1. Introduction to Mobile X-ray Trucks
Mobile X-ray trucks, or X-ray vans, represent one of the latest advancements in mobile radiology. Driven by an increasing demand for diagnostic imaging in various disciplines or sectors, including medicine and health, veterinary, pharmaceutical industry, forensics, museums and cultural heritage, and mechanical and industrial fields, these vehicles are gaining more and more attention to meet the needs of this demanding clientele. To carry out the most common radiographic explorations, simple X-ray machines are often sufficient: applications in the health sector, industrial control systems, and applications in non-destructive testing which are carried out for art.
It’s a “full digital” system, and the X-ray images are processed by flat panel detectors with a control room and a temperature stabilization system. The images can be consulted directly on portable devices, PC workstations, or on other dedicated machines. Mobile X-ray trucks are fully equipped “ready to use” mobile vehicles supplied with electricity generation and storage, refrigerated water for cooling, and for the X-ray machine and other device readers. These X-ray trucks are designed for easy transport and for working in remote and difficult locations where there is no need to use the motor engine.
1.1. Definition and Purpose
A mobile X-ray truck is a specialized vehicle used for on-site imaging, performed using industry-leading radiographic technology to achieve the lowest practical radiation dose. X-ray trucks are used for radiographic testing in a variety of industries, including petrochemical and aerospace, where part size and weight requirements exceed those that would permit the use of traditional in-house or stationary systems. Mobile X-ray trucks, however, are primarily used by medical professionals to provide accessibility to imaging studies in locations lacking imaging facilities. In the healthcare industry, these mobile X-ray trucks are often referred to as “ICU on wheels” by caregivers and may offer more advanced portable CT, MRI, and interventional imaging capabilities in addition to digital radiography.
ICU Automotive is a versatile firm that designs and manufactures several tiers of innovative mobile imaging systems. Our flagship product, the mobile X-ray truck, is intended for use in several novel operating paradigms, examples of which include: 1. Performing additional imaging tests on patients before they leave the emergency room to expedite diagnoses, 2. Minimizing throughput losses associated with the operation of a traditional imaging department, 3. Efficiently imaging all bed-bound individuals within a long-term care facility after a COVID-19 outbreak, and 4. Imaging disabled individuals that must remain in their bed, including bariatric patients. These products are ideally suited for use in disaster relief, academics, and construction on the grounds of existing care and educational-altering establishments. A brief summary of these operating paradigms and the associated economics and ROI can be found in the applicable subpage.
1.2. Evolution and Importance
Mobile X-ray trucks, also called mobile radiography imaging units, have been naturally evolving since their initial use and development, consisting of a radiographic X-ray system that is built into a truck, SUV, van, or bus. The earliest uses of this technology focused on case-by-case bases with images taken for diagnostics in rural areas, military uses, and emergencies. The subfields of emergency medical systems and rural healthcare are where mobile X-ray trucks are most used, valued, and innovate the furthest, and are thus the primary focus of this survey. In emergency medicine, they are equipped to produce a rapid skeletal X-ray on-site in the first 10 minutes upon the arrival of a patient, notifying ER staff of the nature of the hospital bed arrangement and shortening their overall hospital stay. This gives options for patients with more serious injuries to be immediately operated on while awaiting the results of additional scans; providing them with quicker and stronger care can save lives and decrease morbidity. In rural healthcare, mobile X-rays are used by small rural hospitals, clinics, private practices, assisted living facilities, or home health agencies that achieve economies of scale and provide fixed-location X-ray services with a less expensive way to differentiate service add-ons and stand out against competition.
