COVID-19 Pandemic Impact on Decreased Imaging Utilization: A Single Institutional Experience

The Financial Impact of COVID on Radiology Health Systems

The coronavirus pandemic of 2019 (COVID-19) was arguably the most pivotal global event that current generations have witnessed, with unprecedented global challenges, and colossal effects on health systems. The financial consequences, in particular, were profound and far-reaching. Staggering estimates of up to $50.7 billion dollars per month in lost revenue for the US health system were reported by the American Hospital Association (Kaye et al., 2021). The pandemic caused significant increases in cost of drugs, disruptions to medical supply chains, day-to-day workflow, and operations in all areas of medicine and various healthcare systems. Radiology experienced a significant burden of the damage, finding itself at the forefront of the pandemic's economic fallout (American Hospital Association).

Utilization trends for MR arthrography of the hip and shoulder: a retrospective cross-sectional analysis of 20-year data from a tertiary care academic medical center

OBJECTIVE

The purpose of this study is to analyze changes in the utilization of MRA of the hip and shoulder at a large tertiary care academic medical center during a period of significant technological advancements over the last 20 years.

MATERIALS AND METHODS

This retrospective cross-sectional analysis identified MRA of the hip and shoulder performed at our institution over a 20-year period (2/2003-2/2023) in relation to the total number of MR hip and shoulder examinations during the same period. Patient characteristics and referring provider demographic information were extracted. Descriptive statistics and trend analysis were performed.

RESULTS

The total number of MRIs of the hip and shoulder increased overall, with small dips in 2020 and 2022. MRA of the hip increased significantly over the first 10 years of the study period (p = 0.0005), while MRA of the shoulder did not change significantly (p = 0.33). The proportion of both MRA of the hip and shoulder declined over the last 10 years (hip, p = 0.0056; shoulder, p = 0.0017). Over the same period, there was significant increase in the proportion of examinations performed at 3 Tesla versus 1.5 (p < 0.0001).

CONCLUSION

Overall, there was a downward trend in MR shoulder and hip arthrogram utilization in the second half of this 20-year study period. However, utilization varied somewhat by referring specialties and credentials. These changes are likely reflective of both improvements in image quality and evolving practice recommendations. Awareness of such trends may be valuable in ensuring appropriate patient care, as well as for anticipating the needs of a musculoskeletal radiology practice.

Trends in breast, colon, pancreatic, and uterine cancers in women during the COVID-19 pandemic in North Carolina

IMPORTANCE

The COVID-19 pandemic led to reductions in primary care and cancer screening visits, which may delay detection of some cancers. The impact on incidence has not been fully quantified. We examined change in cancer incidence to determine how the COVID-19 pandemic may have altered the characteristics of cancers diagnosed among women.

METHODS

This study included female patients aged ≥18 years and diagnosed with breast (n = 9489), colon (n = 958), pancreatic (n = 669), or uterine (n = 1991) cancer at three hospitals in North Carolina. Using interrupted time series, we compared incidence of cancers diagnosed between March 2020 and November 2020 (during pandemic) with cancers diagnosed between January 2016 and February 2020 (pre-pandemic).

RESULTS

During the pandemic, incidence of breast and uterine cancers was significantly lower than expected compared to pre-pandemic (breast-18%, p = 0.03; uterine -20%, p = 0.05). Proportions of advanced pathologic stage and hormone receptor-negative breast cancers, and advanced clinical stage and large size uterine cancers were more prevalent during the pandemic. No significant changes in incidence were detected for pancreatic (-20%, p = 0.08) or colon (+14%, p = 0.30) cancers.

CONCLUSION AND RELEVANCE

In women, the COVID-19 pandemic resulted in a significant reduction in the incidence of breast and uterine cancers, but not colon or pancreatic cancers. A change in the proportion of poor prognosis breast and uterine cancers suggests that some cancers that otherwise would have been diagnosed at an earlier stage will be detected in later years. Continued analysis of long-term trends is needed to understand the full impact of the pandemic on cancer incidence and outcomes.

Impact of the COVID-19 pandemic and COVID vaccination campaign on imaging case volumes and medicolegal aspects

Purpose

The coronavirus pandemic (COVID-19) significantly impacted the global economy and health. Italy was one of the first and most affected countries. The objective of our study was to assess the impact of the pandemic and the vaccination campaign on the radiological examinations performed in a radiology department of a tertiary center in Southern Italy.

Materials and methods

We analyzed weekly and retrospectively electronic medical records of case volumes performed at the Radiology Department of "Mater Domini" University Hospital of Catanzaro from March 2020 to March 2022, comparing them with the volumes in the same period of the year 2019. We considered the origin of patients (outpatient, inpatient) and the type of examinations carried out (x-ray, mammography, CT, MRI, and ultrasound). A non-parametric test (Wilcoxon Signed Rank test) was applied to evaluate the average volumes.

Results

Total flows in the pandemic period from COVID-19 were lower than in the same pre-pandemic period with values of 552 (120) vs. 427 (149) median (IQR) (p < 0.001). The vaccination campaign allowed the resumption of the pre-vaccination pandemic with total flows 563 (113) vs. 427 (149) median (IQR) p < 0.001. In the post-vaccination period, the number of examinations was found to overlap with the pre-COVID period.

Conclusion

The pandemic impacted the volume of radiological examinations performed, particularly with the reduction of tests in outpatients. The vaccination allowed the return to the pre-COVID period imaging case volumes.

Evolution and impact of a dedicated ultrasound clinic on clinical rheumatology practice at an academic medical center

BACKGROUND

Rheumatologic ultrasonography (RhUS) has grown in scope and application over the past 20 years. While many studies have shown the benefits of RhUS, few have investigated the efficacy of a dedicated clinic. This study explores the impact of a dedicated ultrasound clinic on patients and rheumatologists at an academic medical center (AMC).

METHODS

We analyzed claims data for patient visits, X-rays (XR), magnetic resonance imaging (MRI), and RhUS from an AMC with an established RhUS clinic, alongside two affiliated community medical practices (CMPs) without RhUS. We also analyzed RhUS clinic records on referral indication, procedures, results, and follow-up treatment changes. Pre- and post-RhUS visit patient surveys and referring physician (RP) surveys assessed experience and impact of the RhUS clinic.

