Imaging Utilization During the COVID-19 Pandemic Highlights Socioeconomic Health Disparities

ObjectiveThe devastating impact from the coronavirus disease 2019 (COVID-19) pandemic highlights long-standing socioeconomic health disparities in the United States. The purpose of this study was to evaluate socioeconomic factors related to imaging utilization during the pandemic.MethodsRetrospective review of consecutive imaging examinations was performed from January 1, 2019, to May 31, 2020, across all service locations (inpatient, emergency, outpatient). Patient level data were provided for socioeconomic factors (age, sex, race, insurance status, residential zip code). Residential zip code was used to assign median income level. The weekly total imaging volumes in 2020 and 2019 were plotted from January 1 to May 31 stratified by socioeconomic factors to demonstrate the trends during the pre-COVID-19 (January 1 to February 28) and post-COVID-19 (March 1 to May 31) periods. Independent-samples t tests were used to statistically compare the 2020 and 2019 socioeconomic groups.ResultsCompared with 2019, the 2020 total imaging volume in the post-COVID-19 period revealed statistically significant increased imaging utilization in patients who are aged 60 to 79 years (P = .0025), are male (P < .0001), are non-White (Black, Asian, other, unknown; P < .05), are covered by Medicaid or uninsured (P < .05), and have income below $80,000 (P < .05). However, there was a significant decrease in imaging utilization among patients who are younger (<18 years old; P < .0001), are female (P < .0001), are White (P = .0003), are commercially insured (P < .0001), and have income ≥$80,000 (P < .05).DiscussionDuring the pandemic, there was a significant change in imaging utilization varying by socioeconomic factors, consistent with the known health disparities observed in the prevalence of COVID-19. These findings could have significant implications in directing utilization of resources during the pandemic and subsequent recovery.     

Identifying Factors Important to Patients for Resuming Elective Imaging During the COVID-19 Pandemic

PurposeTo identify factors important to patients for their return to elective imaging during the coronavirus disease 2019 (COVID-19) pandemic.MethodsIn all, 249 patients had elective MRIs postponed from March 23, 2020, to April 24, 2020, because of the COVID-19 pandemic. Of these patients, 99 completed a 22-question survey about living arrangement and health care follow-up, effect of imaging postponement, safety of imaging, and factors important for elective imaging. Mann-Whitney U, Fisher’s exact, χ² tests, and logistic regression analyses were performed. Statistical significance was set to P ≤ .05 with Bonferroni correction applied.ResultsOverall, 68% of patients felt imaging postponement had no impact or a small impact on health, 68% felt it was fairly or extremely safe to obtain imaging, and 53% thought there was no difference in safety between hospital-based and outpatient locations. Patients who already had imaging performed or rescheduled were more likely to feel it was safe to get an MRI (odds ratio [OR] 3.267, P = .028) and that the hospital setting was safe (OR 3.976, P = .004). Staff friendliness was the most important factor related to an imaging center visit (95% fairly or extremely important). Use of masks by staff was the top infection prevention measure (94% fairly or extremely important). Likelihood of rescheduling imaging decreased if a short waiting time was important (OR = 0.107, P = .030).ConclusionAs patients begin to feel that it is safe to obtain imaging examinations during the COVID-19 pandemic, many factors important to their imaging experience can be considered by radiology practices when developing new strategies to conduct elective imaging.     

Rescheduling Nonurgent Care in Radiology: Implementation During the Coronavirus Disease 2019 (COVID-19) Pandemic

ObjectiveTo meet hospital preparedness for the coronavirus disease 2019 pandemic, the Centers for Disease Control and Prevention and ACR recommended delay of all nonemergent tests and elective procedures. The purpose of this article is to report our experience for rescheduling nonemergent imaging and procedures during the pandemic at our tertiary academic institution.MethodsWe rescheduled the nonemergent imaging and procedures in our hospitals and outpatient centers from March 16 to May 4, 2020. We created a tiered priority system to reschedule patients for whom imaging could be delayed with minimal clinical impact. The radiologists performed detailed chart reviews for decision making. We conducted daily virtual huddles with discussion of rescheduling strategies and issue tracking.ResultsUsing a snapshot during the rescheduling period, there was a 53.4% decrease in imaging volume during the period of March 16 to April 15, 2020, compared with the same time period in 2019. The total number of imaging studies decreased from 38,369 in 2019 to 17,891 in 2020 during this period. Although we saw the largest reduction in outpatient imaging (72.3%), there was also a significant decrease in inpatient (40.5%) and emergency department (48.9%) imaging volumes.DiscussionThe use of multiple communication channels was critical in relaying the information to all our stakeholders, patients, referring physicians, and the radiology workforce. Teamwork, quick adoption, and adaptation of changing strategies was important given the fluidity of the situation.     

