Experts are continuing to learn more about the novel coronavirus, and a new document published in Radiology details how some radiology departments are handling the situation and what others can do to prepare in the face of this emergency pandemic.
As part of this March 16 report, the editorial board of Radiology has established a team of imaging experts who are actively coordinating, developing and implementing radiology readiness policies for COVID-19 across the U.S. and in Singapore. Their policies—created alongside infection control experts—can help serve as an outline for departments to develop strategies of their own, with an emphasis on preparedness.
“With improved disease understanding, chest CT findings are no longer part of the diagnostic criteria for COVID-19,” wrote Mahmud Mossa-Basha, MD, radiology vice chair of operations at the University of Washington School of Medicine in Seattle and colleagues. “Instead, at present, the focus of most radiology departments outside of China has shifted from diagnostic capability to preparedness.”
That particular institution has been at the “epicenter” of the COVID-19 outbreak, with 19 confirmed hospitalizations, 267 cases across the state and 24 deaths. Mossa-Basha detailed the institutions top five priorities. They are:
1. Early detection and limiting exposure: UWSOM has three large medical centers and many other satellite locations. Each hospital has established screening protocols at its entrances with the radiology front desk also taking on such a role. Patients with respiratory symptoms who come in for outpatient imaging or procedures have their appointment canceled and are referred to a primary provider. Nonemergent imaging for inpatients with suspected COVID-19 is delayed.
2. X-ray and chest CT use: Real-time-polymerase chain reaction testing is highly accurate, less resource-intensive and has a one-day turnaround time at the Seattle institution. Chest CT imaging for the virus has proven to be less accurate.
“Thus, imaging is reserved for those cases where it will impact patient management and is clinically indicated or to evaluate for unrelated urgent/emergent indications,” the authors wrote. “In our current workflow and with the accuracy and rapidity of the RT-PCR testing, there is no need for immediate CT imaging.”
When imaging is performed, the department does so in less-crowded areas or via portable methods. It is also considering an isolated imaging area for CT scanning.
3. Scanning suspected cases or RT-PCR-positive individuals: These patients wear masks during exams and a deep cleaning is completed after each appointment. This leaves the exam area unavailable for between 30 minutes and one hour. Hospital infection control staff consider RT-PCR results, imaging findings, clinical characteristics, potential exposures, and risk factors and comorbidities before removing these individuals from isolation.
4. Protecting staff: University of Washington Medicine is working with the state to limit the need for patients to physically enter “major” hospitals and clinics. For example, Harborview Medical Center has a team of physicians and nurses who test and examine patients in their own homes. Drive-thru testing is also available in some cases.
5. Maintaining imaging departments: Radiology staff are afforded work-from-home schedules when possible. Radiology outposts and isolated reading rooms have been implemented across the enterprise and within outpatient imaging centers. Additionally, most meetings are now performed virtually.
A number of other healthcare institutions shared individualized action plans and how their own radiology departments are ramping up to handle more COVID-19 cases. The authors recommended each plan focus on early detection, limiting virus exposure to others, safety precautions, cleaning protocols, training, and maintenance of operations and staffing.
“The Editorial Board hopes that readers may find similarity of the highlighted healthcare systems to their own environment, providing impetus for action or confirmation of their current preparedness activities,” David A. Bluemke, MD, PhD, Radiology editor and professor in the Department of Radiology at University of Wisconsin's School of Medicine and Public Health in Madison, said in a statement.