RESULTS

From 2018 to 2021, referrals to the RhUS clinic substantially increased. In parallel, XR and MRI orders changed by -76 % and -43 % respectively, compared with 163 % and -24 % at CMPs. Discordance between RP pre-RhUS assessments and RhUS results were common. Patient surveys showed RhUS led to increased disease understanding and impacted thoughts and decisions about their therapy. RPs found utility in RhUS across a range of indications and were confident with RhUS results.

CONCLUSIONS

These findings suggest a dedicated RhUS clinic can be a valuable resource in clinical rheumatology practice. Implementation of a RhUS clinic at this AMC spurred rapid adoption of RhUS into clinical decision-making with notable benefits for patients and physicians alike. This may serve as a model for implementation of similar clinics at other institutions.

The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa

Background Coronavirus (COVID-19) was officially declared a pandemic in March 2020 and has had a major impact on global healthcare services, including radiology. However, little is known about the full impact of COVID-19 on the utilization of diagnostic imaging in Africa's public healthcare sector. Objectives The objective of this study was to compare public sector diagnostic imaging utilization by modality for the whole Western Cape Province (WCP) of South Africa (SA), as well as its metropolitan and rural areas, in 2019 and 2020 in terms of the absolute number of investigations and investigations per 1000 people. Method We performed a retrospective analysis of Western Cape Government Department of Health and Wellness and Stats SA District Council 2021 Mid-Year Population Estimates data. All diagnostic imaging investigations performed in 2019 and 2020 were collated and stratified by imaging modality, geographic region (metropolitan/rural), and calendar year. Data are presented as the total number of investigations and investigations per 1000 people. We calculated mammography utilization for women aged 40-70 years and compared data for 2019 and 2020. Results Between 2019 and 2020, the provincial population increased by 1.9%, while total imaging investigations and investigations per 1000 people decreased by 19% (1,384,941 vs. 1,123,508, -261,433) and 20% (262/103 vs. 208/103), respectively. Total numerical decline was highest in plain radiographs (1,005,545 vs. 800,641, -204,904), accounting for more than three-quarters (78%) of the total reduction. Percentage decline was most pronounced for mammography, as utilization was almost halved (15.7/103 vs. 8.9/103, -43%), whereas computed tomography was the least impacted (17.9/103 vs. 16.7/103, -12%) with the remaining modalities decreasing between approximately one-quarter and one-fifth (magnetic resonance imaging = 26%, fluoroscopy = 25%, general radiographs = 23%, ultrasound = 16%, chest radiographs = 18%). Proportional metropolitan (-18.7%) and rural decreases (-19.3%) were similar. Conclusion COVID-19 had a substantial impact on WCP imaging services, decreasing overall radiological investigations by almost one-fifth. The greatest impact was on elective investigations, particularly mammography. Although the proportional impact was similar for the metropolitan and rural areas, COVID-19 nonetheless exacerbated existing discrepancies in imaging utilization between the geographical regions. The medium- and long-term clinical impacts of decreased imaging are still to be defined.

Telehealth Use During the COVID-19 Pandemic Among Veterans and Nonveterans: Web-Based Survey Study

BACKGROUND

In the first year of the COVID-19 pandemic, studies reported delays in health care usage due to safety concerns. Delays in care may result in increased morbidity and mortality from otherwise treatable conditions. Telehealth provides a safe alternative for patients to receive care when other circumstances make in-person care unavailable or unsafe, but information on patient experiences is limited. Understanding which people are more or less likely to use telehealth and their experiences can help tailor outreach efforts to maximize the impact of telehealth.

OBJECTIVE

This study aims to examine the characteristics of telehealth users and nonusers and their reported experiences among veteran and nonveteran respondents.

METHODS

A nationwide web-based survey of current behaviors and health care experiences was conducted in December 2020-March 2021. The survey consisted of 3 waves, and the first wave is assessed here. Respondents included US adults participating in Qualtrics web-based panels. Primary outcomes were self-reported telehealth use and number of telehealth visits. The analysis used a 2-part regression model examining the association between telehealth use and the number of visits with respondent characteristics.

RESULTS

There were 2085 participants in the first wave, and 898 (43.1%) reported using telehealth since the pandemic began. Most veterans who used telehealth reported much or somewhat preferring an in-person visit (336/474, 70.9%), while slightly less than half of nonveterans (189/424, 44.6%) reported this preference. While there was no significant difference between veteran and nonveteran likelihood of using telehealth (odds ratio [OR] 1.33, 95% CI 0.97-1.82), veterans were likely to have more visits when they did use it (incidence rate ratio [IRR] 1.49, 95% CI 1.07-2.07). Individuals were less likely to use telehealth and reported fewer visits if they were 55 years and older (OR 0.39, 95% CI 0.25-0.62 for ages 55-64 years; IRR 0.43, 95% CI 0.28-0.66) or lived in a small city (OR 0.63, 95% CI 0.43-0.92; IRR 0.71, 95% CI 0.51-0.99). Receiving health care partly or primarily at the Veterans Health Administration (VA) was associated with telehealth use (primarily VA: OR 3.25, 95% CI 2.20-4.81; equal mix: OR 2.18, 95% CI 1.40-3.39) and more telehealth visits (primarily VA: IRR 1.5, 95% CI 1.10-2.04; equal mix: IRR 1.57, 95% CI 1.11-2.24).

CONCLUSIONS

Telehealth will likely continue to be an important source of health care for patients, especially following situations like the COVID-19 pandemic. Some groups who may benefit from telehealth are still underserved. Telehealth services and outreach should be improved to provide accessible care for all.

The effect of Covid-19 pandemic on healthcare utilization in public vs private centers in Iran: a multiple group interrupted time-series analysis

BACKGROUND

The outbreak of Coronavirus in late 2019 and its continuation in the following years has affected all human societies, government organizations, and health systems. Access to health services is an important issue during crises. The present study aimed to investigate the effect of the Covid-19 pandemic on the consumption of health services in the public sector compared to the private sector in Iran.