Operational Radiology Recovery in Academic Radiology Departments After the COVID-19 Pandemic: Moving Toward Normalcy

This article presents a current snapshot in time, describing how radiology departments around the country are planning recovery from the baseline of the coronavirus disease 2019 pandemic, with a focus on different domains of recovery such as managing appointment availability, patient safety and workflow changes, and operational data and analytics. An e-mail survey was sent through the Society of Chairs of Academic Radiology Departments list server to 114 academic radiology departments. On the basis of data reported by the 38 survey respondents, best practices and shared experience are described for three key areas: (1) planning for recovery, (2) creating a new normal, and (3) measuring and forecasting. Radiology practices should be aware of the common approaches and preparations academic radiology departments have taken to reopening imaging in the post–coronavirus disease 2019 world. This should all be done when maintaining a safe and patient-centric environment and preparing to minimize the impact of future outbreaks or pandemics.     

Variables Influencing Radiology Volume Recovery During the Next Phase of the Coronavirus Disease 2019 (COVID-19) Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has reduced radiology volumes across the country as providers have decreased elective care to minimize the spread of infection and free up health care delivery system capacity. After the stay-at-home order was issued in our county, imaging volumes at our institution decreased to approximately 46% of baseline volumes, similar to the experience of other radiology practices. Given the substantial differences in severity and timing of the disease in different geographic regions, estimating resumption of radiology volumes will be one of the next major challenges for radiology practices. We hypothesize that there are six major variables that will likely predict radiology volumes: (1) severity of disease in the local region, including potential subsequent “waves” of infection; (2) lifting of government social distancing restrictions; (3) patient concern regarding risk of leaving home and entering imaging facilities; (4) management of pent-up demand for imaging delayed during the acute phase of the pandemic, including institutional capacity; (5) impact of the economic downturn on health insurance and ability to pay for imaging; and (6) radiology practice profile reflecting amount of elective imaging performed, including type of patients seen by the radiology practice such as emergency, inpatient, outpatient mix and subspecialty types. We encourage radiology practice leaders to use these and other relevant variables to plan for the coming weeks and to work collaboratively with local health system and governmental leaders to help ensure that needed patient care is restored as quickly as the environment will safely permit.     

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

BackgroundThe risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic.MethodsAn expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario.ResultsTwelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non–small-cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non–small-cell lung cancer.ConclusionsThere was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.     

Assessment of US Radiology Residency Program Websites in the COVID-19 Era

ObjectiveTo provide an updated evaluation of radiology residency program websites in light of virtual interviewing during the COVID-19 pandemic and encourage programs to improve the quality of their online website presence.MethodsWe evaluated the websites of 197 US radiology residency programs between November and December 2021 for the presence or absence of 30 metrics. The metrics chosen are those considered important by applicants when choosing a program and have been used in other similar papers.ResultsOf the 197 programs, 192 (97.5%) had working websites. The average radiology residency website had 16 of 30 (54%) metrics listed on their websites. Five programs did not have accessible websites and were not included in the analysis. The most comprehensive website had 29 of 30 (97%) of metrics listed and the least comprehensive website had 2 of 30 (7%). There is a statistically significant difference in website comprehensiveness between top 20 and non–top 20 radiology program websites.ConclusionAlthough radiology residency program websites have generally become more comprehensive over time, there is still room for improvement, especially in times of virtual interviews when residency applicants are becoming more and more reliant on program websites to gain essential information about a program. Some key areas to include are diversity and inclusion initiatives, resident wellness, applicant information, program benefits, and showcase of people in the program.     

COVID-19 Vaccine Mandates: Impact on Radiology Department Operations and Mitigation Strategies

ObjectiveCoronavirus disease 2019 (COVID-19) vaccine mandates are being implemented in health systems across the United States, and the impact on the radiology department workforce and operations becuase of vaccine hesitancy among health care workers is currently unknown. This article discusses the potential impact of the COVID-19 vaccine mandate on a large multicenter radiology department as well as strategies to mitigate those effects.MethodsWeekly vaccine compliance data were obtained for employees across the entire health system from August 17, 2021, through September 13, 2021, and radiology department–specific data were extracted. Vaccine compliance data was mapped to specific radiology job titles and the five different hospital locations.ResultsA total of 6% of radiology department employees were not fully vaccine compliant by the initial deadline of September 10, 2021. MR technologists and radiology technology assistants had the highest initial rates of noncompliance of 37% and 38%, respectively. Vaccine noncompliance rates by the mandate deadline ranged from 0.5% to 7.0% at the five hospital sites. Only one hospital required a decrease in imaging hours of operation because of the vaccine mandate.ConclusionDespite initial concerns about the impact of vaccine mandate noncompliance on departmental operations, there was ultimately little effect because of improved vaccine compliance after the mandate. Understanding individual employee and locoregional differences in vaccine compliance can help leaders proactively develop mitigation strategies to manage this new challenge during the COVID-19 pandemic.     

