Several studies point out that the diagnostic quality of the images may be a challenge, since the health care staff may take to cull between good plenty image quality with no transportation of patients and optimal image quality with transport [19, 21, 22, 24, 25]. Prech et al. studied image quality of chest, hip and pelvis images using Visual Grading Analysis and found that in that location were no significant differences in image quality between mobile 10-ray and X-ray at the hospital [17]. Kjelle et al. studied the utilization of diagnostic imaging amid nursing home residents and if in that location were differences betwixt hospitals with and without mobile service. The authors found a lower use of more advanced radiology by nursing dwelling residents compared to the full general population and indicated that mobile X-ray resulted in fewer CT and ultrasound examinations at infirmary [25].

Is mobile X-ray a price effective intervention compared to X-ray at the hospital?

Nosotros establish 1 prospective written report comparing costs between mobile Ten-ray and X-ray at the hospital [29]. The authors found significant differences in costs between mobile 10-ray and Ten-ray at the hospital from a societal perspective. The societal benefit to the elderly patient at nursing homes was high, reducing the anxiety and possible risks associated with transfer from the nursing home to infirmary for radiography [20].

Kjelle et al. described in their interview report that it was of import to get support from the meridian management in all organizations, which was a challenge [28]. The support was necessary in order to get coin allocated to the project. Financial barriers would result in managers at the hospitals non being willing to invest in mobile equipment, staff and vehicle. Even though mobile 10-ray may salvage coin, because of fewer hospitalizations and less transporting the savings are not always visible in the department budget at the hospital [25].

Overall the literature suggests that mobile 10-ray is cost constructive compared to X-ray at the hospital, but this is not supported by testify from a RCT. The studies investigate costs such as cost per patient, salary, capital costs of equipment and operating costs [21, 24, 25]. Many patients would not exist examined, had mobile X-ray service not existed [27].

Discussion

Summary of evidence

The purpose of this scoping review was to place published knowledge most mobile X-ray exam outside the hospital compared to examination at the infirmary in high income countries from 2009 till now. Other reviews included a specific target population or outcome measure in their studies, but by including all type of patients and outcomes, we hoped to discover results that could bear witness which written report pattern and outcome measures should be used to certificate the event of mobile 10-ray. By including all literature several different qualitative and quantitative methods were described to measure out outcomes such as population wellness, experience of care, quality and costs. Also the quality of the studies differed a lot and there was no agreement about the appropriate consequence measures. It was surprising that just 12 studies could be included in the review, but when reading the studies, nosotros constitute that mobile Ten-ray is a hard topic with many aspects to consider, when defining target population and measuring effects such every bit population wellness, experience of intendance and costs.

Target population

We found that the target population was frail elderly, demented patients, homeless, drug users, asylum seekers and nursing dwelling house residents [xviii,19,xx,21,22,23,24, 26,27,28,29].

Other patient groups may as well exist included or at least studied as possible target populations, e.thousand. hospice patients for palliative care, group home for people with intellectual disabilities, or psychiatric patients. In defining the target population land, environment and specific factors may too influence the definition of the relevant target population. The problem is also, that the target population might differ in each land and therefore it may not exist possible to define a specific target population for mobile X-ray in general.

To define specific outcomes of mobile X-ray, a specific target population and location is needed. Mobile X-ray could be used in other locations than described in the literature, east.g. at the local general practitioner (GP), in a healthcare heart in order to run across the ambulant patient's needs, but as well the needs of the health intendance staffs, crowded hospitals and general practitioners. Nosotros do not know if the locations described are the adequate locations, since information technology may differ in each country [eighteen,19,20,21,22,23,24,25, 27].

Improvements of population wellness

We plant that improvements of population health were: increasing the certainty of presumed diagnoses, and so treatment could be avoided in many cases [22], forbid patients from existence treated at the hospital [20], fewer patients may demand transportation to the hospital [21, 24, 27], and probably fewer patients would become delirious [19].

The measurements for improved population health are not clear, for instance consequences of transportation, environmental changes or waiting fourth dimension for the patient. Another problem is measuring the effect of mobile X-ray all studies conclude that further studies are needed to measure the upshot, but at the same time they constitute that mobile Ten-ray probably is beneficial to the patient in dissimilar ways. The problem is that one outcome measure may be relevant for ane patient grouping but non for all patient groups. For demented patients delirium may exist a relevant event measure, for a homeless, sensitivity and specificity of detecting tuberculosis may be more relevant. The outcomes of the studies describing improved population health give a mixed and unclear indication of what to be used equally outcome measures and written report pattern [18,19,20,21,22,23,24, 26,27,28,29].

Experiences of intendance

Experience of care was generally measured as satisfaction and we found that the included patient and healthcare staff seemed to exist satisfied with mobile X-ray [19, 21, 24]. Also the image quality is good [17, 19]. But the question is, if satisfaction is directly comparable to experience of care.

In all studies we just found positive results. But experience of care and satisfaction may not be comparable between unlike patient populations and different health care staffs. When asking a demented nursing dwelling house resident, relatives or health intendance staff about their satisfaction with mobile 10-ray, no transportation or preventing the possible effects of delirium could exist related to high satisfaction [nineteen, 21, 24]. Asking homeless residents or aviary seekers most satisfaction, these outcome measures probably would not even exist relevant. Therefore studying experience of intendance information technology is necessary to be very specific of study grouping and aim. It could exist relevant to ask the patients virtually their experiences being examined with mobile X-ray, but information technology may be difficult with certain patient groups, eastward.g. patients with severe dementia.

