Future scenarios and opportunities for interventional radiology in the post COVID-19 era

Pandemic outbreak has led health systems worldwide into a rapid reorganization in response to coronavirus infections, forcing interventional radiology units to adapt. Interventional procedures have evolved in number, type and setting and have arguably been optimized as a direct consequence of this pandemic; a result that will undoubtedly lead to radical change within the specialty. This paper explores the future of interventional radiology from various perspectives, and forecasts the new opportunities that will be presented, from the adaptation of the interventional radiology staff and angiography suite, to the immunological environment, and through to digital medical education. We analyze the economic impact and the future relationship we can expect with the rest of the medical industry.

Rapid outbreak of the coronavirus disease 2019 (COVID-19) has led to an unprecedented knockdown of health systems worldwide. During the first weeks of the pandemic, a rapidly growing number of patients required immediate hospitalization, and many of them were admitted to intensive care units (ICU). Human, economic, and medical resources have been redistributed to fight against the pandemic spread. Widely varied rates of virus evolution in terms of time and severity have been observed between the nations, and whilst this allows us to theorize on the course of the disease, many uncertainties remain as how the disease will evolve in the short- to midterm (1).Narrowing to the field of interventional radiology (IR), we have been forced to adapt our practices to this situation in a very short period of time. An abrupt stop was made to daily practices, with priority being given to only the most urgent oncologic and trauma procedures, and other basic services necessary to fight against the disease on the front line.The purpose of this article is to explore how IR may evolve over the next 1–3 years. The authors do not pretend to predict or fix ideas about what will happen, rather, they share hypothesis on what may occur, with the aim to spark meaningful reflection and debate. This article has been designed to inspire bold thinking about this inevitable era of change and opportunity, always with the conviction that our “resilient” specialty will prevail as it has done for generations.     

The operation of a ward-based radiology consultation service

A radiology consultation service, consisting of an attending radiologist and a senior radiology resident, functioned for ten months on an acute care medical ward in a teaching hospital. The consultants conducted daily conferences during which they discussed, approved, and scheduled all imaging tests. During the study interval, there were significantly fewer procedures performed on patients in the consultation ward than were performed on patients in three other medical wards of the hospital. The service was well accepted by the medical staff. Early and sustained participation by a radiologist who functions as an advisor during diagnostic evaluations can help limit inappropriate or redundant imaging examinations.     

COVID-19: Impact on radiology departments and implications for future service design,service delivery,and radiology education

The pandemic caused by SARS-CoV-2 (severe adult respiratory distress syndrome Coronavirus-2) and its most severe clinical syndrome, COVID-19, has dramatically impacted service delivery in many radiology departments. Radiology (primarily chest radiography and CT) has played a pivotal role in managing the pandemic in countries with well-developed healthcare systems, enabling early diagnosis, triage of patients likely to require intensive care and detection of arterial and venous thrombosis complicating the disease. We review the lessons learned during the early response to the pandemic, placing these in the wider context of the responsibility radiology departments have to mitigate the impact of hospital-acquired infection on clinical care and staff wellbeing. The potential long-term implications for design and delivery of radiology services are considered. The need to achieve effective social distancing and ensure continuity of service during the pandemic has brought about a step change in the implementation of virtual clinical team working, off-site radiology reporting and postgraduate education in radiology. The potential consequences of these developments for the nature of radiological practice and the education of current and future radiologists are discussed.     

Imaging in the COVID-19 era: Lessons learned during a pandemic

The first year of the coronavirus disease 2019 (COVID-19) pandemic has been a year of unprecedented changes, scientific breakthroughs, and controversies. The radiology community has not been spared from the challenges imposed on global healthcare systems. Radiology has played a crucial part in tackling this pandemic, either by demonstrating the manifestations of the virus and guiding patient management, or by safely handling the patients and mitigating transmission within the hospital. Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic, including workflow alterations, volume reductions, and strict infection control strategies. Despite the ongoing challenges, considerable knowledge has been gained that will guide future innovations. The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19, and to discuss the implications of the pandemic on radiology departments globally, including infection control strategies and delays in cancer screening. Lastly, the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.     