COVID-19 vaccine-associated ganulomatous mass mimicking a sarcoma: a case report

Several studies have previously documented the development of complications stemming from injection with one of the various COVID-19 vaccines. No study, however, has discussed the spontaneous development of a soft tissue mass shortly after a COVID-19 vaccine injection. We report on 66-year-old female with concerns of a growing shoulder mass, 2 weeks after receiving a COVID-19 vaccine booster. Initial work-up with X-ray and MRI was concerning for a soft tissue neoplasm, specifically a soft tissue sarcoma. Subsequent ultrasound guided biopsy demonstrated a benign granulomatous lesion. No further management was required as the lesion spontaneously resolved during a 3-month follow-up period.     

Collateral Damage: The Impact of the COVID-19 Pandemic on Acute Abdominal Emergency Presentations

IntroductionIn March 2020, the World Health Organization declared a pandemic caused by a novel coronavirus. Public information created awareness as well as concern in the general population. There has been a reported decrease in the number of patients attending emergency departments (ED) during the pandemic. This is the first study to determine differences in the types of presenting illnesses, severity, and rate of resultant surgical intervention during the pandemic.Methods and MaterialsWe carried out a retrospective, observational cohort study comparing two groups of patients attending the ED at our tertiary-care academic hospital. A historical comparison cohort was obtained by reviewing the number of patients referred by the ED for abdominal CT between March 15 and April 15, 2020, compared with March 15 and April 15, 2019. CT reports were reviewed; primary pathologies, complications, and subsequent surgical intervention were documented and compared between the two groups.ResultsIn all, 733 patients were included in the 2019 cohort, and 422 patients were included in the 2020 cohort. In 2019, 32.7% had positive CT findings, increasing to 50.5% in 2020. The number of complications increased from 7.9% to 19.7%. The rate requiring surgical intervention increased from 26.3% to 47.6% in 2020.ConclusionTo date, there is little published data regarding the presentation and severity of illnesses during the coronavirus disease 2019 pandemic. This information has important public health implications, highlighting the need to educate patients to continue to present to hospital services during such crises, including if a purported second wave of COVID-19 arises.     

Coronavirus Disease 2019 (COVID-19) Pandemic Shifts Inpatient Imaging Utilization

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on imaging utilization across practice settings. The purpose of this study was to quantify the change in the composition of inpatient imaging volumes for modality types and Current Procedural Terminology–coded groups during the COVID-19 pandemic.MethodsA retrospective study of inpatient imaging volumes in a large health care system was performed, analyzing weekly imaging volumes by modality types (radiography, CT, MRI, ultrasound, interventional radiology, nuclear medicine) in years 2020 and 2019. The data set was split to compare pre-COVID-19 (weeks 1-9) and post-COVID-19 (weeks 10-16) periods. Further subanalyses compared early post-COVID-19 (weeks 10-13) and late post-COVID-19 (weeks 14-16) periods. Statistical comparisons were performed using χ² and independent-samples t tests.ResultsCompared with 2019, total inpatient imaging volume in 2020 post-COVID-19, early and late post-COVID-19 periods, declined by 13.6% (from 78,902 to 68,168), 16.6% (from 45,221 to 37,732), and 9.6% (from 33,681 to 30,436), respectively. By week 16, inpatient imaging volume rebounded and was only down 4.2% (from 11,003 to 10,546). However, a statistically significant shift (P < .0001) in the 2020 composition mix was observed largely comprised of radiography (74.3%), followed by CT (12.7%), ultrasound (8%), MRI (2.4%), interventional radiology (2.3%), and nuclear medicine (0.4%). Although the vast majority of imaging studies declined, few Current Procedural Terminology–coded groups showed increased trends in imaging volumes in the late post-COVID-19 period, including CT angiography chest, radiography chest, and ultrasound venous duplex.DiscussionDuring the COVID-19 pandemic, we observed a decrease in inpatient imaging volumes accompanied by a shift away from cross-sectional imaging toward radiography. These findings could have significant implications in planning for a potential resurgence.     

Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties

Reports are rising of patients with unilateral axillary lymphadenopathy, visible on diverse imaging examinations, after recent coronavirus disease 2019 vaccination. With less than 10% of the US population fully vaccinated, we can prepare now for informed care of patients imaged after recent vaccination. The authors recommend documenting vaccination information (date[s] of vaccination[s], injection site [left or right, arm or thigh], type of vaccine) on intake forms and having this information available to the radiologist at the time of examination interpretation. These recommendations are based on three key factors: the timing and location of the vaccine injection, clinical context, and imaging findings. The authors report isolated unilateral axillary lymphadenopathy (i.e., no imaging findings outside of visible lymphadenopathy), which is ipsilateral to recent (prior 6 weeks) vaccination, as benign with no further imaging indicated. Clinical management is recommended, with ultrasound if clinical concern persists 6 weeks after the final vaccination dose. In the clinical setting to stage a recent cancer diagnosis or assess response to therapy, the authors encourage prompt recommended imaging and vaccination (possibly in the thigh or contralateral arm according to the location of the known cancer). Management in this clinical context of a current cancer diagnosis is tailored to the specific case, ideally with consultation between the oncology treatment team and the radiologist. The aim of these recommendations is to (1) reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged nodes in the setting of recent vaccination and (2) avoid further delays in vaccinations and recommended imaging for best patient care during the pandemic.     

Radiology Imaging Volume Changes During Discrete COVID-19 Pandemic Waves: Implications for the Delta Variant of Coronavirus and Future Pandemics

PurposeThe aim of this study was to evaluate radiology imaging volumes at distinct time periods throughout the coronavirus disease 2019 (COVID-19) pandemic as a function of regional COVID-19 hospitalizations.MethodsRadiology imaging volumes and statewide COVID-19 hospitalizations were collected, and four 28-day time periods throughout the COVID-19 pandemic of 2020 were analyzed: pre–COVID-19 in January, the “first wave” of COVID-19 hospitalizations in April, the “recovery” time period in the summer of 2020 with a relative nadir of COVID-19 hospitalizations, and the “third wave” of COVID-19 hospitalizations in November. Imaging studies were categorized as inpatient, outpatient, or emergency department on the basis of patient location at the time of acquisition. A Mann-Whitney U test was performed to compare daily imaging volumes during each discrete 28-day time period.ResultsImaging volumes overall during the first wave of COVID-19 infections were 55% (11,098/20,011; P < .001) of pre–COVID-19 imaging volumes. Overall imaging volumes returned during the recovery time period to 99% (19,915/20,011; P = .725), and third-wave imaging volumes compared with the pre–COVID-19 period were significantly lower in the emergency department at 88.8% (7,951/8,955; P < .001), significantly higher for outpatients at 115.7% (8,818/7,621; P = .008), not significantly different for inpatients at 106% (3,650/3,435; P = .053), and overall unchanged when aggregated together at 102% (20,419/20,011; P = .629).ConclusionsMedical imaging rebounded after the first wave of COVID-19 hospitalizations, with relative stability of utilization over the ensuing phases of the pandemic. As widespread COVID-19 vaccination continues to occur, future surges in COVID-19 hospitalizations will likely have a negligible impact on imaging utilization.     

Initial Impact of COVID-19 on Radiology Practices: An ACR/RBMA Survey

PurposeThe coronavirus disease 2019 (COVID-19) pandemic affected radiology practices in many ways. The aim of this survey was to estimate declines in imaging volumes and financial impact across different practice settings during April 2020.MethodsThe survey, comprising 48 questions, was conducted among members of the ACR and the Radiology Business Management Association during May 2020. Survey questions focused on practice demographics, volumes, financials, personnel and staff adjustments, and anticipation of recovery.ResultsDuring April 2020, nearly all radiology practices reported substantial (56.4%-63.7%) declines in imaging volumes, with outpatient imaging volumes most severely affected. Mean gross charges declined by 50.1% to 54.8% and collections declined by 46.4% to 53.9%. Percentage reductions did not correlate with practice size. The majority of respondents believed that volumes would recover but not entirely (62%-88%) and anticipated a short-term recovery, with a surge likely in the short term due to postponement of elective imaging (52%-64%). About 16% of respondents reported that radiologists in their practices tested positive for COVID-19. More than half (52.3%) reported that availability of personal protective equipment had become an issue or was inadequate. A majority (62.3%) reported that their practices had existing remote reading or teleradiology capabilities in place before the pandemic, and 22.3% developed such capabilities in response to the pandemic.ConclusionsRadiology practices across different settings experienced substantial declines in imaging volumes and collections during the initial wave of the COVID-19 pandemic in April 2020. Most are actively engaged in both short- and long-term operational adjustments.     

Operational Strategies to Prevent Coronavirus Disease 2019 (COVID-19) Spread in Radiology: Experience From a Singapore Radiology Department After Severe Acute Respiratory Syndrome

As coronavirus disease 2019 (COVID-19) infection spreads globally, the demand for chest imaging will inevitably rise with an accompanying increase in risk of disease transmission to frontline radiology staff. Radiology departments should implement strict infection control measures and robust operational plans to minimize disease transmission and mitigate potential impact of possible staff infection. In this article, the authors share several operational guidelines and strategies implemented in our practice to reduce spread of COVID-19 and maintain clinical and educational needs of a teaching hospital.