Diagnostic Imaging's Weekly Scan: Jan. 11 to Jan. 15, 2021

January 15, 2021
Whitney J. Palmer

COVID-19 and Long-Term Lung Effects; Reduce Emergency Department Imaging Recalls; COVID-19, Myocarditis, and Athletes; Plus, New Recommendation for X-ray Gonad Shielding

Welcome to Diagnostic Imaging’s Weekly Scan. I’m senior editor, Whitney Palmer.

Before we get to our featured interview this week with Dr. Donald Frush, instructor of radiology in the Duke University School of Medicine and Health System, about the announced recommendation against across-the-board gonad shielding with X-ray imaging from the National Council on Radiation Protection and Measurements (NCRP), here are the top stories of the week.

In contrast to what you might have anticipated, the severity of a patient’s case of COVID-19 is not necessarily linked to how well his or her lungs will recover from the virus. Fortunately, post-recovery imaging at least shows that most people’s lungs will not experience any long-term scarring. In a study from Trinity College in Dublin, published in the Annals of the American Thoracic Society, investigators followed 153 patients for an average of 75 days in an outpatient clinic, evaluating their condition with chest X-rays and CT, as well as a six-minute walk test. They also examined blood samples for disease indicators, such as C-reactive protein. The results surprised them. Only 4 percent of patients who had previous abnormal X-rays had any evidence of lung scarring on chest CT, and shorter six-minute walk test distances were associated with frailty and longer hospitalizations – not disease severity. These outcomes point to a need for greater cardiovascular and fitness assessment, as well as rehabilitation for patients who have fatigue and breathlessness after COVID-19 recovery.

Looking to reduce your emergency department medical imaging recall rates? It might be as easy as adding an attending radiologist to the overnight hours, according to University of Toronto researchers. This group of investigators tested an intervention at Sunnybrook Health Sciences Center from 2016 to 2018, and they found having an attending radiologist in-house after-hours sliced imaging exam recalls by approximately 90 percent. In fact, they said in their article in Emergency Radiology, the average number of recalls plummeted from 61 annually to 7. This drop was impressive they said since the number of images ordered in the emergency department actually rose annually during this time, climbing from 13,883 in 2016 to 15,112 in 2018. While radiology residents still provided preliminary reports and remained the main points-of-contact for referring physicians, the attending radiologists were responsible for final reports for both emergency department patients and inpatients. Not only did their intervention improve work flow, but it also improved patient comfort and safety because patient were not called back for a re-scan. In addition, emergency physicians also reported a higher level of satisfaction.

New findings this week from Vanderbilt University contradicted some alarming results published in the fall about the effects of COVID-19 on the cardiovascular health of athletes. Initially, it was reported that approximately 15 percent of athletes suffered from myocarditis, captured on cardiac MRI, after recovering from the virus. Vanderbilt’s investigators determined the real amount is 3 percent, and their findings were published by the American Heart Association in Circulation. Vanderbilt researchers compared COVID-19-positive athletes to 60 healthy controls to make this determination. Unfortunately, they realized, no screening tests that they evaluated were effective in pinpointing which athletes had myocarditis – this was a let-down because the team had hoped those screenings would have been definitive, limiting the need for cardiac MRI to the most necessary instances. Still, in one beneficial result, they found both COVID-19-positive and health athletes experience similar levels of benign scarring in healthy heart muscle in the same location, indicating it is not a consequence of the virus and should not restrict an athlete from competition.

And, finally this week, Diagnostic Imaging spoke with Dr. Donald Frush, an instructor of radiology at Duke University School of Medicine and Duke University Health System about the recommendations against the universal use of gonad shielding during X-ray imaging that were released this week. Frush, who served as the chair of the NCRP subcommittee on gonadal shielding discussed the reasoning behind the recommendation, the challenges that exist to implementing the protocol change, what facilities can do to successfully shift their shielding practice, and the drawbacks that exist to still using shielding routinely.

Here’s what he had to say.

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