The literature shows that mobile Ten-ray may facilitate high quality of treatment and care [17, nineteen,20,21, 24, 27]. The question is, if the quality of the studies permits making conclusions concerning experience of care, since we did non observe two studies measuring feel of intendance, using the same outcome in an identical population. We find, that the target population for measuring experience of care could as well be other groups than the patients and health care staff in the studies. For instance GP, heads of departments, relatives or other persons involved in mobile X-ray, who could limited their satisfaction. When asking the referring doctors if the mobile X-ray exam had given of import data to patients and their families, they replied positively [nineteen, 21, 25, 27]. In the qualitative written report by Kjelle, the authors institute that the full general quality of intendance in nursing homes was considered to be improved, considering healthcare staff did not have to arrange for volunteers or family to accompany patients to the infirmary or the staff had to back-trail the patients [28].

The literature shows that measuring experience of intendance is hard [19, 21, 27, 29] and it may be the reason why, no one has documented a gold standard for doing that. This is probably because the patients are hard to accomplish and therefore, they might have difficulties sharing their experiences of mobile 10-ray [20]. Data from referring doctors, healthcare staff, and relatives may be biased and non representing patients' views. The image quality is good and reduces the use of other imaging examinations in nursing domicile residents [17]. The image quality seems to be good and while conducting this scoping review new studies concerning prototype quality take been published, so the quality is in focus [17].

Cost-effectiveness

Mobile X-ray seemed in ane study to be cost effective, merely using costs equally an result measure, all relevant costs of mobile 10-ray must be considered and compared to X-ray at the hospital to conclude if mobile Ten-ray is cost efficient [20, 29]. It is suggested that probably the costs are lower using mobile X-ray seen in a social perspective not including derived costs for case costs for relatives accompanying the patient [29].

Limitations

There are several limitations of our scoping review. Limiting the review past language, years and locations may take resulted in cardinal studies being missed. Nevertheless, we wanted to look at literature describing mobile X-ray in a western context within the terminal years. On the other hand mobile 10-ray is being used in India, and then it could be relevant to include a broad literature in a systematic review. Choosing only to search few economical specific databases could besides have express the findings, simply we find that all literature about mobile X-ray would be published in healthcare journals, since we did not detect any reports in the economical databases.

Conclusions

In conclusion, this scoping review indicates that mobile X-ray in high income countries may be used exterior the hospital in nursing homes, homes for the elderly and in shelters. Patients and health intendance staff seem to exist satisfied with mobile X-ray. The image quality is good and mobile 10-ray may be toll constructive. In general, the included literature may lack the prove for documenting the effect of mobile X-ray, peradventure considering the effect is difficult to measure in a broad population. There are challenges documenting the event of mobile 10-ray yet, mobile X-ray has come up to stay even if we still need a articulate respond on how to develop the mobile X-ray, to whom it should be offered and therefore the topic needs more research.

Future enquiry

Mobile X-ray is a relatively unexplored and new field and therefore much research needs to be conducted. Hereafter research could for instance be RCT measuring the effect, finding target populations, patient satisfaction and/or cost effectiveness.

Availability of data and materials

"All data generated or analysed during this report are included in this published article".

Abbreviations

CT:

Computered tomography

GP:

Full general practitioner

MXS:

Mobile X-ray service

RCT:

Randomized controlled trial

RACF:

Residential aged care facilities

PICO:

Patient, intervention, comparing and outcome

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Acknowledgments

We thank AU Library, Health Science for assist in the literature search.

Declarations

"Non applicable".

Author information

Affiliations

1. The Section of Radiology, Aarhus Academy Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Kingdom of denmark

   Maria Dietz Toppenberg, Thomas Erik Møller Christiansen & Finn Rasmussen

2. DEFACTUM, Social and Wellness Services and Labour Marketplace, Olof Palmes Allé fifteen, 8200, Aarhus N, Denmark

   Camilla Palmhøj Nielsen

3. Department of Elderliness, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus Due north, Denmark

   Else Marie Damsgaard

Contributions

MDT conducted the literature search, designed the review protocol and search strategy, conducted the literature retrieval, reviewed all abstracts identified, read all potentially relevant articles, scored all articles included in the review, and wrote the initial draft of the paper. EMSD and CPN reviewed all abstracts identified, read all potentially relevant articles, scored all manufactures included in the review, and contributed to and edited the newspaper. FM and TEMC contributed to and edited the paper. The author(south) read and approved the terminal manuscript.

Corresponding writer

Correspondence to Maria Dietz Toppenberg.

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Competing interests

"The authors declare no competing interests".

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Toppenberg, M.D., Christiansen, T.Due east.M., Rasmussen, F. et al. Mobile X-ray outside the hospital: a scoping review. BMC Health Serv Res xx, 767 (2020). https://doi.org/10.1186/s12913-020-05564-0

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• Received: 08 August 2019

• Accepted: 21 July 2020

• Published: 20 Baronial 2020

• DOI : https://doi.org/10.1186/s12913-020-05564-0

Keywords

• Mobile X-ray
• Target population
• Population health
• Experience of care
• Price effectiveness

Source: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05564-0

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