COVID-19: A call for mentorship in radiology

During the COVID-19 pandemic, mentorship relationships have undergone significant strain. Sudden changes in the practice environment have caused radiologists to focus their attention to more immediate and essential clinical needs, thus leaving important extracurricular non-clinical endeavors like mentorship by the wayside. However, mentorship is essential more than ever during the pandemic to build strength and resilience in radiology. Specifically, mentorship can foster job resilience, facilitate career development, promote diversity, support wellness, and stimulate future practice growth during this pandemic. Practical actions are described that mentors can follow to help develop and sustain mentorship relationships during the pandemic.SummaryMentorship is critical now during the COVID-19 pandemic to build strength and resilience in radiology.     

COVID-19 in the radiology department: What radiographers need to know

ObjectivesThe aim is to review current literature related to the diagnosis, management, and follow-up of suspected and confirmed Covid-19 cases.Key findingsMedical Imaging plays an important auxiliary role in the diagnosis of Covid-19 patients, mainly those most seriously affected. Practice differs widely among different countries, mainly due to the variability of access to resources (viral testing and imaging equipment, specialised staff, protective equipment). It has been now well-documented that chest radiographs should be the first-line imaging tool and chest CT should only be reserved for critically ill patients, or when chest radiograph and clinical presentation may be inconclusive.ConclusionAs radiographers work on the frontline, they should be aware of the potential risks associated with Covid-19 and engage in optimal strategies to reduce these. Their role in vetting, conducting and often reporting the imaging examinations is vital, as well as their contribution in patient safety and care. Medical Imaging should be limited to critically ill patients, and where it may have an impact on the patient management plan.Implications for practiceAt the time of publication, this review offers the most up-to-date recommendations for clinical practitioners in radiology departments, including radiographers. Radiography practice has to significantly adjust to these new requirements to support optimal and safe imaging practices for the diagnosis of Covid-19. The adoption of low dose CT, rigorous infection control protocols and optimal use of personal protective equipment may reduce the potential risks of radiation exposure and infection, respectively, within Radiology departments.     

COVID-19 pandemic revisited: lessons the radiology community has learned a year later

Emergency Radiology - For more than 1 year, COVID-19 pandemic has impacted every aspect of our lives. This paper reviews the major challenges that the radiology community faced over the...     

Quality improvement in interventional radiology: an opportunity to demonstrate value and improve patient-centered care

The changing healthcare environment offers an opportunity for interventional radiology (IR) to showcase its value-specifically, to demonstrate that IR often offers the better, safer, faster, and less expensive treatment option for various clinical scenarios. The best way to demonstrate the value of IR now and to maintain this value in the future is through implementation of patient-centered care built on standardized care delivery, continuous quality improvement, and effective team dynamics.     

Impact of the COVID-19 pandemic on radiology physician work RVUs at a large subspecialized radiology practice

PurposeAs the COVID-19 pandemic continues, efforts by radiology departments to protect patients and healthcare workers and mitigate disease spread have reduced imaging volumes. This study aims to quantify the pandemic's impact on physician productivity across radiology practice areas as measured by physician work Relative Value Units (wRVUs).Materials and methodsAll signed diagnostic and procedural radiology reports were curated from January 1st to July 1st of 2019 and 2020. Physician work RVUs were assigned to each study type based on the Medicare Physician Fee Schedule. Utilizing divisional assignments, radiologist schedules were mapped to each report to generate a sum of wRVUs credited to that division for each week. Differential impact on divisions were calculated relative to a matched timeframe in 2019 and a same length pre-pandemic time period in 2020.ResultsAll practice areas saw a substantial decrease in wRVUs from the 2020 pre- to intra-pandemic time period with a mean decrease of 51.5% (range 15.4%–76.9%). The largest declines were in Breast imaging, Musculoskeletal, and Neuroradiology, which had decreases of 76.9%, 75.3%, and 67.5%, respectively. The modalities with the greatest percentage decrease were mammography, MRI, and non-PET nuclear medicine.ConclusionAll radiology practice areas and modalities experienced a substantial decrease in wRVUs. The greatest decline was in Breast imaging, Neuroradiology, and Musculoskeletal radiology. Understanding the differential impact of the pandemic on practice areas will help radiology departments prepare for the potential depth and duration of the pandemic by better understanding staffing needs and the financial effects.     