METHODS

The research population consisted of all insured individuals covered by Iran Health Insurance Organization in Fars province, which amounts to approximately 2,700,000 people. The required information including the utilization of laboratory, radiology, medicine, and hospitalization services was extracted on a monthly basis from February 2019 to February 2021. The Multiple Group Interrupted Time Series Analysis (MGITSA) was used for data analysis along with STATA.15 software.

RESULTS

According to the findings of MGITSA, in the short-term, the utilization of private laboratory, radiology, medication, and hospital admissions had decreased by approximately 18,066, 8210, 135,445, and 1086 times, respectively (P < 0.05). In the long-run, the use of laboratory and radiology services had increased by about 2312 and 514 times (P < 0.05), respectively. The comparison between the public and private sectors showed that in the short-term, the use of radiology services decreased by about 12,525, while the use of medication increased by about 91,471 times (P < 0.05). In the long-run, the use of laboratory services decreased by about 1514 times (P = 0.076) and no change was observed in the other services utilization (in public relative to private centers).

CONCLUSIONS

Utilization of health services in the public versus private centers, except for medication and hospitalization, significantly decreased in the short-term. However the utilization of most services returned to the usual trend in the long-term. The reduction in access to health services could impose a significant burden of various diseases, at least in the short-term, and increase health costs in the coming years.

Implications of the COVID-19 pandemic in monitoring health and cardiovascular diseases: survey study

OBJECTIVE

To analyze the implications of COVID-19 in the monitoring of health and cardiovascular diseases in health services.

METHOD

This is a descriptive, cross-sectional, survey-type study with 798 adults, selected by snowball on social networks, between June and July 2020. Data were collected in an electronic form validated for this study.

RESULTS

There was a negative impact on monitoring health and cardiovascular diseases with missed appointments and elective exams. Symptoms such as chest pain and hypertensive crisis were neglected due to fear of contagion, lack of knowledge or structural lack of services, in addition to impaired monitoring of chronic conditions.

CONCLUSION

The severity of results is noted considering the COVID-19 progression and the risk of complications. It is necessary to organize flows and structures compatible with each care profile, in health services, to guarantee care and promote diagnosis and control of chronic conditions in the set of actions to contain pandemics. It is crucial to prioritize primary care in health follow-ups during pandemic periods, as this has a direct impact on the progression of critical conditions at other levels of care.

The impact of the COVID-19 pandemic on the use of diagnostic imaging examinations in the Brazilian unified healthcare system (SUS)

Objectives

To assess the impact of the COVID-19 pandemic on the volumes of use of diagnostic imaging examinations in the Brazilian Unified Health System (SUS), the only healthcare provider for approximately 160 million people.

Methods

We collected the monthly numbers of diagnostic imaging examinations in the years 2019, 2020, and 2021 from a database provided by SUS. Data were collected by specific type of examination across different imaging modalities, both for the outpatient (elective and emergency) and inpatient settings.

Results

There was a large reduction in the annual volume of almost all types of diagnostic imaging examinations in SUS in 2020, compared to 2019. Decreases were generally greater among outpatients than in the hospital setting, in which the annual volume of use of most modalities was similar or even higher in 2021 than in the pre-pandemic period. Computed tomography (CT) was the only modality for which use increased in 2020 compared to 2019. In contrast to other types of examinations, the use of chest CT was much higher in both 2020 and 2021 than in the preceding years. The relative changes in diagnostic imaging use in SUS started around March-April 2020, when the pandemic began to get worse in Brazil, and tended to correlate to COVID-19 incidence in Brazil over the following months.

Conclusions

The COVID-19 pandemic had a large impact on the use of diagnostic imaging examinations in the SUS. Policies and actions are needed to alleviate the resulting potential adverse health effects and to optimize the use of diagnostic tests in the future.

Impact of the COVID-19 pandemic on imaging case volumes in King Abdullah University Hospitals (KAUH)

Objective

COVID-19 has an increased burden on the delivery of services because the measures taken by the governments forced hospitals to cancel most of their elective procedures and led to the shutting down of outpatient clinics. This study aimed to evaluate the impact COVID-19 pandemic on the volume of radiology exams based on patient service locations and imaging modality in the North of Jordan.

Methods

The imaging case volumes that were performed at the King Abdullah University Hospital (KAUH), Jordan, from 1 January 2020 to 8 May 2020, were retrospectively collected and compared to those from 1 January 2019 to 28 May 2019, to determine the impact of the pandemic of COVID-19 on the volume of radiological examinations. The 2020 study period was chosen to cover the peak of COVID-19 cases and to record the effects on imaging case volumes.

Results

A total of 46,194 imaging case volumes were performed at our tertiary center in 2020 compared to 65,441 imaging cases in 2019. Overall, the imaging case volume in 2020 decreased by 29.4% relative to the same period in 2019. The imaging case volumes decreased for all imaging modalities relative to 2019. The number of nuclear images showed the highest decline (41.0%) in 2020, followed by the number of ultrasounds (33.2%). Interventional radiology was the least affected imaging modality by this decline, with about a 22.9% decline.

Conclusion

The number of imaging case volumes decreased significantly during the COVID-19 pandemic and its associated lockdown. The outpatient service location was the most affected by this decline. Effective strategies must be adopted to avoid the aforementioned effect on the healthcare system in future pandemics.

Impact of COVID-19 Pandemic on the Workload of Diagnostic Radiology: A 2-Year Observational Study in a Tertiary Referral Hospital

RATIONALE AND OBJECTIVES

To evaluate the impact of COVID-19 pandemic on diagnostic imaging workload in a tertiary referral hospital.

MATERIALS AND METHODS

Radiological examinations performed in pre-pandemic period (2015-2019) and in pandemic period (2020-2021) were retrospectively included. Based on epidemiological data and restriction measures, four pandemic waves were identified. For each of them, the relative change (RC) in workload was calculated and compared to the 5-year averaged workload in the corresponding pre-COVID-19 periods. Workload variations were also assessed according to technique (radiographs, CT, MRI, ultrasounds), body district (chest, abdomen, breast, musculoskeletal, head/neck, brain/spine, cardiovascular) and care setting (inpatient, outpatient, emergency imaging, pre-admission imaging).