The first mobile X-ray trucks were invented and deployed in the First World War to improve the efficiency of field hospitals. They usually had a focus on using bulky imaging equipment which required a large truck and was mostly found in the radiology departments of generative knowledge or clinical investigation. Instead, the rapid organic evolution of mobile X-ray trucks in the 21st century can be traced to the failure of large hospitals to use traditional fixed X-ray machines in a timely fashion. Today’s most common mobile X-ray trucks are of low absorption types such as digital radiography and pulmonary X-ray. Recent X-ray work is being done at the frontiers of cardiology, orthopedics, and dental care, as well as some specialized work in telemedicine and traditional film radiology. Because they have all-in-one closed integrated systems with comparable standard permanent units, mobile X-ray trucks and better computerized tomography scan electron shielding can significantly increase the overall signal to accelerate diagnostic imaging if the moving platform is highly stabilized. Some mobile X-ray chest X-rays are used to check for a recent outbreak of pulmonary fibrosis suitable for COVID-19; some oral and maxillofacial X-rays use digital radiography for oral and mandibular surgery, new implant planning, and orthodontics. They focus on dental implants and complete CT scanning and 3D/4D X-rays for the dental aspect. Mobile X-ray trucks can often be used for quantitative clinical programs; some of these have new discoveries in chiropractic bracing, including in skeletal and respiratory X-ray studies and large animal radiation therapy.
2. Technological Advancements in Mobile X-ray Trucks
Some of the technological advancements that have been made for the common mobile X-ray truck are the movement from film radiography to digital radiography. Digital images are available nearly instantly and are capable of being evaluated before the patient leaves the exam room. With digital technology, it is easy to archive images, access images, and send images to a specialist or referring practitioner. The transition in digital technology has improved image quality, reduced radiation to patients, increased workflow, and minimized processing time. These images can be adjusted by changing contrast, brightness, flipping the image, or magnifying it. This is advantageous when looking for the perfect image. Numerous tools for enhancement can be performed after the image is taken. For example, enhancement of soft tissue with algorithms and tools that change exposure and contrast of images. With digital imaging dictating relative diagnostic accuracy, it is easier.
A portable X-ray machine that is capable of penetrating an intermediary plate has been perfected for mobile use. Other advancements include wireless technology for communication with PACS and other peripherals. This technology includes data storage of the patient and their image for protection of the patient’s rights to confidentiality, which is required by law. The X-ray system becomes mobile as this single generator is capable of handling various imaging situations. The system has been automated to the point that the technologist enters certain data and is able to then position the patient and explore the image without additional adjustments. Furthermore, the bucky has the plate in it, so a mobile self-contained bucky can also be incorporated on the X-ray, allowing for an X-ray to be done without the X-ray truck. This technology decreases the time for the exam and allows for better and less distorted images. With this technology, the X-ray truck has three different X-ray units. Some systems today come with additional technology such as fluoroscopy, and these systems allow for pain injections using more advanced technology. The X-ray truck has become an important part of the field of medicine and has had a profound effect on modern society. In the following sections, both the Shadowmaster, the Clearlead, and the Z-Medica will be evaluated in more specifics.
2.1. Digital Radiography
2. Innovations in Mobile X-ray Trucks
2.1. Digital Radiography A transformative technology in mobile X-ray imaging is digital radiography. Digital images have a number of advantageous characteristics. Digital cameras use tiny light-sensitive electrical parts rather than film to record a picture. These sensors are then converted to an image by an integrated computer called a digital signal processor. Most digital radiographic systems contain a radiographic flat panel detector, which is made of both X-ray sensors that capture the images. The X-rays pass through the patient and strike the special phosphor, which gives off light and releases electrons with the single X-ray photon energy level that are then easily detected by sensors. The computer software, or image processing system, enhances and communicates the image to a picture archival system, in a similar way to a digital camera storing the image on a digital storage device.
