A clinician utilizes a MinXRay portable x-ray machine in Angola to examine a patient. The company recently adopted new safety guidelines with the help from researchers at McGovern Medical School.
A clinician utilizes a MinXray portable x-ray machine to examine a patient.

Thanks to the efforts of researchers in the Diagnostic & Interventional Imaging Department at McGovern Medical School, the UTHealth name will be all over a new set of safety standards for a series of portable X-ray machines created by MinXray that can be used outside of medical facilities all over the world.

The collaboration was first sparked by a chance meeting between Dr. Ronald Bilow, director of disaster preparedness for UTHealth and associate professor in the Department of Diagnostic & Interventional Imaging, and representatives from MinXray while visiting vendor exhibits at the World Association of Disaster Emergency Medicine (WADEM) Congress. They discussed what Bilow called their “mutual needs” – Dr. Bilow serves as an emergency medicine radiologist on the Texas Emergency Medical Task Force Region 6 (EMTF6), and one of his clinical interests is to potentially expand the scope of radiology beyond the health care facility setting.

“To my end, I strongly desired to obtain mobile X-ray capabilities for the EMTF6 MMU (Mobile Medical Unit),” Bilow said. “In fact, I was asked to deploy to an MMU shortly following Hurricane Harvey, as part of the regional relief response. MinXray had a need for hard evidence regarding radiation safety that they could leverage towards marketing their equipment.”

Andrew Kester, educational coordinator with MinXray, said their portable imaging equipment sees substantial usage in remote locations across the world, sometimes in less developed areas or environments with little to protect patients from radiation. For example, their equipment has been used in places like Angola, Haiti, and Mongolia – locations that all need easy-to-use training materials for clinicians or nurses working in difficult environments or with staff that might not be fully trained.

Kester said there was an industry standard guideline of the distance at which other people should be standing to avoid radiation exposure in general, but safety standards for portable X-ray units lacked clear recommendations. This is where radiation physicists like Dr. Charles Beasley, associate professor, and Dr. Moiz Ahmad, assistant professor of diagnostic and interventional imaging, came in.

“There is plenty of literature on radiation safety regarding X-ray units that are either fixed in hospitals or can be wheeled around in them, but nothing on the use of X-ray units that can be wheeled out into the field,” Ahmad said.

“We were at a quandary,” Beasley said. “We had a lot of good references that gave us technical numbers, but the question was how we can provide that information in a very simple and understandable format that will cross language, cultural, and educational barriers.”

MinXray shipped a unit to the medical school and the team set to work testing it in a large space provided by Memorial Hermann Hospital, determining what the exposure in the surrounding area would be like for a patient. Using metal and plastic stand-ins for patients, Beasley said they tested 360 degrees around the unit and at various distances.

Instead of giving highly technical information for their findings, they called on Beth Watson, MEd, in Academic Technology.  Watson suggested they provide the guidelines  as large pictures and easy-to-read shapes and diagrams to show where patients, doctors, and other people who may be in the room should stand to go with the text, especially for non-English speaking users. Cynthia Reyna, also in Academic Technology, and Watson turned the sketches into high quality graphics for the guidelines document.

“It was a different mindset for us,” Beasley said. “We’re used to working around the hospitals and medical technicians.” Watson added, “When one of the MinXray guys said that a guy using it could be someone who dug a ditch that morning, my heart just dropped. We couldn’t do this in words alone.”

Instead of technical measurements or jargon for defining safe levels of radiation, they kept it simple and even included a tape measure bundled with the unit to allow operators an easy way to determine how far away others should be.

“We also did calculations based on our readings and determined a threshold for the number of exams that can be completed safely for patients,” Ahmad said. “Rather than putting the exact number of the level of radiation, we say ‘you can perform x number of X-rays’ instead.”

Kester said in some parts of the world, the lack of an X-ray program means people like mechanics or even truck drivers would need to understand the safety guidelines and training procedures, so they need to be as easy to understand as possible. He said MinXray was impressed with the results and the two-page safety guidelines are distributed at the front of reading materials for their portable units and will go a long way in helping their company’s branding and education initiatives abroad.

“It also helps me on a technical side,” Kester said. “When I do these presentations, demos, or webinars, I now have hard data to show.”

Ahmad said researchers can also expand on the use of mobile X-ray units with a series of other radiological exams surveying the levels of radiation around these units.

“There is some potential of publishing this data and that’s something we would like to pursue,” Beasley said.