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.     

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.     

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.     

Early-Stage Radiology Volume Effects and Considerations with the Coronavirus Disease 2019 (COVID-19) Pandemic: Adaptations,Risks, and Lessons Learned

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic resulted in significant loss of radiologic volume as a result of shelter-at-home mandates and delay of non-time-sensitive imaging studies to preserve capacity for the pandemic. We analyze the volume-related impact of the COVID-19 pandemic on six academic medical systems (AMSs), three in high COVID-19 surge (high-surge) and three in low COVID-19 surge (low-surge) regions, and a large national private practice coalition. We sought to assess adaptations, risks of actions, and lessons learned.MethodsPercent change of 2020 volume per week was compared with the corresponding 2019 volume calculated for each of the 14 imaging modalities and overall total, outpatient, emergency, and inpatient studies in high-surge AMSs and low-surge AMSs and the practice coalition.ResultsSteep examination volume drops occurred during week 11, with slow recovery starting week 17. The lowest total AMS volume drop was 40% compared with the same period the previous year, and the largest was 70%. The greatest decreases were seen with screening mammography and dual-energy x-ray absorptiometry scans, and the smallest decreases were seen with PET/CT, x-ray, and interventional radiology. Inpatient volume was least impacted compared with outpatient or emergency imaging.ConclusionLarge percentage drops in volume were seen from weeks 11 through 17, were seen with screening studies, and were larger for the high-surge AMSs than for the low-surge AMSs. The lowest drops in volume were seen with modalities in which delays in imaging had greater perceived adverse consequences.     

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.     

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.     

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.     

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.     

Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Imaging Case Volumes

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has had significant economic impact on radiology with markedly decreased imaging case volumes. The purpose of this study was to quantify the imaging volumes during the COVID-19 pandemic across patient service locations and imaging modality types.MethodsImaging case volumes in a large health care system were retrospectively studied, analyzing weekly imaging volumes by patient service locations (emergency department, inpatient, outpatient) and modality types (x-ray, mammography, 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. Independent-samples t tests compared the mean weekly volumes in 2020 and 2019.ResultsTotal imaging volume in 2020 (weeks 1-16) declined by 12.29% (from 522,645 to 458,438) compared with 2019. Post-COVID-19 (weeks 10-16) revealed a greater decrease (28.10%) in imaging volumes across all patient service locations (range 13.60%-56.59%) and modality types (range 14.22%-58.42%). Total mean weekly volume in 2020 post-COVID-19 (24,383 [95% confidence interval 19,478-29,288]) was statistically reduced (P = .003) compared with 33,913 [95% confidence interval 33,429-34,396] in 2019 across all patient service locations and modality types. The greatest decline in 2020 was seen at week 16 specifically for outpatient imaging (88%) affecting all modality types: mammography (94%), nuclear medicine (85%), MRI (74%), ultrasound (64%), interventional (56%), CT (46%), and x-ray (22%).DiscussionBecause the duration of the COVID-19 pandemic remains uncertain, these results may assist in guiding short- and long-term practice decisions based on the magnitude of imaging volume decline across different patient service locations and specific imaging modality types.     

Radiological review of rhinocerebral mucormycosis cases during the COVID-19 Pandemic: A single-center experience

Mucormycosis is caused by the fungi belonging to the order Mucorales and class Zygomycetes. The incidence of mucormycosis has increased with the onset of the severe acute respiratory syndrome coronavirus 2 infections leading to the coronavirus disease 2019 (COVID-19) pandemic. This rise is attributed to the use of immunosuppressive medication to treat COVID-19 infections. Authors have retrospectively collected data of our cases of mucormycosis diagnosed from April 2020 to April 2021 at our institute. A total of 20 patients with rhinocerebral mucormycosis were studied. Most of the study subjects were male patients (90%) and were of the age group 41-50 years. Most patients in the review had comorbidities (85%) with diabetes being the most common comorbidity. Para nasal sinuses were involved in all the cases. Involvement of the neck spaces was present in 60% of the cases. Involvement of the central nervous system was present in 80% of the cases. Orbital involvement was present in 90% of the cases. The authors reviewed the various imaging findings of mucormycosis on computed tomography and magnetic resonance imaging in this article.     

Quantifying Impact of Disruption to Radiology Education During the COVID-19 Pandemic and Implications for Future Training

PurposeThe aim of this study was to assess the impact on radiology resident education due to the COVID-19 pandemic in order to inform future educational planning.MethodsDuring a 10-week study period from March 16 to May 22, 2020, changes to educational block-weeks (BW) of first through fourth year residents (R1-4) were documented as disrupted in the setting of the COVID-19 pandemic. The first 5 weeks and the second 5 weeks were evaluated separately for temporal differences. Overall and mean disrupted BW per resident were documented. Wilcoxon rank-sum tests were used to assess pairwise differences between classes with Bonferroni-adjusted P-values, as well as differences in the early versus later phase of the pandemic.ResultsOf 373 BW, 56.6% were assigned to virtual curriculum, 39.4% radiology clinical duties, 2.9% illness, and 1.1% reassignment. Scheduling intervention affected 6.2 ± 2.3 (range 1-10) mean BW per resident over the 10-week study period. The R3 class experienced the largest disruption, greater than the R2 classes, and statistically significantly more than the R1 and R4 classes (both P < 0.05). The second half of the pandemic caused statistically significantly more schedule disruptions than the first half (P = 0.009).DiscussionThe impact of COVID-19 pandemic varied by residency class year, with the largest disruption of the R3 class and the least disruption of the R4 class. To optimize future educational opportunities, shifting to a competency-based education paradigm may help to achieve proficiency without extending the length of the training program.     

