A 9-Step Plan to Confront COVID-19

COVID-19 can present a myriad of challenges to the clinician, but adopting a methodical, practical approach can make it easier for radiologists and technologists to render services to these patients. A nine-step plan released by providers in Russia details how.

Between mid-April and mid-June 2020, a network of 48 outpatient CT facilities in Moscow conducted more than 170,000 CT scans and identified more than 82,000 cases of COVID-19 pneumonia. A pre-existing plan, developed between 2012 and 2018 at the Moscow Center for Diagnostics and Telemedicine (CDT), has made it simpler for radiologists to read remotely.

“The goals of this innovation were to reduce workload on medical facilities under the conditions of rapidly spreading disease,” explained Sergey Morozov, chief regional radiology officer of Moscow, “and to reduce mortality rates from COVID-19.”

In brief, the plan, designed to foster quick, accurate, and standardized radiology diagnostics, includes:

• Infrastructure preparation (digital equipment and uniform resource identifiers operation)
• Quality training of radiologists and X-ray technicians
• Development of methodological materials and diagnostic protocols based on international experience
• Fast learning through distance education
• Integration of new protocols into the RIS in the form of study-report templates
• Regular discussion of complicated cases at online meetups and conferences
• Using a special dashboard to monitor performance
• Using a remote study reporting system
• Implementing AI algorithms to help doctors

In an effort to streamline image reading – and keep technologists and radiologists safe – the CDT divided departments into “green” and “red” zones. Radiologists who read reports and do not have face-to-face contact with patients stay in the clean “green” zone. The CT rooms and all the staff who work there – radiographers, medical volunteers who greet and escort patients, and workers who disinfect equipment – comprise the “red” zone. These staff members are outfitted with Class Three personal protective equipment, and those coming off shift are careful not to overlap duties with those coming on shift.

Workflow Support

With more than 1,000 diagnostic devices currently connected to Moscow’s Unified Radiological Information Service (URIS), CDT has designed a workflow that streamlines the diagnostic process. When a radiographer performs a study, a personalized referral is created, and patient-specific images are uploaded to URIS. After the radiologist writes the report, URIS-connected clinicians can access both the report and images in real time.

“This interoperability between different facilities has proven to be invaluable in a pandemic and to isolation restrictions, when a transfer of physical image mediums, [such as CD or films,] became impossible,” Morozov said.

Within 20 minutes, he said, a patient with suspected COVID-19 infection could be imaged, and a referring physician could have a completed radiology report in hand. And, patients can be hospitalized without re-examination. Other benefits include reduced radiation exposure, shortened waiting times, and study reports available in any format.

As part of the effort to facilitate a smoother workflow and prevent further COVID-19 spread, CDT also launched a telemedicine program. This initiative has not only helped facilities that have a shortage of radiologists, but it has also benefited those environments where the number of studies is overwhelmingly high, Morozov said. In these situations, images with suspected COVID-19 are flagged and placed at the top of the worklist.

Using Artificial Intelligence

Given the large number of studies generated during the pandemic, artificial intelligence tools have been vitally important, Morozov explained.

URIS is equipped with algorithms to process CT scans as soon as they are received, and the radiologist has the opportunity to review both the original study and the one processed by artificial intelligence which includes pathological findings marked in red. The tools can also generate a report on spots of probable viral pneumonia, but final diagnostic and treatment conclusions still come from the radiologist, he said.