A digital image has a much finer resolution and clarity compared to traditional photographic films. The image is immediately available upon exposure, eliminating the chemical and time-consuming process in the darkroom required for conventional X-ray film. The digital image can be manipulated by electronic means for better evaluations. Mass digital storage and local area networks permit rapid and remote access to the digital image. This has significantly modified the way radiologists work and also their overall productivity, as it allows them to share and interpret together in real time as well as in remote locations. The technology has had the further advantage of streamlining the process and, by providing a quick diagnosis, treatment, and feedback, can indirectly increase patient safety and reduce mistakes. The theory of image interpretation aimed at analyzing the production of radiographic images displayed with an optimal look-up table on a computer monitor has shown that digital radiography using the CR imaging system will result in normal visualizations of the anatomical lung, aorta, chest wall, as well as the abdominal wall, but increase the visualization ward in images used CAP compared to LNMAP. Thus, digital radiography technology is often used in various aspects of therapy to diagnose and understand conditions within the patient’s body. Digital radiographs and CAT scans are used to diagnose causes of disease. Digital radiography using CR (Computed Radiography) imaging can help in evaluating the patient’s nutritional status so that in the future it can be used to evaluate the effects of nutrition through the ideal body weight index and quality of life of cancer patients. Other diseases of the respiratory system can also be detected through digital radiography, including the pattern of tuberculous lung diseases in moderate and heavy weight and chronic obstructive pulmonary disease (COPD) assessed as mild, moderate, and severe according to the Global Initiative for Chronic Obstructive Disease guidelines.
2.2. Portable X-ray Machines
Diagnostic imaging is the primary function of mobile X-ray trucks, so the development of portable X-ray machines is a necessity to understand the potential practical applications. As movable X-ray machines become smaller, they are also far more accessible in many regions. A major benefit of increased accessibility to X-ray machines is the expanded availability of diagnostic images. Physicians, patients, and rural or unreached populations benefit in particular. Over the last decade, small strides in portable technology have translated into significant performance benefits, smaller sizes, and other advantages. Battery life, system portability, ease of use, and digital image quality are four major factors that lend practicality to mobile models of diagnostic imaging equipment.
Portable X-ray machines come with a digital detector and battery power that have some level of performance portability. The columns of baggage covered in this chapter detail the system’s battery life, ease of use, and digital image quality. Ideally, the clinical capability of the medical utility model solidly integrates with the mobile X-ray truck in order for the development of the two to be exponential. There are many potential assets that will begin to encourage future participants and developers in their quest. One key advantage is the ability to treat more aggressive emergency medical services as well as urgent care services. At present, there are portable big-screen X-ray machines and complex mobile surgical X-ray systems. We also have various styles. The mini-trolley type is the most classically portable. They usually come in the middle of 100-200 pounds and without a battery, which is a nearly 4-foot portable X-ray machine with a portable handle in a stacked container. More powerful tractor-based systems are available with battery, stand, and shielding plates at all speeds. Two commercial and professionally portable machines will be available soon.
3. Design and Features of ICU Automotive’s Mobile X-ray Trucks
Conventional truck base: basic health requirements. Conventional truck base with better than basic options: a desire to provide the best convenience for both the patient and the medics. Equipment mounted into a full-size coach body: additional equipment and elaborate parameters. Such gradation gives the opportunity to adapt the vehicle to the policy in the scope of the healthcare provided in different countries around the world, i.e., to be used based on possibilities. The standard full-sized coach body offers ample space for the medical staff to conduct their procedures, and the patients are comfortably examined. Healthcare for a patient has different needs; therefore, thinking about the vehicle for health diagnostic units and the safety of such a facility, we have also created standardization in the interior equipment suitable for a mobile X-ray unit that is mounted in our coach body ICU PTU. Medical standards require monitoring vital functions of the patient during the entire therapy. The standard telemetry system includes a patient monitor and a defibrillator. Other medical equipment may be adapted to the requirements of the ordering party.
The vehicle specifies an interior dimension, the layout based on performing research, and offering the best possible contact, communication, and trust between the diagnostician and patient. A spacious container part of the body will allow for the effective operation of radiographers, laboratory assistants, nurses of emergency medical teams, and doctors. The furniture in the RV, together with the work area for research, may be arranged in line with customer requirements based on examples shown in the floor plans. A non-standard equilibrium of the full-sized coach provides access to collect and mount an ambulance on the minibus or truck chassis. The comprehensive design of health shows the wide possibilities of implementing the interior design, making it ergonomic and functional exactly as required. A comprehensive design offers endless possibilities for changes that may be made through rough or trial orders from customers, not to the final shape of a visualization.
