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  • Dr Niyas Ummer

Radiology in the Time of COVID-19


Health workers, including radiology staff, are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infection. Hazards include virus exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence. This article outlines a few guidelines to reduce such hazards to both healthcare workers and patients.


Imaging Protocols:

  1. Postpone non-urgent outpatient imaging

  2. Slowly increases volume of cases to prevent increased staff and patient exposures


Scheduling:

  1. Sufficient time interval between appointments and extending working hours (overtime, weekends, off days) allows social distancing of patients and facilitates disinfection of room and equipments

  2. Pre-registration via online or phone to limit staff and patient interaction

  3. Do not allow accompanying visitors except in physically or mental challenged cases


Patient Management:

  1. Symptomatic patients are given surgical masks with use of droplet and contact precautions, and isolated from other patients.

  2. Dedicated rooms can be used for scanning, ideally with negative pressure, if available.

  3. Hand washing with soap and water for 20 seconds is preferable, or hand sanitizers with at least 60% ethanol and 70% isopropyl alcohol. Avoid touching face.

  4. Screening for fever and symptoms on check in. Travel history recorded in questionnaire. Pre-procedural COVID-19 testing kit can be used if available.

  5. Masking all patients once in the imaging center, if not already masked.

  6. If intra-oral procedures are required, an antimicrobial oral rinse before taking the image is mandatory. Mouth rinse containing oxidative agents such as 0.2% povidone or 1% hydrogen peroxide are recommended.

  7. Measures to prevent gag and/or cough reflex are advised.


Scanning protocol:

  1. Smaller FOV scans

  2. Faster scans (lower resolution as diagnostically acceptable)

  3. Partial (180 degree) scans


Office Protocols:

  1. Supply of adequate hand sanitizer at all work areas and patient contact areas, including front desks, with emphasis on hand cleaning.

  2. Reorganization of waiting room spaces to allow for at least 6 feet of distancing between chairs, with signs in waiting areas, imaging suites, control areas, and outside the building emphasizing social distancing.

  3. One-way traffic movement through hallways and rooms with separate entry and exit points to reduce potential exposures.

  4. In centres with ample convenient parking, patient checks-in remotely from their car by phone, text, or website/app, then wait inside the car until their allotted appointment.

  5. Sometimes during imaging, patient mask may have to be removed. Make sure distance from an x-ray room to the console room should follow a standard guideline to prevent aerosol transmission (at least 3 meters away).

  6. Hard copies of images can be a major means of transmission since disinfection with solutions can affect the quality of the radiographs. Teleradiology system is recommended to prevent contamination.


Healthcare worker protection:

  1. Maintain social distancing in console areas and break/lunch areas. Reduced staffing and staggered breaks.

  2. Education of staff through communication of guidelines for use of PPE, easy-to-read charts

  3. Surgical/isolation masks should be worn by all HCW while in clinical facilities. If soiled or exposed during droplet precautions without a covering face shield, the mask should be disposed of, with use of a new mask for the next patient interaction.

  4. Surgical masks with covering face shield (if available) should be worn for exposure to patients with respiratory symptoms

  5. Pregnancy - As of now, there is no evidence to indicate teratogenic effects or detrimental effects on pregnancy from COVID-19 infection; however, there have been reports of transmission during late stages of pregnancy. Recommend redeploying pregnant HCW to sites with minimized exposure to patients.

  6. Meetings should be held via teleconferencing software. Safe social distancing at small meetings (few attendees) if not virtual. Encourage frequent and potentially daily updates for the entire department.


Radiologist Workflow:

  1. Staff can be scheduled to work in exclusive teams that alternate working for 2 weeks followed by 2 weeks out.

  2. Reconfigure reading rooms and radiologists in the reading room to maintain distancing.

  3. Radiologists should sterilize shared workstation equipment before and after use; ideally, workstations should be dedicated to a single radiologist for full shift with cleaning between shifts.

  4. Phone communications between radiologists and other staff are preferable to in-person communications.

  5. Radiologists who can perform their clinical duties remotely should be permitted to do so. Virtual teleconsultations may also be considered.


Postimaging Room Cleaning:

  1. Droplet precautions - Standard antiseptic wipe down of equipment using quaternary ammonium/alcohol-impregnated wipes. No need for room closure if adequate air circulation.

  2. Airborne precaution - Standard wipe down. Room closed for 1 hour after imaging for rooms with greater than 6 air exchanges per hour, which includes cleaning time. Use high-efficiency particulate air (HEPA) filter if possible and available to accelerate air circulation and shorten room closure.


CBCT Machine Infection Control:

  1. CBCT units are barrier wrapped in the region contacting the patient, and also the control panel.

  2. The bite peg, if used, should also be covered in a similar way, but its use may be avoided by aligning to the commissure of the lips and asking the patient to place their incisors edge to edge.

  3. A chin rest can be used instead of a bite peg, and aligning to the canine prominence, or alar line, which can be palpated through the mask and marked with pen on the mask.

  4. Following the examination, the barrier wrapping should be removed, and the areas wiped down with disinfectant.


Continuing Education:

  1. Virtual case reviews

  2. Online multidisciplinary conferences



References:

  • RSNA COVID-19 Task Force: Post-COVID Surge Radiology Preparedness

  • 1RSNA COVID-19 Task Force: Best Practices for Radiology Departments during COVID-19

  • Saki M, Haseli S, Iranpour P. Oral Radiology Center as a Potential Source of COVID-19 Transmission; Points to Consider. Acad Radiol 2020

  • Recommendations for Diagnostic Imaging during COVID-19 pandemic - British Society of Dental and Maxillofacial Radiology and the Faculty of Dental Surgery, Royal College of Surgeons of England

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©2018 by Dr Niyas Ummer Mohammed