The use of patient-centered outcome measures in radiology: a systematic review

RATIONALE AND OBJECTIVES: To undertake a systematic review of literature on patient centred outcomes and explore the use of patient defined outcomes in radiology research. MATERIALS AND METHODS: i) Data sources: Published empirical studies in peer reviewed journals. ii) Study selection: Systematic search of English language radiology literature between 1990-2003, using four electronic databases, and reference lists of papers. Work relating to diagnostic or interventional imaging was included. Screening was excluded, together with articles based solely on the audit of patients' medical records. Patients needed to have inputted directly into the study, for example responding to questionnaires or participating in interviews. iii) Data extraction: Abstracts were retrieved and relevant full text articles obtained. Each paper was reviewed independently by two reviewers (research team members) using a data extraction form, developed by the authors. Categorisation of papers was undertaken at team meetings. RESULTS: A total of 26 publications met the inclusion criteria for the review. Papers were placed within three categories: i) the primary aim of the study was investigate patient centred outcomes (n = 10); ii) the primary aim of the study was to describe the radiological procedure itself but patient contact was made post-procedure (n = 5) and iii) the primary aim of the study was to investigate patients' experiences during procedures (n = 11). Validated outcome measures were used in 10 studies. None of the outcome measures used were developed specifically for radiology. No papers were found where researchers had used patient defined outcomes. CONCLUSION: The research highlighted difficulties relating to the review and reporting of outcomes research. The results indicated little patient engagement in outcome research in radiology.     

Lessons learned during the COVID-19 pandemic: a single institution radiology chief resident experience

Coronavirus Disease 2019 (COVID-19) has posed incredible new challenges for radiology residency programs, including resident training under tenuous and uncertain conditions, barriers to communication, deployment-induced anxiety, and social isolation. Chief residents and program leadership play a critical role in guiding radiology residents through these unprecedented times. Best practices and creative approaches experienced in a single institution's residency program located in New York City are shared in an effort to encourage other programs struggling with similar obstacles to prioritize resident education and wellness.     

Virtual medical student radiology clerkships during the COVID-19 pandemic: Distancing is not a barrier

BackgroundStress on medical education caused by COVID-19 has prompted medical schools to bar their students from onsite education at hospitals and clinics, limiting their educational experiences. Radiology is uniquely positioned to be a virtual rotation during this health crisis and beyond.PurposeTo implement virtual radiology clerkships and evaluate educational outcomes.MethodsWe developed virtual radiology clerkships using best practices from adult education theory; emphasizing self-directed and interactive learning through recommended reading materials, pre-recorded lectures, video conferencing, web-based learning modules from the ACR, as well as multimodality radiology resources to allow students flexibility in their individual approach to the subject matter.ResultsThe mean performance on standardized exams for our cohorts was 75% (range 50–96%), matching the national average of 75%. Surveys of medical students after the clerkship showed positive subjective feedback on the content and structure of the course.ConclusionsUnderstanding of medical imaging is vital for student doctors to have a better understanding of applied anatomy, patient care strategies, appropriate use, and image interpretation. Radiology is uniquely positioned to be taught in a virtual format, or in a combination of online and in-person activities. Standardized examination performance for our institutional virtual radiology clerkships is comparable to performance on traditional courses. Virtual clerkships designed with adult learners in mind can help student doctors prepare for residency and future independent practice as they build knowledge and skills needed to provide high quality patient care.     