3.1. Customization Options
The mobile X-ray trucks are available with various customization options, both on the layout and the available onboard equipment. Scroll below to learn more about the possibilities for adaptation of our mobile medical vehicles in terms of your specific requirements.
Our mobile X-ray trucks are highly customizable to adapt them to suit the operational purpose and optimize their use in varying medical settings. All of our products in this lineup are the result of close collaboration between our engineers, our clients, and medical professionals, all of whose precious input allows for the creation of outstanding designs tailored to the specific needs of each healthcare center. Our mobile X-ray vehicles can be configured with a variety of equipment and layout choices, including bedding and stretchers, to become fully equipped ICU tenders, ATM coaches, or any other kind of specialized medical trucks that your healthcare staff or patients require. Some typical customizations of our mobile X-ray projects would be:
– The configuration of additional storage space within the body of the truck for spare parts, patient luggage, or protective suits; – The ease of snow chain installation for winter trips, or chains storage provision; – The trailer enabling; or provision of a bike rack on the back of the truck for rough terrain trips; – The fuel and water tanks for longer trips, to avoid frequent refilling; – Etc.
Our most recent mobile X-ray truck customization project involves a combination of a rotation within the medical imaging business and a high level of user and patient satisfaction for those visiting the mobile radiodiagnostic unit. Offering a mobile unit that has been clearly personalized and adapted to the normal use of a mobile medical center is crucial in today’s patient-oriented market. Our broad experience with previous mobile X-ray projects has shown that in addition to transporting high-end imaging equipment, the configuration is at least as important as the onboard equipment for the efficient and enjoyable operation of the mobile imaging truck for the drivers, nurses in the scope of patient handling, and partially the operators servicing and working with the medical imaging equipment anywhere in the world. The collaboration between the healthcare professionals at the client’s medical imaging department enabled the configuration of a truck with sufficient headroom in the different rooms; efficient but compact, and a clear traffic flow with possible patient – medical imaging examination staff movement within the unit.
3.2. Safety Features
The primary concern with moving a static diagnostic procedure into a mobile setting is the safety aspect, regarding both the operator and patient. At ICU Automotive, we have taken great care to ensure that the people inside the mobile truck remain protected at all times. Additionally, the ICU Automotive X-ray is a product that can be integrated into existing trucks. If deemed necessary, the product layout will be adjusted to accommodate all necessary safety features. Critical safety features include the design of the truck body to act as radiation shielding. Furthermore, floor-to-ceiling lead has been installed in the radiation room to minimize exposure to the operator. The layout and design of the product have been built for safety factors, ensuring that operators have a clear path of egress during emergency scenarios. Moreover, the patients and operator are protected during image acquisition as the operator can stand directly behind the lead barrier, with the patient entrance behind the operator. The ability for the operator to physically stand behind the lead shields serves numerous functions: operator area protection, easy interaction and calming of the patient, and more. The laser camera alignment system serves as an additional precaution, redundancy check, and additional operator reassurance. The highest priority in designing safety features is the integration of fail-safe mechanisms that make it almost impossible for safety protocols to be bypassed.
The truck layout’s stringent focus on operational safety means operators have room to maneuver between workstations during patient delivery, leading to a significantly more ergonomic workspace due to the elimination of the need to climb and crawl. The entire process has been analyzed, with careful consideration of the smallest details, such as the placement of garbage and light switches at operator level for smooth interaction. Furthermore, the truck and equipment are installed with safety-focused fail-safe mechanisms. Significant operator-specific considerations have been given high priority in product development. Guidelines have been standardized, including a step-by-step approach to operating the device and excess radiation management. The need for standardized protocols was highlighted in scenarios of various experience levels. Safety protocols and procedures include possible emergency scenarios, which may be outlined to comply with local guidelines, and the equipment includes various alert systems to inform the operator of potential hazards. To this end, a custom-designed programmable logic controller integration with the X-ray and magnetic resonance imaging units ensures one piece of equipment acts as the master power control, ensuring both machines cannot run simultaneously. Creating a safe work environment is of the highest importance; operators are unlikely to function at their optimal level without trust that what we are designing keeps our end-users safe. Ensuring safety, verifying that safety measures are in place, and maintaining a solid safety track are top UX factors. Generically, the design of the system is based on the operation of the equipment largely in a mobile diagnostic setting.
