Table 4 show the results of the included literature

Precht 2019 [17]

Denmark

To compare image quality of chest, hip and pelvis images taken at the mobile X-ray equipment in nursing homes.

Examinations of chest (n = 20), hip (n = 64), and pelvis (n = 32) equally obtained from each setting of mobile X-ray (ME) and stationary equipment (SE) from patients 70+ years.

RCT.

Mobile X-ray.

Nursing homes and hospital.

Hospital.

January 2018 -?

The images were viewed separately and scored according to Visual Grading Analysis (VGA).

- The VGA showed higher image quality for SE system while the contrast-Detail Radiography phantom showed higher image quality for the ME system.

- The reporting radiographers could recognize some of the images from ME examinations even though the images were blinded.

Aldridge 2012 [18]

England.

To compare engagement strategy for mobile TB screening

Homeless people in 59 hostels (n = 1.192).

- Cluster randomized.

- Quantitative.

Mobile X-ray.

Hostels for the homeless in London.

A National Health Service, ‘Find and Treat’ led the mobile X-ray service.

Feb. 2012 to Oct. 2013.

The number of eligible clients at a hostel venue screened for active pulmonary tuberculosis by the mobile X-ray n = 2.342.

- Of 59 eligible hostels, 46 were randomized.

- Paper includes number in control n = 1.192 eligible with median 45% uptake

Intervention n = 1.150 with median 40% uptake

- Lack of individual data

- Power calculation was performed but not at person level.

Ricauda 2011 [19]

Italy.

To explore the quality of imaging and clinical outcomes using mobile X-ray.

Frail elderly patients already attending Hospital at Home Service (n = 69).

- RCT as a part of a pilot study.

- Quantitative.

Mobile X-ray vs. X-ray at the hospital.

At the patients own home.

I in corporation with the hospital.

June 2008 to June 2009.

- Confusion Assessment Method (score).

- Satisfaction.- Image quality.

- After X-ray examination an acute confusional state requiring treatment occurred in 17% of the patients in the hospital group vs. 0% in the mobile X-ray group.

- 94% of patients examined with mobile X-ray were satisfied.

- No differences in image quality.

- The study is a pilot study

- There was no sample size calculation.

- No description of the satisfaction measures.

- Patients who needed an urgent examination (within 24 h) and patients needing an X-ray examination not suitable at home were excluded.

- Only patients who are referred to X-ray examination of thorax is included

Dozet 2016 [20]

Sweden.

To determine whether examinations of patients in elderly care facilities with mobile radiography were cost effective from a societal perspective compared with hospital based radiology examinations.

Nursing home residents in two different areas (n = 312).

- A prospective study.

- Quantitative.

Mobile X-ray.

10 Nursing homes.

Corporation with the hospital radiograph service.

Nov. 2012 to May 2014.

Questionnaires distributed to the nursing homes .

Mobile X-ray (n = 312).

X-ray at the hospital (n = 71)

- Mobile X-ray has significant lower costs per examination compared with hospital based radiography.

- Differences in health care related costs were also significant lower using mobile X-ray.

- The study only measured health care related costs.

- An imbalance in number of participants from the two study groups.

- Participation was voluntary so not all patients replied on the questionnaire.

-no response rate

Eklund 2012 [21]

Sweden.

To investigate the usefulness of a mobile radiography service for radiological assessment of patients in nursing homes from the patient and staff perspectives.

Nursing homes patients.

- Feasibility study where patients (n = 123) and staff (n = 123) answered questionnaires.

- Quantitative.

Mobile X-ray services for nursing home residents.

10 Nursing homes

Part of the hospital service.

Sep. 2008 to Sep. 2009

Questionnaires measuring patients and staff experience with the mobile X-ray service.

- Security and comfort.

- Acceptance from the patients.

-No need for transportation.

-No need for staff to be absent from the nursing home.

- Data before mobile X-ray are based on estimates on time from the healthcare staff.

- Out of 123 patients 62 were able to answer the questionnaire about patient satisfaction.

- The questionnaire is not published.

- The image quality is not directly being measured.

- A small study population.

Montalto 2015 [22]

Australia.

1. To describe the activity of the mobile X-ray service (MXS), its recipients and the number and type of plain X-rays performed.

2. to measure the impact of the mobile X-ray service on the emergency department attendances by residents of residents of the residential aged care facilities (RACF)

who require plain X-ray services.

The top 30 RACF users of mobile X-ray service in Melbourne (n = 919).

- Descriptive study, that uses before and after cohort approach.

- Quantitative.

Mobile X-ray vs. X-ray at the hospital.

The Mobile X-ray Service was offered in the northern and western regions of Melbourne to nursing home residents.

Organized from the hospital.

1 July 2012 to 30 June 2013.

All plain X-rays requested by and/or conducted on residents from the 30 RACF.

- The MXS delivered 1.532 services attendances to 109 different RACFs.

