9-Point COVID-19 Prep Plan, Breast MRI, COVID-19 Lung Injury, and the Pandemic's Community Imaging Impact

July 10, 2020

Diagnostic Imaging's Weekly Scan; July 10, 2020

Welcome to Diagnostic Imaging’s Weekly Scan. I’m senior editor, Whitney Palmer, bringing you some of the most popular radiology news of the week.

As we enter the fourth full month of the COVID-19 pandemic, radiology practices, in many ways, are still trying to find the best workflow plans that will allow for quick, accurate, and standardized diagnostics. Although each practice must find the strategy that works best for them, radiologists from a 48-center network in Moscow shared the facets of a pre-existing plan that has given way to better workload management and better COVID-19 outcomes. Specifically, they laid out nine steps: infrastructure preparation, including digital equipment and uniform resource identifiers operation, quality training of radiologists and X-ray technologists, the development of methodological materials and diagnostic protocols based on international experience, fast learning through distance education, new protocol integration into the RIS, regular discussion of complicated cases either online or at conferences, using a special dashboard to monitor performance, using a remote study reporting system, and implementing AI algorithms. They also divide their radiology departments into green and red zones. Radiologists who read reports with no face-to-face contact with patients remain in the clean green zone. Radiographers, medical volunteers who greet and escort patients, and workers who disinfect the equipment remain in the red zone. Through this system, the radiologists said, images of a patient with suspected COVID-19 infection can be captured, analyzed, and reported within 20 minutes, giving clinicians the ability to isolate the patient quickly, if needed.

Radiology investigators also revealed some important findings about breast imaging this week. In the Annals of Internal Medicine, investigators from Boston’s Children’s Hospital determined that annual breast cancer screenings for women who were survivors of a pediatric cancer cuts the death rate in this group by more than half. Specifically, they recommended beginning annual MRI screening, with or without mammography, at the age of 25. Overall, women in this group have a 10-percent to 11-percent risk of dying from breast cancer. Implementing the routine screening sooner rather than later slices that risk of mortality by 56 percent to 71 percent. The researchers did say, though, that postponing the screenings until age 30 might be more cost effective for the patient, and it would not have any deleterious effects on the patient’s health or outcomes.

In addition, radiologists from Massachusetts General Hospital published a study this week in the European Journal of Radiology, detailing that pre-operative breast MRI can catch 11 percent more cancers in women who have ductal carcinoma in situ. Even though breast MRI is more sensitive than mammography and does a better job of identifying both calcified and non-calcified DCIS better, whether to use the scan is still up for debate. Consequently, the team set out to determine whether using pre-operative breast MRI would have a positive impact on surgical planning and outcomes. They looked at data from 963 women who had core biopsy-confirmed DCIS, 236 of whom also had breast MRI. Among that group, they found an additional cancer identification rate of 11.2 percent. They did find that women who received breast MRI did have more mastectomies at initial surgery, but the team cautioned that it could be due to non-MRI related factors, such as patient age, breast density, personal breast cancer history, and ordering physician assessment. In addition, women who had the scan had a similar re-excision rate compared to women who did not have breast MRI. Overall, the team said, these findings point to the positive role pre-operative breast MRI can play in surgical decision-making and overall treatment planning.

New findings about the impact of COVID-19 on the body continue to roll in. This time, a study, published in Radiology has revealed that COVID-19-positive patients are more likely to experience a lung injury while ventilated than are patients who do not have the viral infection. According to the study that evaluated 601 intubated COVID-19-positive patients, as well as 285 intubated patients with acute respiratory distress syndrome, 15 percent of the COVID-19 patients experienced at last one barotrauma – an injury associated with increase air pressure in the lungs. They found 31 patients with left pneumothorax, 35 with right pneumothorax, 11 with bilateral pneumothoraces, 54 with either unilateral or bilateral pneumothorax, 59 with pneumomediastinum, and 14 with pneumopericardium. In contrast, only 11 percent of the acute respiratory distress patients developed a barotrauma. Ultimately, the team said, they hope their findings support emerging theories around lung damage from COVID-19 infection.

And, lastly, Diagnostic Imaging spoke this week with Dr. Richard Duszak, professor and vice chair for health policy and practice in the radiology and imaging sciences department at Emory University, and Dr. Danny Hughes, executive director and senior research fellow at the Harvey L. Neiman Health Policy Institute, about their research published this week in the Journal of the American College of Radiology that examined the decline on non-invasive diagnostic imaging completed in community practices during the pandemic. They discussed some of the specific findings of the work, as well as the implications the results could have on workflow and financial planning as the pandemic continues. Here’s what they shared.