Operators’ levels of radiation exposure are determined by their training and certification. Shielding, welds, and barrier trim are all made of lead for optimal protection. Training of the operators in the use of the X-ray equipment for body imaging is accomplished in a one-week course. Extensive instruction and practice are included to ensure the operator can confidently and comfortably maneuver the high-voltage X-ray source within the tube. A certification course is included in the Masters and Operator upgrade courses to educate operators on how to use CT dual energy for baggage screening purposes. The latter two courses are given by a police-certified X-ray expert.
4. Applications and Benefits of Mobile X-ray Trucks
Mobile X-ray trucks have numerous applications and provide multiple benefits in situations where mobility, speed, and flexibility are primary factors. In the field of healthcare, mobile digital imaging trucks and vehicles can provide on-site diagnostic imaging to support telehealth, teleradiology, and telemedicine needs. They can provide rapid diagnostic imaging for emergency medical services, remote-area healthcare, and during public health emergencies. In areas such as homeland security, mobile digital radiography trucks can speed up decisions for security checkpoints, increase the likelihood of detecting contraband, drugs, or weapons through increased imaging angles and multiple-image processing algorithms.
One of the primary drivers of mobile X-ray trucks is their ability to accommodate multi-disciplinary team assessment and diagnosis at the scene, location, or incident, which brings about major operational benefits to imaging services. This can be difficult to quantify in terms of workflow modeling as the combination of all possible variables in ‘real life’ can be incredibly complex. Some of the possible scenarios in which mobile X-ray trucks could provide an impact include major trauma, critical cases of stroke or head injury, cardiac care, or any clinical scenarios where rapid diagnostics benefit from collaboration that is only available during face-to-face meetings. Mobile X-ray trucks have been shown to be clinically effective and cost-efficient for certain applications. Potential cost savings that could be realized extend across various sectors and can take the form of individual company cost savings through in-house imaging and patient management, or more generalized cost savings such as decreasing the burden of high-cost treatment pathways and increasing emergency department and urgent care capacity.
4.1. Medical Sector
Mobile X-ray trucks for medical operations are of great relevance in the following use cases. • Imaging for ambulances: During emergency medical rescue response in accidents, disasters, and critical health interventions, the timely imaging of the injured inside ambulances can provide instant images for quick decision-making. Most often, hospitals are currently not equipped with a dedicated X-ray facility at their sites. Mobile X-ray trucks will be useful in this aspect. • Rural medical facilities: In rural areas, since the patient volume is less in the community, hospitals will not be able to manage comprehensive radiology diagnostics with MRI, CT scans, and fixed X-rays. Here, patient care is provided by small clinics. A mobile X-ray truck can reach these clinics and provide services. • Small hospitals without X-ray facilities: In most of the primary medical centers, small hospitals, and clinics are commercially operated as commercial entities. Mobile trucks with mammography, bone densitometry, bed patient handling systems for general X-ray, ultrasound, and all radiological applications. • Above-mentioned trucks can also support public health initiatives, such as vaccination drives. The ambulances are used for vaccine logistics and also ensure occupational safety at the vaccination sites. Disaster response includes trauma care, emergency medical services activities, army schools, training centers, hospitals, and civilian hospitals. The following hospitals and clinics have some collaboration with medical colleges and the associated medical professionals for patient diagnostics, treatment, and care. In their coordinated team operation, professional specialties such as anesthesiology, cardiology, orthopedics, ophthalmology, diagnostic imaging services, blood banks, gynecology, internal medicine, psychiatry, surgery, ultrasound, interventional radiology, and PET scan medical services in general are health care providers.