RESULTS

A total of 1384380 examinations were included. In 2020 imaging workload decreased (RC = -11%) compared to the average of the previous 5 years, while in 2021 only a minimal variation (RC = +1%) was observed. During first wave, workload was reduced for all modalities, body regions and types of care setting (RC from -86% to -10%), except for CT (RC = +3%). In subsequent waves, workload increased only for CT (mean RC = +18%) and, regarding body districts, for breast (mean RC = +23%) and cardiovascular imaging (mean RC = +23%). For all other categories, a workload comparable to pre-pandemic period was almost only restored in the fourth wave. In all pandemics periods workload decrease was mainly due to reduced outpatient activity (p < 0.001), while inpatient and emergency imaging was increased (p < 0.001).

CONCLUSION

Evaluating imaging workload changes throughout COVID-19 pandemic helps to understand the response dynamics of radiological services and to improve institutional preparedness to face extreme contingency.

The financial impact of COVID-19 on a surgical department: The effects of surgical shutdowns and the impact on a health system

BACKGROUND

The COVID-19 pandemic resulted in sweeping shutdowns of surgical operations to increase hospital capacity and conserve resources. Our institution, following national and state guidelines, suspended nonessential surgeries from March 16 to May 4, 2020. This study examines the financial impact of this decision on our institution's health system by comparing 2 waves of COVID-19 cases.

METHODS

The total revenue was obtained for surgical cases occurring during the first wave of the pandemic between March 1, 2020 and July 31, 2020 and the second wave between October 1, 2020 and February 29, 2021 for all surgical departments. During the same time intervals, in the prepandemic year 2019, total revenue was also obtained for comparison. Net revenue and work relative value units per month were compared to each respective month for all surgical divisions within the department of surgery.

RESULTS

Comparing the 5-month first wave period in 2020 to prepandemic 2019 for all surgical departments, there was a net revenue loss of $99,674,376, which reflected 42% of the health system's revenue loss during this period. The department of surgery contributed to a net revenue loss of $58,368,951, which was 24.9% of the health system's revenue loss. Within the department of surgery, there was a significant difference between the net revenue loss per month per division of the first and second wave: first wave median -$636,952 [interquartile range: -1,432,627; 26,111] and second wave median -$274,626 [-781,124; 396,570] (P = .04). A similar difference was detected when comparing percent change in work relative value units between the 2 waves (wave 1: median -13.2% [interquartile range: -41.3%, -1.8%], wave 2: median -7.8% [interquartile range: -13.0%, 1.8%], P = .003).

CONCLUSION

Stopping elective surgeries significantly decreased revenue for a health system. Losses for the health system totaled $234,839,990 during the first wave, with lost surgical revenue comprising 42% of that amount. With elective surgeries continuing during the second wave of COVID-19 cases, the health system losses were substantially lower. The contribution surgery has to a hospital's cash flow is essential in maintaining financial solvency. It is important for hospital systems to develop innovative and alternative solutions to increase capacity, offer comprehensive care to medical and surgical patients, and prevent shutdowns of surgical activity through a pandemic to maintain financial security.

Oncology and cardiology positron emission tomography/computed tomography faced with COVID-19: A review of available literature data

The COVID-19 pandemic has forced people to significantly change their lifestyles and attitudes, and has greatly burdened healthcare delivery systems worldwide. The redistribution of the medical delivery system to maintain normal medical care while responding generously to COVID-19 is a continuing challenge that weighs heavily on medical institutions. Among imaging modalities, chest X-rays and computed tomography (CT) examinations have clearly made a large contribution to treatment of COVID-19. In contrast, it is difficult to express the standpoint of nuclear medicine examinations in a straightforward manner, as the greatest emphasis in this modality has been on how necessary medical care can continue to be provided. Many clinical reports of nuclear medicine examinations related to COVID-19 have been published, and knowledge continues to accumulate. This review provides a summary of the current state of oncology and cardiology positron emission tomography (PET) examinations related to COVID-19, and includes preparation of the nuclear medicine department, trends in PET examinations, specific imaging findings on 18F-fluorodeoxyglucose (FDG) PET/CT, imaging of complications of COVID-19, PET tracers other than FDG, and the effects of vaccines on PET imaging findings.

Utilization of a cloud-based radiology analytics platform to monitor imaging volumes at a large tertiary center

Rationale and objective

In this study, we evaluate the ability of a novel cloud-based radiology analytics platform to continuously monitor imaging volumes at a large tertiary center following institutional protocol and policy changes.

Materials and methods

We evaluated response to environmental factors through the lens of the COVID-19 pandemic. Analysis involved 11 CT/18 MR imaging systems at a large tertiary center. A vendor neutral, cloud-based analytics tool (CBRAP) was used to retrospectively collect information via DICOM headers on imaging exams between Oct. 2019 to Aug. 2021. Exams were stratified by modality (CT or MRI) and organized by body region. Pre-pandemic scan volumes (Oct 2019-Feb. 2010) were compared with volumes during/after two waves of COVID-19 in Illinois (Mar. to May 2020 & Oct. to Dec. 2020) using a t-test or Mann-Whitney U test.

Results

The CBRAP was able to analyze 169,530 CT and 110,837 MR images, providing a detailed snapshot of baseline and post-pandemic CT and MR imaging across the radiology enterprise at our tertiary center. The CBRAP allowed for further subdivision in its reporting, showing monthly trends in average scan volumes specifically in the head, abdomen, spine, MSK, thorax, neck, GU system, or breast.

Conclusion

The CBRAP retrieved data for 300,000 + imaging exams across multiple modalities at a large tertiary center in a highly populated, urban environment. The ability to analyze large imaging volumes across multiple waves of COVID-19 and evaluate quality-improvement endeavors/imaging protocol changes displays the usefulness of the CBRAP as an advanced imaging analytics tool.

