The COVID-19 pandemic has had a profound impact on radiology, resulting in a sharp drop in imaging volume, a significant increase in working remotely and major changes in clinical operations in radiology departments and practices across the world.

But as the health care industry struggles to control the virus and scientists work on a potential vaccine, radiologists in some parts of the U.S. and the world are returning to their practices — with proper protocols in place — or are planning to reopen soon.

Faced with this challenge, many radiologists are asking one question: How do we return to a normal operation — or as near to normal as possible — after the initial COVID-19 surge?

“Working together to manage the process is critical,” said Christopher Filippi, MD, a diagnostic radiologist at Lenox Hill Hospital-Northwell Health in New York City, and a member of the RSNA COVID-19 Task Force, which leads RSNA’s development of educational resources to assist radiologists in navigating the pandemic.

The task force has issued recommendations on best practices related to radiology and COVID-19, including, “Post-COVID-19 Surge Radiology Preparedness,” a paper focusing on approaches to reopening elective, screening and other time-sensitive examinations that were postponed when the pandemic hit.

“The biggest challenges will be operational, and some of that relates to radiologists’ ability to deliver radiology services to patients who need them,” Dr. Filippi said. “When we begin this process of delivering services to people who need it, we have to ensure we can practice safely in the COVID era, and part of that will involve a lot of work around operational efficiencies as we ramp up, particularly regarding physical distancing.

“So, we have all of these complicated operational issues to work through — even in the outpatient setting,” Dr. Filippi added. “How do you schedule patients? How do you separate them? There is a real hunger for that kind of information from other radiology practices around the country that face similar challenges. And certainly, for example, with breast cancer screening, we really need to get back on track. That will be a big emphasis.”

A Backlog of Imaging Studies

Early in the pandemic, Gary Luker, MD, editor of Radiology: Imaging Cancer, and Adeline Boettcher, scientific editor, authored an article in the journal, “Transitioning to a New Normal after COVID-19: Preparing to Get Back on Track for Cancer Imaging,” predicting a huge backlog of postponed and rescheduled imaging studies will create a surge in demand that will tax the capacities of scanner time and personnel.

At the same time, however, Dr. Luker, professor of radiology, microbiology and immunology, and biomedical engineering at Michigan Medicine in Ann Arbor where he serves as associate chair for clinical research in the Department of Radiology, suggested that radiology departments and practices will face another challenge in returning to normal practice. Patients may not be so willing to return for exams such as mammography and lung cancer screening for a number of reasons, he said.

“I think resuming these exams could be difficult for some patients because they either don’t think this is as critical as they did pre-pandemic, or they may not even have insurance because of employment issues,” Dr. Luker said. “Hospitals and private practices will need to make concerted efforts to reach out to these people and try to convince them that there is a worthwhile risk/benefit ratio in returning for these exams.”

 

Watch Dr. Luker’s interview about radiology’s transition to the new normal as practices begin to reopen after the first COVID-19 surge.

 

Singapore Learned from Experience

While Singapore was hit harder and earlier by the pandemic than the U.S., the country had the advantage of learning important lessons during the SARS outbreak in 2003, according to Bien Soo Tan, MD, professor, vascular and interventional radiology, Singapore General Hospital, and a member of the RSNA COVID-19 Task Force.

As a result, protocols for getting back to business were already in place, paving the way for a smoother post-COVID-19 transition.

“Infection prevention and control became an integral focus for all staff in Singapore General Hospital during SARS and we were constantly training and auditing ourselves to prepare for the next big disease outbreak,” Dr. Tan said. “Over the years, we have also designed our radiology infrastructure to allow for segregation of patients with different infection risks.”

For example, the hospital separates inpatient and outpatient imaging and interventional facilities and has also created negative pressure ultrasound, CT and MRI rooms for safely imaging infected patients.

Singapore General Hospital has also made a number of workflow changes and adjustments as the pandemic evolved, Dr. Tan said. He added that it is critical that all changes have been coordinated at national and institutional levels.

“For example, we screen our patients based on our institution’s protocols to identify patients at risk of infection,” Dr. Tan said. “We are focusing on initiatives to prepare our patients before they show up for their imaging appointments. This is with the intent of reducing patient wait time in the hospital. The need for enhanced infection prevention measures and physical distancing have also meant a slower throughput, and we have therefore adjusted our schedules so that we can continue to serve our patients.”

Teleradiology Could Become Standard

Going forward, there is general agreement in the industry that working remotely will become a standard part of the new normal in radiology — at least to some extent.

At Collaborative Imaging, based in Plano, TX, a physician-owned alliance of more than 500 radiologists from around the country, CEO Dhruv Chopra said the pandemic is forcing radiology practices to be more technologically focused and driven.

Since the company’s 2018 inception, a team of more than 55 software engineers has delivered state-of-the art-solutions that have been key to enabling physicians and health care systems adjust to remote reading as the new normal.

“Some health care systems our physicians serve have historically been resistant to working remotely, largely due to concerns about lack of control or availability of referring physicians,” Chopra said. “But since the pandemic, the efficient workflow processes and improvements realized through working remotely has changed attitudes.”

Among other benefits, expanding teleradiology services has resulted in a reduction in turnaround time since readings aren’t limited to onsite radiologists. “The average turnaround time is eight minutes,” Chopra said.

Studies are routed not only to the most appropriate radiologist, but also to the physician immediately available to read the study. The organization has also seen a marked improvement in communication among physicians using one-touch teleconferencing solutions to review studies in real time.

“The genie is out of the bottle,” Chopra said. “I don’t think we’re going back to the days where we were limited by the boundaries of a hospital.”

Dr. Luker said that there will still be a need for radiologists to have a physical presence in hospitals. Radiologists across many subspecialties perform procedures or hands-on diagnostic scanning studies. And an in-person presence also helps foster teamwork among faculty, staff and trainees and boosts morale for staff who must work on site.

“But many radiology departments and practices have invested heavily in terms of technology to enable a remote work environment,” Dr. Luker said. “Purchases of at-home workstations and teleradiology tools aren’t going away as many institutions continue expanding capabilities for remote image interpretations. For institutions, shifting some workers to home settings reduces parking congestion, and eliminating commuting time and expense while still providing clinical care is satisfying to many radiologists.”

For More Information

Access the RSNA COVID-19 Task Force document, “Post-COVID-19 Surge Radiology Preparedness.”

Access the Radiology paper, “Radiology Department Preparedness for COVID-19: Radiology Scientific Expert Panel.”

Access the RSNA on-demand video, “Radiology Surge and Second Surge Preparedness (Part 2).

The on-demand webinar, “COVID-19 – Radiology Surge and Second Surge Preparedness (Part 2),” is available for CME credit.

 

Originally posted on: https://www.rsna.org/news/2020/July/Post-COVID-Practice