Health News
Imaging Team Scores "Firsts" at 2010 Olympics
February 28th, 2010
Along with offering instant ultrasound diagnoses to help determine whether athletes were fit to return to play, radiology scored a number of other "firsts" at the 2010 Vancouver Winter Olympic and Paralympic Games and enjoyed its own moment in the spotlight.
"The games were perfect opportunities to help the public understand what radiologists do," said Bruce Forster, M.D., of the University of British Columbia in Vancouver and manager for the 2010 Imaging Team. "Radiology played a huge role at the Olympics."
In fact, the radiology team made up of the largest medical force at the Vancouver games—the first Winter Olympics to offer CT, MR, digital radiography and ultrasound within the athletes' village.
Dr. Forster's team—comprising 19 radiologists and 51 technologists, including assistant supervisors Mark Cresswell, M.D., Luck Louis, M.D., Karen Smith, R.T.M.R., R.T.R., and Sue Murray, R.D.M.S.—set technologic and logistic precedents including offering "on-venue ultrasound" (OVUS), which was critical in helping medical staff, coaches and athletes make immediate decisions about whether injured athletes could return to play.
"When we first discussed what role ultrasound would play at the venues, I imagined some tech or radiologist running to the downhill course with, you know, a big black cape, and [sports commentator] Bob Costas would say, 'Oh, there goes the radiologist!'" Dr. Forster said. "Quite frankly that's highly dangerous and not going to help the athlete very much."
OVUS was implemented at the cross-country Nordic, speed skating, freestyle skiing, snowboarding and ice hockey venues. Ultrasound videos obtained near the playing field were sent instantly to imaging centers through a local area network line.
Though OVUS wasn't available at every event, imaging team members said they were pleased to see it was in high demand. "Many of the coaches and team doctors came to me and asked why we were not covering their athletes at different venues," said Cresswell, who oversees the OVUS program. "They see it as a very valuable resource."
"It doesn't take many cases for the value of OVUS to become obvious," added Dr. Forster. "Even if it's just a handful, the stakes are so high and the impact and outcome so significant for these athletes who may train 10 or 15 years for this one chance to compete."
In addition to OVUS, the team provided full imaging services at two "polyclinics" - an Alpine site at Whistler, home to Olympic events including cross-country, downhill skiing and sports such as bobsleigh, and a city site hosting sports like hockey, curling and freestyle skiing and snowboarding.
"The polyclinic at Whistler is not a permanent structure—it's a very large tent," Dr. Forster said in an interview during the Olympic games. "Behind it lies what we call the mobile medical unit, which is a state-of-the-art operating room and recovery ward housed in a trailer with extendable wings"
In order for an Alpine venue to be chosen by the International Olympic Committee (IOC), the facility must have the ability to perform life- and limb-sparing surgery, and Whistler has no operating room, Dr. Forster explained. "This was an essential piece of the puzzle which GE provided, now a legacy for the province of British Columbia," he said. "It's the same unit that was used to save many people after Hurricane Katrina."
Polyclinics provided services for the entire "Olympic family," including athletes, the workforce, members of the National Olympic Committee (NOC) and IOC, family members and others.
Orchestrating the imaging centers took more than three years of intensive planning. "We went through a long process selecting the technologists," said Smith, the team's lead technologist and assistant supervisor. "I knew some of the technologists I chose, but others I'd never met before," she said. "After doing this for a couple of years and then finally having your team arrive, working so hard together—seeing it go live—has been amazing."
Model Created for Future Olympics
Using all four imaging modalities—CT, MR, digital radiography and ultrasound—was also a noteworthy "first," said Dr. Forster.
"In Torino, MR was only available at a local hospital and one CT unit at one of the venues was quite a distance away," Dr. Forster said. "In Beijing, CTs were all sent to all the hospitals. This is a very important step for the care of the athletes—to have CT present at our immediate disposal when the modality was indicated."
Though the Winter Games have only a third as many athletes as the Summer Games, winter sports have a considerably higher incidence of trauma, Dr. Forster explained. "CT is the gold standard, particularly for injuries of the head, spine, abdomen and pelvis, and we need to have it available for these athletes," he said.
The experience also provided a successful all-electronic healthcare record model. "We have full PACS and radiology information system (RIS) and we no longer issue paper reports," Dr. Cresswell said. "Every patient receives a digital CD-ROM of their imaging study, which includes their report. What happens in most modern radiology departments now happens at the Olympics, and I think that's fantastic."