Impact de la crise Covid-19 sur les activités de radiologie hospitalière

Le texte présenté ici réalise une synthèse des données bibliographiques disponibles, avec un focus particulier sur l’impact de la crise COVID sur les programmes de dépistage et de prise en charge précoce des cancers – illustré par l’évaluation de l’impact sur le dépistage du cancer du sein, et la prise en charge du cancer primitif du foie – et sur l’impact théorique attendu dans les années à venir.

Imaging volumes during COVID-19: A Victorian health service experience

BACKGROUND

The World Health Organisation declared the coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. While globally, the relative caseload has been high, Australia’s has been relatively low. During the pandemic, radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes.

AIM

To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.

METHODS

A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves. Weekly volumes across patient class, modality and mobile imaging were summed for periods: wave 1 (weeks 11 to 16 for 2019; weeks 63 to 68 for 2020) and wave 2 (weeks 28 to 43 for 2019; weeks 80 to 95 for 2020). Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.

RESULTS

Summed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8% in adult outpatient imaging volumes and 46.3% in paediatric emergency department imaging volumes. Adult nuclear medicine demonstrated the greatest decrease of 37.1% for the same period. Paediatric nuclear medicine showed the greatest decrease of 47.8%, with angiography increasing by 50%. The pandemic’s second wave demonstrated the greatest decrease of 23.5% in adult outpatient imaging volumes, with an increase of 18.2% in inpatient imaging volumes. The greatest decrease was 28.5% in paediatric emergency department imaging volumes. Nuclear medicine showed the greatest decrease of 37.1% for the same period. Paediatric nuclear medicine showed the greatest decrease of 36.7%. Mobile imaging utilisation increased between 57.8% and 135.1% during the first and second waves. A strong correlation was observed between mobile and non-mobile imaging in the emergency setting (Spearman’s correlation coefficient = -0.743, P = 0.000). No correlation was observed in the inpatient setting (Spearman’s correlation coefficient = -0.059, P = 0.554).

CONCLUSION

Nuclear medicine was most impacted, while computed tomography and angiography were the least affected by the pandemic. The impact was less during the pandemic’s second wave. Mobile imaging shows continuous growth during both waves.

Health situation in Germany during the COVID-19 pandemic. Developments over time for selected indicators of GEDA 2019/2020 - An update

The spread of the coronavirus SARS-CoV-2 in 2020 and the containment measures associated therewith have changed many aspects of daily life. An impact on health even beyond infections itself is assumed as well. The health situation of the population in the first phase of the pandemic was thus analysed using data from the German Health Update (GEDA 2019/2020-EHIS). By continuing the survey, the analyses for 2020 are completed (n=26,507 participants), whereby the focus is now on the third phase of the pandemic (second wave of infection, gradual reintroduction of containment measures). The health indicators are presented on a monthly basis. As in the first phase of the pandemic, no pandemic-related changes were observed for tobacco smoking/ second-hand smoke exposure and for received/lack of/provided support. In contrast to the first phase of the pandemic, declines in utilisation of medical services and depressive symptoms are not observed in the third phase. The increase in body weight/body mass index after the first phase of the pandemic did not continue. The survey period allows for a comparison of the periods before and as of the pandemic situation. A decrease in the medical services utilisation and depressive symptoms as well as an increase in the body weight/body mass index is observed in the period from March 2020 to January 2021 compared to the pre-pandemic period from April 2019 to March 2020.

Impact of the COVID pandemic on emergency department CT utilization: where do we go from here?

Purpose

To analyze the impact of the coronavirus disease (COVID) pandemic on emergency department (ED) computed tomography (CT) utilization.

Methods

A retrospective observational study was conducted assessing seven hospitals’ ED imaging volumes between Jan. 6, 2019, and Feb. 27, 2021. Weekly CT utilization is reported as CTs ordered per 100 ED visits. Utilization was ascertained in aggregate and by body area. Interrupted time series analysis was performed to assess significance of utilization change. Prespecified sensitivity analysis was performed for influenza-like or COVID-like illness (ILI/CLI).

Results

Weekly ED CT utilization increased from 35.9 CTs per 100 visits (95% confidence interval [95% CI] 35.8–36.1) to 41.8 per 100 visits (95% CI 41.7–42.0) in pre- and post-pandemic periods. Weekly ED CT chest utilization increased immediately following the pandemic declaration (+ 0.52 chest CTs per 100 ED visits, 95% CI 0.01–1.03, p < 0.05) and compared to pre-pandemic period (+ 0.02 per 100 ED visits, 95% CI 0.02–0.05, p < 0.02). For both CT abdomen/pelvis and CT head, there was neither an immediate effect (+ 0.34 CT-AP per 100 ED visits, 95% CI − 0.74 to 1.44, p = 0.89; − 0.42 CT-H per 100 ED visits, 95% CI − 1.53 to 0.70, p = 0.46) nor a change in weekly CT utilization (+ 0.03 CT-AP per 100 ED visits, 95% CI − 0.01 to 0.05, p = 0.09; + 0.03 CT-H per 100 ED visits, 95% CI − 0.01 to 0.06, p = 0.10). 

Conclusion

These data may help formulate future strategies for resource utilization and imaging operations as we envision a future with COVID and other federal mandates affecting imaging utilization and appropriateness.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10140-022-02071-z.

Impact of COVID-19 Pandemic on Trauma CT Imaging

Purpose

The goal of this study was to understand the impact of COVID-19 pandemic and associated lockdown measures on the volume, rate, and type of trauma presenting to the emergency department (ED) by using trauma-initiated CT studies to capture patient data.

Materials and Methods

We performed a retrospective observational study comparing patients undergoing CT scans for trauma during the 1^st and 2^nd lockdown periods compared to corresponding prepandemic months. During two lockdown periods, public places such as restaurants, libraries, parks, and shops across the province were shut down. Government-led messaging advised that people should stay at home and practice social distancing. The rate of trauma-initiated CT scans and the proportion of different types of traumas were compared between time periods.

