Radiology Departments & Practices to Adapt to COVID-19 Crisis

Radiologists have been assigned to the frontline because COVID-19 virus has signatures on chest CT characteristic of viruses that damage lungs. There has now been a major shift in perspective for radiology practices and departments with the onset and spread of COVID-19 respiratory illness. Just as radiology practitioners and imaging departments, radiology peer review companies are also closely following the changing guidelines and requirements. Radiology departments now need to focus on preparedness first while until now the focus has been on diagnostic capability. The reason for the shift is -- at present chest CT findings are no longer part of diagnostic criteria for COVID-19.This is because CT may be normal in early illness and after each patient is scanned the machine will have to be completely disinfected, which means the machine remains non-operational until then.

The journal Radiology recently published certain policies and recommendations made by a panel of experts regarding radiology preparedness during the present public health emergency. Radiology departments can follow guidelines given in this article concerning priorities for handling COVID-19 patients, and strategies to implement to prevent further infection spread and protect hospital staff and other patients. These policies and procedures are designed:

• To achieve sufficient capacity for uninterrupted operation during a health emergency of unprecedented proportions.
• To facilitate the care of COVID-19 patients.
• To maintain radiologic diagnostic and interventional support for the hospital and healthcare system.

Though the priorities for COVID-19 preparedness may vary among health systems, the focus must be on early detection, safety precautions, limiting virus exposure to others, cleaning protocols, training, maintenance of operations and staffing.

Though CT is not recommended to screen for COVID-19, as mentioned at the outset, CT will continue to be used in those patients displaying acute respiratory symptoms and some of these patients may have coronavirus infection. The question arises how radiologists should report findings that could signify COVID-19 in patients imaged for other conditions. As this Medscape article points out, findings of COVID-19 on CT – particularly peripheral ground-glass opacities – are sensitive but not specific for coronavirus; other forms of pneumonia resemble COVID-19, especially cryptogenic organizing pneumonia, viral and pneumocystis jirovecii pneumonia, and acute lung injury from drug toxicity, autoimmune diseases, and hypersensitivity among other pathologies. False-positive errors occur more from falsely attributing COVID-19 in patients who are ill with other acute respiratory illnesses.

This is problematic for radiologists who may commit the error of overcalling or undercalling – cognitive errors that occur when the radiologist sees an abnormality but may attach the wrong significance to it and render a wrong diagnosis. Such errors may be the result of inadequate knowledge or a judgmental error. As the above-mentioned Medscape article points out,

• If radiologists fail to mention COVID-19 infection in their reports when they find some suggestive findings and the patients are actually infected, these patients will not be properly isolated and could very well infect others.
• If, on the other hand, a radiologist calls COVID-19 infection on seeing suggestive findings and the patients are not actually infected, it could set off wrong treatment protocols. The patients may not receive treatment for their actual sickness. In addition, the CT scanner used to scan the patients will have to be unnecessarily decontaminated and kept non-operational.
• Attention of the healthcare providers will be unnecessarily focused on people who don’t have coronavirus infection.

To avoid the risk of medical negligence and harm to patients, radiologists will have to adapt to the COVID-19 situation and exercise more diligence and caution. Radiologists could choose to report what they see and wait for the treating physicians to decide how to use that information. However, a combined effort may be more effective and they can come to a more informed conclusion. To reduce cognitive errors and improve the accuracy of CTs, the following are some aspects that can be considered, according to Saurabh Jha, the author of the Medscape article.

• Radiologists must be knowledgeable in the range of findings of COVID-19 on chest CT and recognize its most characteristic findings.
• Radiologists must first talk to the clinicians and all agree that coronavirus infection is possible rather than straightaway mentioning COVID-19.
• Radiologists should express their confidence of COVID-19 diagnosis on chest CT and grade their confidence as low, intermediate, or high.
• Clinicians should express the pre-test probability of this virus infection.
• In the case of patients with co-morbidities, a second radiologist could look at the images and give an opinion.
• Positive COVID-19 CT cases should be collected in a central databank to develop algorithms using machine learning. This will help improve the specificity of CTs and reduce wrong attribution.

When diagnostic or treatment errors occur, they lead to patient harm, physician distress and burnout and a general lack of confidence in the healthcare system. Medical malpractice cases arise and necessitate radiology peer review and other investigative processes. Though errors cannot be completely avoided, they can be reduced by exercising more caution. Radiologists must be aware of potential biases and system issues that could result in mistakes, and pay careful attention to the reasoning processes they use. Appropriate strategies can be used to minimize these negative influences. So, along with preparing well to address the COVID-19 crisis, radiologists must also take great care to report their findings accurately.

Disclaimer: The content in this article is for informative purposes only, and is sourced from reliable internet resources.It is not the personal opinion or premises of the writer or the company employing the writer. For a professional opinion, contact a radiology professional or other authority.