It’s been five years since the COVID-19 pandemic was declared in the U.S., and radiology has learned much since then, according to experts who directly dealt with the disease’s impact.
While the pandemic affected medical operations across the country, the experts said that radiologists developed and honed their sense of resiliency as imaging was placed on the front lines.
“This was something that healthcare systems in the U.S. in the modern era of healthcare had not been used to adapting to, as was the general public,” said Ella Kazerooni, MD, from the University of Michigan.
Medical imaging played a significant role in the early days of the pandemic when it hit its initial peak in April 2020. While services for breast and lung cancer screening were temporarily halted, imagers in x-ray, lung ultrasound, and PET/CT were busy examining patients who presented with COVID-19.
Kazerooni and colleagues worked to develop protocols to reallocate healthcare resources while also keeping workers safe. They also spearheaded the development of guidelines for the American College of Radiology (ACR), recognizing the role that imaging had in diagnosing COVID-19 in patients.
Kazerooni, a lung imaging expert, chairs the ACR’s committee on lung cancer screening and is vice chair of the lung cancer screening panel for the National Comprehensive Cancer Network. The guidelines included best practices for imaging with CT versus chest x-ray in diagnosing COVID, as well as whether imaging is necessary at all in some cases.
“We had to learn very quickly along the way,” she said. “People brought the best expert wisdom they had with practice experience, having had no publications at all in this domain to draw on.”
Amy Patel, MD, director of the Breast Care Center at Liberty Hospital in Missouri, said that while there was uncertainty in the events leading up to the pandemic, her health system was fortunate in having an infectious disease specialist who closely tracked the disease’s progress around the world. Patel and colleagues held discussions and collaborated with health system leaders and county-level medical departments.
“It really was a team effort and given the uncertainty of it all, it really helped that we all were really trying to work together to ensure that patients were safe,” Patel said.
While screening mammography services were halted, Patel and colleagues continued with diagnostic imaging services, especially for symptomatic patients. Her team employed a tracking mechanism for patients who were due for their mammograms once screening operations resumed. Imaging technologists meanwhile were reallocated across the hospital system to assist in various departments.
“It was tough for practices and institutions during that time, but seeing where the needs were and trying to be a team player during such an uncertain and anxious time, I think that was the goal for all of us,” Patel said.
Ramesh Rengan, MD, PhD, from the University of Washington in Seattle, meanwhile, said that special considerations were taken into account for treating cancer patients via radiation oncology. While social distancing guidelines were put in place, Rengan and colleagues had to adjust their practice since cancer care is a more intimate setting.
“It’s where patients are helped onto a treatment table and then their position is adjusted so that in millimeters, their positioning is reproduced so the beam goes with utter precision to where it needs to go to hit the tumor,” he said. “But that involves human contact. That involves multiple technologists who come in and out of the room.”
He added that radiation treatment rooms are not completely sterile like operating rooms for surgeries.
Rengan and colleagues developed clinical guidance for the American Society for Radiation Oncology (ASTRO) on best practices while treating cancer patients in this medical domain, as well as workforce considerations. They determined standards of care between optimal, contingency, and crisis levels to figure out which cancer patients needed immediate radiation oncology care.
“That risk of potential exposure to the virus is something that, from a medical standpoint, is something that’s required [for consideration] because we have to deal with the cancer at hand,” Rengan said. “So, you really had to crystallize your thoughts around that.”
Lessons learned
Although COVID-19 is nowhere near the priority it once was, best practices from 2020 have carried over into today’s clinical workflows.
Patel said having a robust infrastructure for tracking patients who are due for screening is needed. This especially goes for smaller hospitals that may not have adequate resources for a centralized tracking system.
“I think that, heaven forbid we have another pandemic in our lifetimes, I would hope that we’d be a little bit more adept at figuring out a tracking process for these patients to ensure that if they missed their screening…that we are able to get them in in a timely fashion when we could,” Patel said.
Rengen said that composure and temperament were important for maintaining core-guided principles during the pandemic and can carry into challenging situations today.
“You have to remain steadfast in that guiding philosophy,” he said. “If there’s a pandemic going on, even more so. If we are in a situation where we don’t have the kind of resources we need…that doesn’t change. Our true north is putting our patients first.”
Rengen added that transparency and honesty around messaging to patients and colleagues are important in keeping people safe from infectious diseases like COVID.
“I think the lessons and impact of the pandemic still endures, and we’re still learning about it,” he said. “We’re going to learn about the impact of the treatments we’ve delivered to mitigate the virus and how that interacts with cancer.”
Kazerooni, meanwhile, said that radiologists are resilient and creative, which can help with solving problems on an emergent basis. She added that the pandemic helped with good infection safety practices and helped practitioners understand how to go about prioritizing healthcare.
“This [pandemic] gave us a roadmap for what you need to do to keep people safe from an infection control perspective,” she said.
However, Kazerooni added that the pandemic showed the strength of the human spirit in taking care of each other.
“Radiologists, medical practitioners, patients, patient advocates, and communities worked together to figure this out,” she said. “Sure, it was stressful and there was burnout and there was a lot that people had to recover from, but that positive engagement has actually lasted with us as a community as we move healthcare forward post-COVID.”