Coronavirus Disease 2019 (COVID-19) CT Findings: A Systematic Review and Meta-analysis

PurposeTo date, considerable knowledge gaps remain regarding the chest CT imaging features of coronavirus disease 2019 (COVID-19). We performed a systematic review and meta-analysis of results from published studies to date to provide a summary of evidence on detection of COVID-19 by chest CT and the expected CT imaging manifestations.MethodsStudies were identified by searching PubMed database for articles published between December 2019 and February 2020. Pooled CT positive rate of COVID-19 and pooled incidence of CT imaging findings were estimated using a random-effect model.ResultsA total of 13 studies met inclusion criteria. The pooled positive rate of the CT imaging was 89.76% and 90.35% when only including thin-section chest CT. Typical CT signs were ground glass opacities (83.31%), ground glass opacities with mixed consolidation (58.42%), adjacent pleura thickening (52.46%), interlobular septal thickening (48.46%), and air bronchograms (46.46%). Other CT signs included crazy paving pattern (14.81%), pleural effusion (5.88%), bronchiectasis (5.42%), pericardial effusion (4.55%), and lymphadenopathy (3.38%). The most anatomic distributions were bilateral lung infection (78.2%) and peripheral distribution (76.95%). The incidences were highest in the right lower lobe (87.21%), left lower lobe (81.41%), and bilateral lower lobes (65.22%). The right upper lobe (65.22%), right middle lobe (54.95%), and left upper lobe (69.43%) were also commonly involved. The incidence of bilateral upper lobes was 60.87%. A considerable proportion of patients had three or more lobes involved (70.81%).ConclusionsThe detection of COVID-19 chest CT imaging is very high among symptomatic individuals at high risk, especially using thin-section chest CT. The most common CT features in patients affected by COVID-19 included ground glass opacities and consolidation involving the bilateral lungs in a peripheral distribution.     

Coronavirus (COVID-19) Outbreak: What the Department of Radiology Should Know

In December 2019, a novel coronavirus (COVID-19) pneumonia emerged in Wuhan, China. Since then, this highly contagious COVID-19 has been spreading worldwide, with a rapid rise in the number of deaths. Novel COVID-19–infected pneumonia (NCIP) is characterized by fever, fatigue, dry cough, and dyspnea. A variety of chest imaging features have been reported, similar to those found in other types of coronavirus syndromes. The purpose of the present review is to briefly discuss the known epidemiology and the imaging findings of coronavirus syndromes, with a focus on the reported imaging findings of NCIP. Moreover, the authors review precautions and safety measures for radiology department personnel to manage patients with known or suspected NCIP. Implementation of a robust plan in the radiology department is required to prevent further transmission of the virus to patients and department staff members.     

Impact of Coronavirus Disease 2019 (COVID-19) on the Practice of Clinical Radiology

The speed at which coronavirus disease 2019 (COVID-19) spread quickly fractured the radiology practice model in ways that were never considered. In March 2020, most practices saw an unprecedented drop in their volume of greater than 50%. The profound changes that have interrupted the arc of the radiology narrative may substantially dictate how health care and radiology services are delivered in the future. We examine the impact of COVID-19 on the future of radiology practice across the following domains: employment, compensation, and practice structure; location and hours of work; workplace environment and safety; activities beyond the “usual scope” of radiology practice; and CME, national meetings, and professional organizations. Our purpose is to share ideas that can help inform adaptive planning.     

Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Changes in Clinical Presentation and CT Findings

BackgroundQuarantine and stay-at-home orders are strategies that many countries used during the acute pandemic period of coronavirus disease 2019 (COVID-19) to prevent disease dissemination, health system overload, and mortality. However, there are concerns that patients did not seek necessary health care because of these mandates.PurposeTo evaluate the differences in the clinical presentation of acute appendicitis and CT findings related to these cases between the COVID-19 acute pandemic period and nonpandemic period.Materials and MethodsA retrospective observational study was performed to compare the acute pandemic period (March 23, 2020, to May 4, 2020) versus the same period the year before (March 23, 2019, to May 4, 2019). The proportion of appendicitis diagnosed by CT and level of severity of the disease were reviewed in each case. Univariate and bivariate analyses were performed to identify significant differences between the two groups.ResultsA total of 196 abdominal CT scans performed due to suspected acute appendicitis were evaluated: 55 from the acute pandemic period and 141 from the nonpandemic period. The proportion of acute appendicitis diagnosed by abdominal CT was higher in the acute pandemic period versus the nonpandemic period: 45.5% versus 29.8% (P = .038). The severity of the diagnosed appendicitis was higher during the acute pandemic period: 92% versus 57.1% (P = .003).ConclusionDuring the acute COVID-19 pandemic period, fewer patients presented with acute appendicitis to the emergency room, and those who did presented at a more severe stage of the disease.     

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.