The electronic system also allowed transmission of images between sites and to Vancouver General Hospital. Transmissions from OVUS venues enabled radiologists to watch ultrasound video loops in real time and speak live to technologists at the venues.
"This will hold the upcoming Summer Olympics in London in 2012 in good stead," Dr. Cresswell said. "The technology will be tried and tested and the kinks have been essentially erased, making it easy to implement in the future and accepted by the IOC."
Added Smith, "We're hoping to generate good statistical reports via the radiology information system, which has not been used so extensively in the past."
Patient Confidentiality a Priority
With so much media attention and so much at stake for athletes, maintaining patient confidentiality was challenging - especially when the media reports news and rumors even before the medical team could issue a comment. That was the case in the death of Georgian luger Nodar Kumaritashvili, Dr. Forster said.
"It was obviously a great tragedy and a very tough way for everyone to start the games," Dr. Forster said. "We were not, of course, able to provide any specific commentary on that medical encounter or any other."
As with any patient population, the team worked carefully to maintain confidentiality, Dr. Forster said. "The reports and CDs we distribute were kept to a minimum and given to the right people, and kept out of view of the public. We're not suggesting that people were necessarily trying to look, it was just best practice to use this process."
The team was also careful to keep athletes—who are often easily recognizable and may not wish to divulge that they could be injured—out of view of the public and fellow athletes; often patients were accommodated under cover of night.
Radiologists "Part of the Team"
The Olympics imaging framework thrust a spotlight on radiology's central role on the medical team, according to imaging team members.
"The real privilege of working at these games has been to work as a whole team—with patients, emergency doctors, referring physicians, team doctors, physiotherapists," Dr. Cresswell said. "They explain their concerns and what they're trying to achieve and we learn about specific injuries associated with the different sports and maneuvers and change our protocols to accommodate them."
While some team members worked a few weeks before and during the Olympic and Paralympic Games, others were on call for the duration. As new staff members arrived, they were trained to deal with patients almost immediately. The positive energy surrounding the games eased the transition, team members said.
"Radiologists will remember what it was like when their hospital changed from the old system to PACS and everybody had to learn the new RIS and new workflow," Dr. Cresswell said. "That's essentially what happened with each group as they came in. But unlike our normal hospital environment where people may be a bit jaded and worn out, everyone was happy to be here. The positive energy in the clinic was amazing."
"When the shifts ended, hardly anyone ever left right at that time," Smith said. "There was a good transition between the two shifts and people were happy to share the events of the day with each other."
The patients themselves were at the center of that enthusiasm. "It was an absolute pleasure and privilege to be with the athletes," Dr. Cresswell said. "You become part of the team. I would often find myself watching TV and seeing people who I knew were competing with injuries doing extremely well, and I found myself rooting for countries I've never rooted for before. I felt proud for them, even though I had nothing to do with their training." The same team also provided imaging care to those involved in the Paralympics Games, which ran March 12-21.
Even in defeat, the athletes were uplifting. Dr. Forster cited an early blog entry by OVUS technologist lead Sue Murray, recounting how an athlete, upon hearing he had a career-ending injury, requested a television and spent the remainder of his hospital stay cheering on his teammates from his bed. "Olympic spirit is a funny thing. It creeps up on you when you least expect it," Murray wrote in the entry. "If I cry at the TV one more time I think that my husband is going to have me medicated."
Excitement, Teamwork Translate at Home
"We are all feeling positive about what we did and how exciting it was and that will really translate back at our hospitals," Dr. Cresswell said. "But it's more than that. We've all learned different skills and the interaction we've had with athletes and coaches has enabled us to understand their needs more fully."
British Columbia-area facilities will also benefit from the donation of many pieces of legacy equipment. Whistler gets to keep its new 64-slice CT scanner and a number of mobile ultrasound units will be used at future sporting events. "It's going to have an enormous long-term impact on sports development and imaging of all athletes, and it will carry over to patients who are not necessarily athletes," Dr. Cresswell said.
"Our experience has also highlighted the importance of maximizing interaction between radiologists, technologists and other healthcare members," Smith said. "Stretching beyond the routine helps you become a better radiologist and technologist, ultimately benefitting the patient."
"That patient may be an Olympian or weekend warrior," Dr. Forster added. "The Olympics has galvanized for all of us working at the games the critical role our specialty play"
SOURCE: Radiological Society of North America
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