Results

There was no significant difference in overall trauma-initiated CT scans between the prepandemic and pandemic levels. Motor vehicle collision (MVC) cases decreased from 18.2% to 15.6% during the first lockdown period (p = 0.049) and also reduced from 29.1% to 25.2% during the second lockdown period (p = 0.013). Trauma from falls increased from 19.1% to 27.5% (p = 0.036) during the first lockdown, despite no significant change during the 2^nd lockdown. Furthermore, the percentage of stab injuries increased from 25.0% to 38.9% while blunt trauma decreased from 68.5% to 54.3% during two lockdowns (p = 0.015).

Conclusion

The total number of trauma-initiated CT scans did not significantly decrease during the lockdown periods. Stabbings and falls increased during lockdown periods while MVCs and blunt trauma decreased.

The impact of COVID-19 on Western Australian medical imaging clinical practice and workplace

Introduction

Medical imaging plays a key role in the management of patients with coronavirus disease‐2019 (COVID‐19). This field is at risk from the impacts of the pandemic on the practice and workplace of medical imaging professionals (MIPs). Recent research has explored this impact internationally and in various states of Australia; however, the impact of the pandemic on Western Australian (WA) MIPs is yet to be examined.

Methods

This cross‐sectional study aimed to address this issue by surveying clinically practicing WA MIPs on their experience of the impact of COVID‐19. The survey was conducted online between the 1^st and the 31^st of May 2021 and encompassed 101 clinical sites.

Results

Fifty‐one valid (17.1%) responses were recorded, and a majority (66.7%) of the participants were employed in public hospitals. The results showed that most participants (94.1%) perceived an impact on their clinical practice, with expressions of insufficient access to personal protective equipment (PPE). The use of all the appropriate PPE items were dependent on whether the participants were employed in a public hospital, private hospital, or a private practice (P = 0.001). Perceived imaging volume decrease across modalities did not differ significantly among the workplaces, except for interventional radiology (P = 0.006). The participants also expressed concerns about inadequate psychological support.

Conclusions

COVID‐19 has enhanced infection control procedures and modified the routine imaging patterns. Specifically, WA medical imaging centres have altered their PPE and cleaning procedures based on updated health advice. Efforts should be taken to strengthen the support provided to the staff members and to ensure adequate access to PPE supplies.

Characterization of Pediatric Imaging Trends and Likelihood of Exam Cancellation in the COVID-19 Pandemic

Rationale and Objective

The COVID-19 pandemic has caused unprecedented changes in radiology practice worldwide. There is a need for a framework of pediatric radiology resource allocation for future acute resource-limited settings.The aim of this study is to quantify and analyze changes in pediatric radiology practice during the COVID-19 pandemic considering demographic and clinical characteristics.

Materials and Methods

We retrospectively searched our institution's electronic health record for pediatric imaging exams from 09/15/19 to 05/01/20, with 03/15/20 as the dividing date between baseline and pandemic periods. Age, modality, exam indication, need for anesthesia/sedation, and exam completion or cancellation were recorded. All exams were compared between baseline and pandemic periods using a chi-square test and a logistic regression multivariate analysis.

Results

15,424 exams were included for analysis [13,715 baseline period (mean age 10±5 years; 7440 males); 1047 COVID-19 period (mean age 9±5 years; 565 males)]. A statistically significantly lower proportion of adolescent exams (45.5% vs 53.3%), radiography modality (62.4% vs 70.4%) and non-traumatic pain indication (39.1% vs 46.3%) was observed during the COVID-19 period. Conversely, we found a higher proportion of neonatal (5.8% vs 3.8%), infant (5.6% vs 4.1%) and early childhood patients (12.9% vs 9.8%), CT (7.4% vs 5.9%) and ultrasound modalities (18.3% vs 13.5%), oncologic (8.8% vs 6.5%) and congenital/development disorder indications (6% vs 3.9%), and studies performed under anesthesia (2.7% vs 1.3%). Regarding exam completion rates, the neonatal age group (OR 1.960 [95% CI 0.353 – 0.591]; p <0.020) and MRI modality (OR 1.502 [95% CI: 0.214 – 0.318]; p <0.049) had higher odds of completion during the COVID-19 pandemic, while fluoroscopy modality was associated with lower odds of completion (OR 0.524 [95% CI: 0.328 – 0.839]; p = 0.011).

Conclusion

The composition and completion of pediatric radiology exams changed substantially during the COVID-19 pandemic. A sub-set of exams resilient to cancellation was identified.

COVID-19 pandemic and the effect of increased utilisation of mobile X-ray examinations on radiation dose to radiographers

Introduction

The use of ionising radiation results in occupational exposure to medical imaging professionals, requiring routine monitoring. This study aims to assess the effect of increased utilisation of mobile X‐ray units, mobile imaging of non‐routine body regions and radiographer work practice changes for impact on staff radiation dose during the early stages of the COVID‐19 pandemic.

Methods

A retrospective analysis of general radiology departments across two metropolitan hospitals was performed. Personal radiation monitor exposure reports between January 2019 and December 2020 were analysed. Statistical analysis was conducted using a Mann–Whitney U test when comparing each quarter, from 2019 to 2020. Categorical data were compared using a Chi‐squared test.

Results

Mobile X‐ray use during the pandemic increased approximately 1.7‐fold, with the peak usage observed in September 2020. The mobile imaging rate per month of non‐routine body regions increased from approximately 6.0–7.8%. Reported doses marginally increased during Q2, Q3 and Q4 of 2020 (in comparison to 2019 data), though was not statistically significant (Q2: P = 0.13; Q3: P = 0.31 and Q4 P = 0.32). In Q1, doses marginally decreased and were not statistically significant (P = 0.22).

Conclusion

Increased utilisation and work practice changes had no significant effect on reported staff radiation dose. The average reported dose remained significantly lower than the occupational dose limits for radiation workers of 20 mSv.

