A five-tiered approach to cross-sectional interventional procedures can help radiologists determine which patients to treat first, minimizing likelihood of viral transmission.
Interventional radiologists should consider a tiered approach to triaging patient procedures as a way to continue to combat the further spread of COVID-19 infection, say industry leaders.
In an article published June 3 in the American Journal of Roentgenology, researchers from a variety of academic medical centers nationwide, highlighted the need for specific steps to protect both interventional radiology providers and patients from potential viral transmission.
The nature of these procedures – frequently modality-guided, including fluid aspiration, drainage catheter placement, percutaneous biopsy, and tumor ablation – means all members of the interventional team must be particularly adept at putting on and taking off personal protective equipment. And, in some instances, patients require an admission to manage post-procedure complications.
To minimize any treatment delays that could cause patient harm, the team, led by Ghaneh Fananapazir, M.D., director of ultrasound at the University of California-Davis, suggested a five-tier approach for both inpatient and outpatient scenarios.
“Each patient must be evaluated independently for the risk-to-benefit ratio given the host of possible outcomes for each individual,” the team wrote. “A tiered approach should be considered with target windows of when to perform the procedures.”
They suggested: urgent procedures, procedures that should be performed within two weeks, procedures that should be performed within two months, procedures that can be delayed by two months, and procedures that can be delayed by six months. See Table 1 for examples of procedures that fall into each tier.
“Each procedure request must be triaged into a tier on a case-by-case basis,” the team cautioned, advocating for referring physician consultations, “because clinical circumstances can dictate one procedure as urgent, whereas different clinical data may render the same procedure safe to delay.”
Continued Safety Measures
In addition to the tiered system, Fananapazir’s team outlined specific safety protocols interventional radiologists should implement to protect themselves, their staff, and their patients during every procedure.
Hygiene: Receptionists and outpatients must follow appropriate hygiene procedures at all times.
Limit Personnel: Despite educational needs, academic institutions should consider limiting personnel in the interventional suite.
Create a Radiologist List: Develop a list of attending radiologists who can perform procedures.
Perform Procedures: Be sure procedures are conducted in a manner that will strictly control the risk of viral transmission.
Disinfect the Room: Continue to follow all recommended sanitation procedures.