For the elderly, X-rays make house calls
August 11, 2011
by
Brendon Nafziger, DOTmed News Associate Editor
Many elderly and chronically sick patients often receive home health visits from nurses or health aides who give routine, basic medical care. And now, they might be getting X-rays, too.
An Italian pilot project suggests older patients too frail to safely or comfortably visit the hospital for X-rays could be scanned at home.
In their small study, the researchers found that chest X-rays taken at home were of comparable quality to those acquired in the hospital, but were much less likely to trigger an episode of delirium in elderly patients.
"Modern portable x-ray units are light enough to be easily transported and used in the home and may spare frail patients the trauma of transportation and unfamiliar surroundings, as well as other hospital-associated adverse effects," write Dr. Nicoletta Aimonino Ricauda and colleagues in the new study, published online August 8, in the Archives of Internal Medicine. Ricauda works in the department of medical and surgical disciplines-geriatric section at the University of Torino.
About 12 million people receive care at home in the United States, according to the National Association for Home Care and Hospice.
While various companies offer home X-ray services in the United States, it's not clear how widespread it is, as reimbursement is likely still an issue in some areas, according to experts DOTmed News spoke with.
"This is just one of those trends where you're seeing something traditionally only available in hospitals that they're able to provide in the community," Richard Brennan, executive director of the Home Care Technology Association of America, an affiliate of the NAHH, told DOTmed News.
"Now the cost of entry has lowered, and they've been able to miniaturize and mobilize these technologies, so you will start to see them more and more as payers find reasons to reimburse for them," he added.
Less delirious
In the randomized, controlled trial, 34 patients received chest X-rays at home, and 35 in the hospital. Most were scanned to check for pneumonia or worsening heart failure or obstructive pulmonary disease.
The scans were processed using a mobile CR unit, the Point-of-Care 260, made by Carestream Health of Rochester, N.Y. The radiologic technicians who performed the scans then wirelessly transferred them back to radiologists at San Giovanni Battista Hospital in Torino.
Seven radiologists, blinded as to whether the images were taken at home or in the hospital, judged the scans based on six criteria, such as symmetrical reproduction of the thorax and whether they showed small, round details of the whole lung.
Images from the two groups did not significantly differ in quality, the authors said.
But hospital-based scanning was more likely to trigger a delirium episode. After being scanned in the hospital, 17 percent of the patients, whose average age was 78, experienced delirium. None of the home-scanned patients did, the authors said.
The quality of the images captured by the mobile X-rays wasn't entirely surprising, according to a radiologist with the American College of Radiology.
"The type of patients they're talking about, at least some of the time, if they were in the hospital, they'd have a portable study done," Dr. Paul Larsen, chair of the ACR Quality and Safety Commission, told DOTmed News. "Is that really different, doing a portable exam in the hospital versus in the home? Not necessarily."
"I think from the ACR standpoint, our main concern would be high quality work is done, and that's obviously something they address in the study," Larsen added.
Nonetheless, the authors caution that the sample size was small and only performed at one center, so the results might not be applicable generally.