Abdominal Imaging Utilization during the First COVID-19 Surge and Utility of Abdominal MRI

We sought to determine relative utilization of abdominal imaging modalities in coronavirus disease 2019 (COVID-19) patients at a single institution during the first surge and evaluate whether abdominal magnetic resonance imaging (MRI) changed diagnosis and management. 1107 COVID-19 patients who had abdominal imaging were analyzed for modality and imaging setting. Patients who underwent abdominal MRI were reviewed to determine impact on management. Of 2259 examinations, 80% were inpatient, 14% were emergency, and 6% were outpatient consisting of 55% radiograph (XR), 31% computed tomography (CT), 13% ultrasound (US), and 0.6% MRI. Among 1107 patients, abdominal MRI was performed in 12 within 100 days of positive SARS-CoV-2 PCR. Indications were unrelated to COVID-19 in 75% while MRI was performed for workup of acute liver dysfunction in 25%. In 1 of 12 patients, MRI resulted in change to management unrelated to COVID-19 diagnosis. During the first surge of COVID-19 at one institution, the most common abdominal imaging examinations were radiographs and CT followed by ultrasound with the majority being performed as inpatients. Future COVID-19 surges may place disproportionate demands on inpatient abdominal radiography and CT resources. Abdominal MRI was rarely performed and did not lead to change in diagnosis or management related to COVID-19 but needs higher patient numbers for accurate assessment of utility.

Disparities in the Use of In-Person and Telehealth Primary Care Among High- and Low-Risk Medicare Beneficiaries During COVID-19

We conducted a retrospective cohort study using a difference-in-differences design to estimate differences in primary care outpatient clinic visit utilization among high- and low-risk Medicare aging beneficiaries from an Accountable Care Organization during the COVID-19 pandemic compared to a control cohort from the previous year. High-risk was defined as having a Hierarchical Condition Category score of 2 or higher. A total of 582 101 patient-month records were analyzed. After adjusting for patient characteristics, those in the high-risk group had 339 (95% CI [333, 345]) monthly outpatient encounters (in-person and telehealth) per 1000 patients compared to 186 (95% CI [182, 190]) in the low-risk group. This represented a 22.8% and 26.5% decline from the previous year in each group, respectively. Within each group, there was lower utilization among those who were older, male, or dually eligible for Medicaid in the high-risk group and among those who were younger, male, or non-white in the low-risk group. Telehealth use was less common among patients who were older, dually eligible for Medicaid or living in rural/suburban areas compared to urban areas. All results were significant at the 95% level. We found significant disparities based on age, gender, insurance status, and non-white race in primary care utilization during the pandemic among Medicare beneficiaries. With the exception of gender, these disparities differed between high- and low-risk groups. Interventions targeting these vulnerable groups may improve health equity in the setting of public health emergencies.

COVID-19 Pandemic-Associated Changes in the Acuity of Brain MRI Findings: A Secondary Analysis of Reports Using Natural Language Processing

Rationale and Objectives

We aimed to assess early COVID-19 pandemic-associated changes in brain MRI examination frequency and acuity of imaging findings acuity.

Methods

Using a natural language processing model, we retrospectively categorized reported findings of 12,346 brain MRI examinations performed during 6-month pre-pandemic and early pandemic time periods across a large metropolitan health system into 3 acuity levels: (1) normal or near normal; (2) incidental or chronic findings not requiring a management change; and (3) new or progressive findings requiring a management change. Brain MRI frequency and imaging finding acuity level were compared over time.

Results

Between March and August of 2019 (pre-pandemic) and 2020 (early pandemic), our health system brain MRI examination volumes decreased 17.0% (6745 vs 5601). Comparing calendar-matched 6-month periods, the proportion of higher acuity findings increased significantly (P< 0.001) from pre-pandemic (22.5%, 43.6% and 34.0% in acuity level 1, 2, and 3, respectively) to early pandemic periods (19.1%, 40.9%, and 40.1%). During the second 3 months of the early pandemic period, as MRI volumes recovered to near baseline, the proportion of higher acuity findings remained high (42.6% vs 34.1%) compared with a similar pre-pandemic period. In a multivariable analysis, Black (B coefficient, 0.16) and underinsured population (B coefficient, 0.33) presented with higher acuity findings (P< 0.05).

Conclusions

As the volume of brain MRI examinations decreased during the early COVID-19 pandemic, the relative proportion of examinations with higher acuity findings increased significantly. Pandemic-related changes in patient outcomes related to reduced imaging access merits further attention.

Radiology Imaging Volume Changes During Discrete COVID-19 Pandemic Waves: Implications for the Delta Variant of Coronavirus and Future Pandemics

Purpose

The aim of this study was to evaluate radiology imaging volumes at distinct time periods throughout the coronavirus disease 2019 (COVID-19) pandemic as a function of regional COVID-19 hospitalizations.

Methods

Radiology imaging volumes and statewide COVID-19 hospitalizations were collected, and four 28-day time periods throughout the COVID-19 pandemic of 2020 were analyzed: pre–COVID-19 in January, the “first wave” of COVID-19 hospitalizations in April, the “recovery” time period in the summer of 2020 with a relative nadir of COVID-19 hospitalizations, and the “third wave” of COVID-19 hospitalizations in November. Imaging studies were categorized as inpatient, outpatient, or emergency department on the basis of patient location at the time of acquisition. A Mann-Whitney U test was performed to compare daily imaging volumes during each discrete 28-day time period.

Results

Imaging volumes overall during the first wave of COVID-19 infections were 55% (11,098/20,011; P < .001) of pre–COVID-19 imaging volumes. Overall imaging volumes returned during the recovery time period to 99% (19,915/20,011; P = .725), and third-wave imaging volumes compared with the pre–COVID-19 period were significantly lower in the emergency department at 88.8% (7,951/8,955; P < .001), significantly higher for outpatients at 115.7% (8,818/7,621; P = .008), not significantly different for inpatients at 106% (3,650/3,435; P = .053), and overall unchanged when aggregated together at 102% (20,419/20,011; P = .629).

Conclusions

Medical imaging rebounded after the first wave of COVID-19 hospitalizations, with relative stability of utilization over the ensuing phases of the pandemic. As widespread COVID-19 vaccination continues to occur, future surges in COVID-19 hospitalizations will likely have a negligible impact on imaging utilization.