4.2. Security and Border Control
In security applications, mobile X-ray technology can contribute substantially to the safety of citizens and first responders in the field. ICU trucks can be of great help for security at sports events or happenings with a high risk of terrorism. This is even more important, as the checkpoint could be designed to speed up entry controls, to also speed up access to traffic jams and, in case of emergency, the system could be used as a surveillance and security device. Based on the advantages that X-ray can provide in many diverse security sectors, the mobile solution, easy to install on any commercial vehicle, is considered of great importance. The major fields of application of mobile non-destructive X-ray technology are: the control of overland and underground vehicles at border entrances, valuable assistance for customs controls and smuggling prevention, the search for missing persons trapped in underground environments, and the non-invasive control of aviation goods loading in freight.
When equipped with non-destructive X-ray technology, customs X-ray mobile trucks become valuable tools that can be used for non-invasive inspection to detect contraband and to verify the goods shipped to ensure compliance with the rules and regulations issued by the customs authority. An efficient external enhanced country security system, planned and performed by a multidisciplinary professional team, together with human resources, can dramatically reduce the number and success of terrorist attacks. Moreover, such an intelligent monitoring system can also be used for traffic regulation and vehicle tracking, via dedicated algorithms that could alert the police to an eventual theft vehicle entrance or a dangerous but not terrorist situation. The actual deployment of medical X-ray trucks in different security scenarios is improving knowledge regarding operational success and the accurate correlation of their utility. With respect to a border or customs scenario, the supporting system tailored for technological impact can accelerate trade and enhance security through a risk management system. This is beneficial for the economy, enhancing world trade and travel while monitoring for dangerous cargo or people. In a security-only checkpoint (sporting event, embassy, or high-target site), this is beneficial for non-destructively monitoring for suspicious or illegal materials to protect the public and the facilities.
5. Future Trends and Innovations in Mobile X-ray Technology
What are trends and innovations that can be expected from mobile X-ray systems and services within the next few years, and what are future needs regarding mobile X-ray services? Mobile X-ray systems are expected to become more intelligent in order to process raw data more efficiently and provide a better and faster image diagnosis. This is enabled by the latest advances in artificial intelligence and machine learning. At the same time, these technologies enable secure evaluation and analysis of image data for the prediction of patient recovery. In addition, mobile X-ray systems are also expected to be able to inform the radiologist about deviations that could improve the quality of the images to be taken, as well as to achieve a faster diagnosis. A growing trend is the ability to connect the system to telemedicine services for immediate consultation with a physician. This refers in particular to systems and services outside traditional healthcare options, i.e., nursing care, care for people with disabilities, and home care.
Future X-ray systems will be able to reveal an unprecedented new quality due to improved detector technology with direct conversion. In addition, the systems will be able to adjust themselves even more specifically to the respective clinical image question and to the patient, e.g., in terms of the necessary radiation dose, based on AI and machine learning via automated adjustment of the angulation, filter use, accelerating potential, and other system-specific radiographic factors. Due to the high degree of automation in these systems, potentially new regulatory approval procedures are required which are suitable for AI and machine learning. In the field of mobile digital X-ray diagnostics, there is an urgent need for cross-sectoral structuring of the medical technology industry and service provision in order to enable cooperation between system technology manufacturers and companies from the areas of logistics and digital infrastructure, such as telecommunications companies for mobile X-ray systems. This includes the need for a new know-how transfer and regulatory framework, for example, for logistics companies that are not authorized to manufacture medical devices. Moreover, both industry and end users also see mobile, patient-centered X-ray systems in the future and thus the needs for the on-the-spot diagnosis of patients. In addition to medical services, there is an increasing trend in terms of sustainability to equip systems with emission-free and long-lasting batteries and onboard new propulsion technologies.
