How has COVID-19 affected radiology practice?

By Kate Madden Yee, AuntMinnie.com staff writer

May 22, 2020 -- The COVID-19 pandemic has had a dramatic effect on how radiology is practiced, from case volume and the scheduling of elective imaging to changes in interventional procedures and offsite workflow, according to four studies published online this month in the Journal of the American College of Radiology.

Researchers from around the U.S. presented findings that show how wide the impact of the virus and its corresponding disease has been.

"Medical practices have been taken by surprise by the COVID-19 pandemic as they rush and react daily to changing patient needs, government policies, and provider protection," wrote one study team led by Dr. Mohammed Imran Quraishi of the University of Tennessee in Knoxville.

Imaging volume impact

Public policy, financial hardship, and patient fear caused a rapid decline in imaging volume for many radiology departments during the peak of the COVID-19 crisis, wrote a group led by Dr. Jason Naidich of Northwell Health in Manhasset, NY, in a study published on May 16.

'[Our results] revealed an overall 28% decline in the total imaging volume over a seven-week period during the COVID-19 pandemic compared to 2019, including all patient service locations and imaging modality types," the team noted.

Naidich's group reviewed imaging volumes at Northwell's network between January 2019 and April 2020 to evaluate COVID-19's impact by patient service locations and imaging modalities. The network consists of 23 hospitals, 52 urgent care facilities, and 17 imaging centers.

The researchers evaluated imaging volume data for the first 16 weeks of both 2019 and 2020, but the 2020 data was divided into two categories: pre-COVID-19 (weeks one through nine) and post-COVID-19 (weeks 10 through 16). They found that imaging volume decreased dramatically when the same periods in 2019 were compared with 2020:

Percent changes in imaging volumes in 2020 compared with 2019
Weeks 1-9 (pre-COVID-19) 10-16 (post-COVID-19) 16
Total volume +0.88% -28.1% -40.1%
Location
Emergency +2.6% -26.7% -45.6%
Inpatient -2.4% -13.6% -4.2%
Outpatient 2.4% -56.6% -87.6%
Modality
X-ray -0.81% -14.2% -22.2%
Mammography +8.5% -58.4% -93.6%
Ultrasound +3.4% -46.9% -63.7%
CT +3% -34.9% -46.5%
MRI +2% -51.2% -73.6%
Nuclear medicine -5.2% -53.4% -85%
Interventional -8.1% -39.8% -55.6%

"Anecdotal experience suggests that radiology practices should anticipate 50% to 70% decreases in imaging volume that will last a minimum of three to four months, depending on the location of practice and the severity of the COVID-19 pandemic in each region," the investigators wrote.

Interventional changes

A team led by Dr. Alexis Cahalane from Massachusetts General Hospital in Boston found significant decreases in interventional procedure volume and type when it compared four weeks of 2020 to their equivalents in 2019. The group's results were published on May 16.

Elective surgeries and procedures were postponed beginning March 16 of this year to make operating rooms and intensive care unit staff available for patients with COVID-19, Cahalane and colleagues wrote. Interventional radiologists were reassigned to an intensive care unit (ICU)-based team to provide bedside venous access options for these patients; an ambulatory team was also created to perform bedside procedures such as ultrasound-guided paracentesis, thoracentesis, or drainages.

The researchers compared interventional radiology procedure volume between March 16 and April 17, 2020, and March 18 to April 19, 2019. They found a 46% volume reduction between the two periods, with a particular decrease in CT-guided procedures (56.6%) and fluoroscopy (42.5%).

"The fall in cases within interventional radiology mirrors the significant changes in work patterns and caseloads across multiple specialties," the group concluded. "As the pandemic continues, we plan to continue to follow this early signal and reallocate our resources to areas that require most urgent support."

Offsite workflow shifts

The COVID-19 crisis has shifted radiologists' work offsite -- a trend that may continue even after the pandemic ebbs, Quraishi and colleagues wrote in a study published May 17. The team conducted a survey of 174 U.S. attending radiologists posted on the American College of Radiology's (ACR) Engage platform in March.

"Our survey in the early COVID-19 pandemic period found that the majority of radiology practices have leveraged internal teleradiology for normal workday shifts and found sufficient benefit to consider continuing [this practice] after the pandemic passes," the group wrote.

The survey showed that, before the COVID-19 crisis, teleradiology was used for call and overnight shifts, but this has changed in the face of the pandemic, with 65.2% of practices providing home workstations for its staff and 73.6% switching daytime shifts to remote reading. Respondents reported decreased stress levels (64.8%), improved report turnaround time (96%), no change in rapport with peers (71.3%), and fewer interruptions (64%).

"Over half ... of the respondents reported that they perceived enough benefit from their experience with internal teleradiology that they plan to continue a similar workflow after the pandemic subsides," the group concluded.

Elective imaging rescheduling

Finally, in a study published on May 19, a team led by Dr. Achala Vagal of the University of Cincinnati Medical Center in Ohio described a tiered prioritization protocol it used starting March 16 to reschedule nonurgent imaging. The date to begin scanning deferred patients was set as May 4.

The group developed the following system to determine whether an imaging exam should be rescheduled:

  • Tier 1. Imaging studies that did not require radiologist approval, such as CT pulmonary angiography and those to evaluate new focal neurological deficit and mental status changes, continued.
  • Tier 2. Imaging for neoplasm with progression findings for active disease on recent imaging or recent surgery (within past three to six months) with signs of complication or disease recurrence also continued.
  • Tier 3. Breast and lung cancer screening, imaging for chronic pain or known malignancy with prior stable imaging, and cases with unclear indication were rescheduled.

A total of 30,000 studies were rescheduled during the period. The researchers noted a decrease in overall imaging volume of 53.4% compared with the same period in 2019. Total weighted relative value units decreased by 52.4% between the two periods. Outpatient volumes decreased by 72.3%, inpatient volumes by 40.5%, and emergency department volumes by 48.9%.

"As the number of COVID cases in our region are hopefully nearing a plateau, we are now actively working on a recovery/reentry plan," the group wrote. "This will involve a phased process to ensure adequate social distancing ... We understand that how we operationalize our recovery, including patient experience during reentry, is critical for our stabilization."


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