Container CT scanner: a solution for modular emergency radiology department during the COVID-19 pandemic

During the coronavirus disease 2019 (COVID-19) pandemic period, container computed tomography (CT) scanners were developed and used for the first time in China to perform CT examinations for patients with clinically mild to moderate COVID-19 who did not need to be hospitalized for comprehensive treatment, but needed to be isolated in Fangcang shelter hospitals (also known as makeshift hospitals) to receive some supportive treatment. The container CT is a multidetector CT scanner installed within a radiation-protected stand-alone container (a detachable lead shielding room) that is deployed outside the makeshift hospital buildings. The container CT approach provided various medical institutions with the solution not only for rapid CT installation and high adaptability to site environments, but also for significantly minimizing the risk of cross-infection between radiological personnel and patients during CT examination in the pandemic. In this article, we described the typical setup of a container CT and how it worked for chest CT examinations in Wuhan city, the epicenter of COVID-19 outbreak.

Fangcang shelter hospitals, also known as makeshift hospitals, were developed and used for the first time in China to tackle the coronavirus disease 2019 (COVID-19) outbreak by providing medical care and disease monitoring for patients with mild to moderate COVID-19 who were isolated from their families and communities (1). Similarly, stand-alone computed tomography (CT) scanners, known as container CTs, were developed and used for the first time in China to perform CT examinations on patients with clinically mild to moderate COVID-19 who received supportive treatment at makeshift hospitals. These container CTs were first deployed outside makeshift hospital buildings and later also at some regular hospitals as stand-alone CT scanners designated for fever patients and confirmed COVID-19 patients.Chest CT images have been widely used to help with early diagnosis, assess the degree of pulmonary infectious involvement, monitor disease progression, and evaluate treatment effects (2). These CT examinations were originally performed in regular hospital settings with normally installed CT scanners. However, at makeshift hospitals that were converted from civil building facilities such as stadiums, schools, and exhibition halls, no space was available that could meet the shielding and radiation protection standards necessary to install CT scanners. Furthermore, during that critical pandemic period, many hospitals in Wuhan urgently needed to be equipped with more CT scanners to rapidly improve the imaging examination capabilities for patients with fever, suspected patients, and patients with confirmed COVID-19. Unfortunately, these hospitals usually lack readily available sites for rapid CT installations because it normally takes at least a month to build or remodel a CT shielding room even without the complications of the complete lockdown in Wuhan city. To figure out this issue, under tremendous pressure to rapidly install new CT scanners at both regular hospitals and makeshift hospitals, Chinese medical equipment companies worked closely with frontline radiologists and technologists and developed an innovative container CT, which functions as a modular emergency radiology department. To date, more than 140 container CTs have been installed at makeshift hospitals and regular hospitals in China since the COVID-19 outbreak.In this article, we presented a typical in-depth solution for container CT deployment in Wuhan during the COVID-19 outbreak.     

Readability of radiology reports: implications for patient-centered care

IntroductionRadiology reports, although written primarily for healthcare providers, are read increasingly by patients and their family. This study sought to assess the readability of radiology reports.Materials and methodsFrom 108,228 consecutive radiology reports from a large US health system, we excluded duplicate reports, reports of research exams, and reports with missing data. For each report, we measured the numbers of words and sentences, and computed a “reading grade level” (RGL) as the mean of three readability indices: Flesch-Kincaid Grade Level, Gunning Fog index, and Simple Measure of Gobbledygook. Analysis of variance (ANOVA) evaluated the effects of modality, patient setting, examination urgency, and combinations thereof on RGL.ResultsThe 97,052 reports in the study cohort had a mean (±standard deviation) of 17.6 ± 12.8 sentences and 203 ± 161 words. Patient setting, modality, and examination urgency all had significant independent effects on RGL (all with p < 0.001). There were 4094 reports (4.2%) at a reading grade level of 8 or lower.ConclusionRadiology reports often contain complex concepts and polysyllabic terms unfamiliar to lay readers. Only 4% of all radiology reports in our sample were readable at the 8th grade level, which is the reading level of the average US adult. Although radiology reports are written for physicians and other healthcare providers, radiologists might explore using simpler, more structured language to address the goals of patient-centered care.