CDC, the American College of Radiology (ACR), and the Royal College of Radiology continue to discourage the use of CT as a front-line screening tool for COVID-19. But imaging teams should be preparing for increased volumes regardless. There remains a possibility that CT scans may be used for diagnoses if the shortages of viral tests and/or testing supplies continue, as occurred in China last month.
Map: How ready is your state to cope with a COVID-19 outbreak?
More immediately, imaging departments are likely to see imaging orders for COVID-19 patients as part of staging and treatment planning. The ACR recommends that clinicians order images only when it will potentially change the management of the disease. While this guidance will hopefully limit the inappropriate use of imaging, we still anticipate growing numbers of imaging exams ordered for COVID-19 patients.
With that in mind, here are three steps that these departments should take to prepare:
1. Understand and follow infection control protocols
CDC currently recommends that all transport and radiology staff wear all recommended personal protective equipment (PPE) and practice hand hygiene when transporting patients for imaging and conducting scans. After imaging a patient with suspected or confirmed COVID-19, all surfaces within the imaging room, including equipment, must be cleaned and decontaminated by staff wearing proper protective equipment. Furthermore, facilities must consider the air-flow within the imaging room in order to prevent against airborne transmission. Based on CDC guidelines on ventilation, rooms may need to sit idle for a period of time depending on the HVAC system, filtration levels, and air exchange rates of the facility. ACR's latest position statement on the use of CT and COVID-19 notes this could be up to an hour.
If possible, facilities should take advantage of mobile imaging equipment to avoid the additional infection measures that must be taken when COVID-19 patients are transported. For more detailed guidance on safety steps imaging departments can take, including how University of Washington Medicine and NYU Langone Health are protecting their staff and patients, we recommend this expert panel published in Radiology on March 16th.
2. Consider postponing elective imaging procedures
CDC has recommended that health care facilities reschedule non-urgent patient visits and process high-priority visits as rapidly as possible to prepare for the coming influx of COVID-19 patients. As COVID-19 cases continue to ramp up, here are steps to consider:
- Evaluate current volume of pre-operative imaging scans. These scans are almost certain to fall off the calendar, given that hospitals and surgeons are currently rescheduling and postponing elective surgeries. Imaging leaders can develop a better sense of true future capacity in upcoming capacity by identifying these "likely rescheduled" exams. Furthermore, leaders can use this list of upcoming exams to proactively reach out to their top referring providers with a full list of upcoming exams for their patients and have one consolidated conversation.
- Evaluate preventative screening volumes, as these exams can be postponed with relatively low risk and patient impact. Given social distancing recommendations, many patients will appreciate a proactive approach to offering other appointment options for these screenings.
- Evaluate all other scheduled diagnostic or interventional procedures to determine urgency. For any that are non-urgent or elective, such as varicose vein treatment, providers should proactively reach out to referring providers to have a conversation about rescheduling.
- Frontload high-priority exams. Taking the steps above will free short-term capacity. Imaging leaders should work with referring providers and patients to attempt to move time-sensitive exams forward.
When communicating with referring providers, imaging leaders should establish who will handle patient communication. If imaging takes the lead on this communication, be sure to explain the context, as patients may not understand the role radiology will need to play in the COVID-19 outbreak. In addition, this communication should reassure patients that a postponement of their imaging carries little, if any, risk.
3. Ensure radiologists are prepared to identify COVID-19
As COVID-19 continues to spread across the United States, radiologists must be prepared to identify COVID-19 in CT images. By familiarizing themselves with the patterns of disease on chest CTs and x-rays, radiologists can prepare for the imaging of COVID-19 patients. Perhaps more importantly, radiologists may also be able to catch COVID-19 in patients with little-to-no symptoms who received chest imaging for unrelated conditions.
As providers continue to grapple with COVID-19 in the United States and around the world, we will continue to publish on the latest imaging related guidance and practices. For example, researchers in Italy recently published a letter to the editor in Radiology on the potential of using bedside lung ultrasounds as an alternative to CT scans. This development would allow portable ultrasound in the ED to replace a CT scan, which could be crucial as hospitals face a high numbers of COVID-19 patients with limited imaging resources available.
If you or your organization is actively rescheduling outpatient imaging procedures due to COVID-19, we would love to speak with you. Please email me directly at aderholM@advisory.com so that we can continue to share emerging evidence and practices.
Your top resources for coronavirus readiness
You're no doubt being inundated with a ton of information on how to prepare for possible patients with COVID-19. To help you ensure the safety of your staff and patients, we pulled together the available resources on how to safely manage and prevent the spread of COVID-19.