- Most patients were bed or wheelchair bound followed by those who needed assistance to ambulant.

- There were an 11,5% reduction in Emergency Department representation the year where mobile X-ray was offered.

- The study was conducted during implementation of MXS.

- Based on a single service on a single hospital.

- The study is not randomized.

- The study population was chosen from the authors based on their use of MXS.

- There was no patient payment as in other services.

- Some of the authors were involved in the service delivery.

Story 2012 [23]

England.

To establish the sensitivity and specificity of mobile digital CXR and to test the hypothesis that actively identified cases have reduced the odds of sputum smear positivity vs. those presenting passively to health care services from the same populations.

Homeless, drug users and asylum seekers (n = 352).

- Observational study.

- Quantitative.

Screening using mobile X-ray.

Homeless hostels, day centers, drug treatment services and prisons in London.

Part of the Hospital service.

April 2005 to March 2010.

All individuals were included, sensitivity and specificity was calculated

- The intervention had a sensitivity of 81% and a specify of 99%.

- Cases identified through screening were less likely to be smear-positive than passively identified cases.

- Small patient group.

- Analysis is based on existing data, meaning that confounding variables was not possible.

- The time period when data was collected vary and may impact the result.

Thingnes 2010 [24]

Norway.

To explore knowledge about expectations, meanings and opinions concerning implementing mobile X-ray at nursing homes.

Nursing home residents.

- Focus group interview with an unknown number of participants in the three groups: Nurses, health care staff and radiographs.- Qualitative.

Mobile X-ray.

Nursing home already included in a pilot project.

Mobile X-ray is organized from the hospital.

2 months, intervention.

Transcription and recording interviews.

- Everyone thought that mobile X-ray would be a great advantage for the patients due to no transportations to the hospital.

- Implementation of mobile X-ray demand great corporation between healthcare staff, great communication and maybe an increased workload.

- The study is based on expectations and not on experiences.

- The interview did not include doctors and secretaries, which means that we do not get their point of view.

Kjelle 2018 [25]

Norway.

To analyze the cost of with a social perspective of X-ray examination and treatment of nursing home residents.

Simulation of nursing home residents (n = 1.000).

- A case control study.- Quantitative.

Two alternatives were compared, including a hospital-based service and a combination of hospital-based and mobile radiography.

Hospital compared to nursing homes.

Mobile X-ray was offered from the Department of Radiology at the hospital.

Data was collected in 2015.

Costs based on the 2016 Norwegian kroner converted to the Euro.

- Cost per examination at the hospital was EUR 2.790 and in combination with mobile X-ray and hospital EUR 1.946.

- Effects of mobile X-ray service were not evaluated only costs.

- When real data could not be found, assumptions were made.

- Cost of treatment and ambulance transportation do not have high influence of the result.

Kjelle 2019 [26]

Norway

To determine the utilization of diagnostic imaging among nursing home residents and if there were differences between hospitals with or without mobile X-ray service.

11.066 examinations of nursing home residents.

- Data from radiological information systems of 11 hospitals.

-Quantitative.

Mobile X-ray.

Nursing homes and hospital.

Hospital.

All diagnostic imagine procedures for nursing home residents in year 2015.

Data were collected from the radiology information systems, of 12 different hospitals.

- Mobile radiography services increase the level closer to the user rate in the general population.

- The study did not compare before and after implementation data, but compared hospitals with mobile X-ray service to hospitals without mobile X-ray service.

Vigeland 2017 [27]

Norway.

To examine the use and benefit of a mobile X-ray service that enables imagining at nursing homes.

The study population is nursing home residents.

Questionnaires on behalf of the patients fulfilled by: referring doctors (n = 300) and follow-up doctors (n = 100).

- Cohort study based on a pilot study.

- Quantitative.

Satisfaction with mobile X-ray.

42 Nursing- and assisted living homes in 10 municipalities

in Norway.

Oslo University Hospital was responsible for the mobile X-ray service.

March to Sep. 2015.

Questionnaires to referring doctors and follow-up doctors.

- In 73% the patients would have been sent to the hospital radiology department if the mobile X-ray service had been available.

- In 20% the patients would not have been examined.

- Is a part of a pilot project.

- The questionnaires are only for doctors.

- The response rate is low.

- There are no end points measured.

- No data before and after implementing mobile X-ray for instance concerning hospitalization.

Kjelle 2018 [28]

Norway

To explore success criteria and barriers in the process of implementing mobile radiography service from the point of view of the hospital and municipal managers.

Information from managers from five hospitals and six municipalities.

- Interview study.

- Qualitative.

Mobile X-ray.

Hospital and municipality where mobile X-ray had been implemented.

Hospital.

Feb 2016 – may 2016.

Interviews.

- Financial, structural and procedural barriers.

- Main success criteria were external funding and support and engagement

- Recruitment was based on the organizations finding a volunteer to represent them in the interview.