Prevention of COVID-19 Should Drive Nonurgent Radiology Practice During the Pandemic

By Will Boggs, MD

May 14, 2020

NEW YORK (Reuters Health) — Preventing infection with SARS-CoV-2, the virus that causes COVID-19, should be the foremost priority in resuming routine radiology care during the pandemic, according to a statement from the American College of Radiology (ACR).

"The COVID-19 pandemic has been hyper-local, with unique pandemic statistics depending on city, state, and country," Dr. Matthew S. Davenport from Michigan Medicine, Ann Arbor, Minnesota told Reuters Health by email. "Therefore, equally appropriate yet different responses might be pursued by health systems in different locations to account for those differences."

To help guide those responses, an ACR working group, led by Dr. Davenport, issued several recommendations regarding the safe re-engagement of nonurgent diagnostic and interventional radiology care during the COVID-19 pandemic.

Safety is the overriding guiding principle. According to the ACR statement, "If the risk of illness or death to a healthcare worker or patient from healthcare-acquired COVID-19 is greater than the risk of illness or death from delaying radiology care, the care should be delayed; however, if the opposite is true, the radiology care should proceed in a timely fashion."

Any strategy for resuming routine radiology care during the pandemic should include consideration of local COVID-19 statistics; availability of personal protective equipment (PPE); local, state, and federal government mandates; institutional regulatory guidance; local safety measures; healthcare worker availability; patient and healthcare worker risk factors; factors specific to the indication for radiology care; and examination or procedure acuity.

The risk for healthcare-acquired COVID-19 can be minimized for most diagnostic radiology examinations and interventional radiology procedures by ensuring that appropriate safety measures are in place (screening and testing for COVID-19, infection control processes, proper PPE use, and so on).

The working group recognizes that accurate risk-benefit analyses of postponing versus performing a given examination or procedure is often impossible, so decision-making will necessarily be guided by imperfect attempts to estimate these risks.

"The timing of reengaging nonurgent work is probably the most controversial item," Dr. Davenport said. "In the text, we argue that time-insensitive care should be deferred for at least two weeks after the local peak of the pandemic. There is no 'right' answer here, so that can lead to potential areas of disagreement."

Co-author Dr. Stephanie Weinstein from University of California San Francisco told Reuters Health by email, "The risk-benefit assessment is a challenging one, with many unknowns and complex factors to be considered. Engagement of referring providers should help navigate these decisions. Additionally, tiered systems can be effective for prioritization of time-sensitive care along with consideration of backlogs of previously deferred cases."

Dr. Ali Gholamrezanezhad from Keck School of Medicine of USC, Los Angeles, California, who recently reviewed what radiology departments should know during the COVID-19 outbreak, told Reuters Health by email, "There are major risks to resuming nonurgent imaging studies and radiology procedures during COVID-19, including but not limited to the transmission of infection and also the inability to meet demand for imaging studies and radiology procedures in the department of radiology while following social distancing recommendations and optimal infection control measures. However, these potential risks in fact run counter to each other and may result in difficult decision-making scenarios in the daily practice of radiology."

"As many healthcare systems move past peak demand for managing the COVID-19 burden, a tiered approach must be implemented to resume optimal and safe care for deferred urgent cases, chronic medical conditions, and routine nonurgent care," he said. "This approach not only includes infection control measures, but also management of medical staff."

"One more important point is the fact that healthcare systems should be prepared and plan for potential second and subsequent peaks of COVID-19 disease after the reopening of the community activities in phase 2 and even 3," he added.

The complete ACR statement appears in the online report in Journal of the American College of Radiology.

SOURCE: Journal of the American College of Radiology, online May 6, 2020.