Has the COVID-19 outbreak changed the way we are treating prostate cancer? An EAU - YAU Prostate Cancer Working Group multi-institutional study

Introduction

The COVID-19 outbreak has become the dominant issue throughout the world whilst the governments, nations and health services are trying to deal with its impact. The aim of our study is to assess the impact of COVID-19 on patients treated with radical prostatectomy (RP) for prostate cancer (PCa) at European referral centers in terms of surgical volume (SV), waiting list meant as time from biopsy to surgery (WL) and risk of adverse pathologic findings at RP due to the selection of men with more adverse disease characteristics at final pathology.

Material and methods

Consecutive patients with a diagnosis of histologically proven PCa treated with RP between March 2020 (WHO declaration of pandemic) and December 2020 were identified. Patients with metastatic disease not eligible to local treatment and recurrent prostate cancer after RP or RT were excluded. Patients treated at the same institutions between March 2019 and December 2019 were considered as the control group. Multivariable logistic regression analysis tested the impact of the COVID-19 outbreak on the risk of adverse pathologic findings at RP after adjusting for confounders. The percentage change of SV and WL was assessed comparing the months of pandemic with the equivalent timespan of the previous year.

Results

A total of 2,574 patients treated with RP (927 cases and 1647 controls) were identified in 8 European tertiary referral centers. At multivariable analysis patients who were treated during the pandemic had higher risk of extra prostatic disease (OR:1.35, p = 0.038) and lymph node invasion (LNI) (OR:1.72, p = 0.048). An average 23% reduction of the SV with the equivalent timespan of the previous year allowed an illusory reduction of the WL after the peak gained during the first wave of COVID-19.

Conclusions

Our results showed that the COVID-19 outbreak resulted in a delay in the administration of curative-intent therapies in patients with localized PCa. This, in turn, resulted in a stage migration phenomenon with a potential impact on oncologic control.

Impact of the COVID-19 Pandemic on Breast Cancer Mortality in the US: Estimates From Collaborative Simulation Modeling

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has disrupted breast cancer control through short-term declines in screening and delays in diagnosis and treatments. We projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030.

METHODS

Three established Cancer Intervention and Surveillance Modeling Network breast cancer models modeled reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact.

RESULTS

By 2030, the models project 950 (model range = 860-1297) cumulative excess breast cancer deaths related to reduced screening, 1314 (model range = 266-1325) associated with delayed diagnosis of symptomatic cases, and 151 (model range = 146-207) associated with reduced chemotherapy use in women with hormone positive, early-stage cancer. Jointly, 2487 (model range = 1713-2575) excess breast cancer deaths were estimated, representing a 0.52% (model range = 0.36%-0.56%) cumulative increase over breast cancer deaths expected by 2030 in the absence of the pandemic's disruptions. Sensitivity analyses indicated that the breast cancer mortality impact would be approximately double if the modeled pandemic effects on screening, symptomatic diagnosis, and chemotherapy extended for 12 months.

CONCLUSIONS

Initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions.

Preparedness of Primary Health Care Leaders During COVID-19 Outbreak, Riyadh, Saudi Arabia: A Qualitative Study

Purpose

Our study aims to explore the preparedness of the frontline leaders of the primary health care (PHC) centres in dealing with the COVID-19 pandemic and to understand their experiences in implementing preventive interventions necessary to routinise health care service delivery.

Methods

A qualitative exploratory study was conducted using in-depth interviews with the participants in English. The interviews were transcribed verbatim, and inductive coding followed by thematic analysis was performed using NVivo version 12.

Participants

Six participants in charge of managing their respective primary health care settings were included in the study. Purposive sampling was used to identify participants until saturation was reached. After agreement, the interviews were scheduled as per availability.

Results

The results were grouped into three major themes and nine subthemes. Most leaders reported that they were trained in pandemic preparedness, but there was a lack of focused readiness to handle a massive-scale, infectious disease outbreak or pandemic. The initial lack of guidelines specific to COVID-19 was a barrier in making decisions related to staff and patient care. Services were interrupted initially and there was lack of staff since many acquired COVID-19 and were isolated. The shortage of the staff was delt by repurposing staff from other departments to the essential care services. Fears related to pandemic was one of the main concerns reported among staff and patients. Several initiatives were taken to ensure staff safety and uninterrupted service delivery to patients. The use of technology was an effective mechanism in preparing for the pandemic.

Conclusion

This qualitative study helped in understanding the experiences of primary health care leaders during the COVID-19 pandemic. The facilities lacked overall preparedness at the beginning of the pandemic; however, many initiatives were taken in course of time to ensure smooth operations and continued service delivery to the patients.

What can we learn from the SARS-COV-2 pandemic about the value of specific radiological examinations?

BACKGROUND

The SARS-COV-2 pandemic provides a natural intervention to assess practical priority setting and internal evaluation of specific health services, such as radiological services. Norway makes an excellent case as it had a very low infection rate and very few cases of COVID-19. Accordingly, the objective of this study is to use the changes in performed outpatient radiological examinations during the first stages of the SARS-COV-2 pandemic to assess the practical evaluation of specific radiological examinations in Norway.

METHODS

Data was collected retrospectively from the Norwegian Health Economics Administration (HELFO) in the years 2015-2020. Data included the number of performed outpatient imaging examinations at public hospitals and private imaging centers in Norway and was divided in to three periods based on the level of restrictions on elective health services. Results were analyzed with descriptive statistics.

RESULTS

In the first period there was a 45% reduction in outpatient radiology compared to the same time period in 2015-2019 while in period 2 and 3 there was a 25 and 6% reduction respectively. The study identified a list of specific potential low-value radiological examinations. While some of these are covered by the Choosing Wisely campaign, others are not.

CONCLUSION

By studying the priority setting practice during the initial phases of the pandemic this study identifies a set of potential low value radiological examinations during the initial phases of the SARS-COV-2 pandemic. These examinations are candidates for closer assessments for health services quality improvement.

Changes in Mammography Use by Women's Characteristics During the First 5 Months of the COVID-19 Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic led to a near-total cessation of mammography services in the United States in mid-March 2020. It is unclear if screening and diagnostic mammography volumes have recovered to prepandemic levels and whether use has varied by women's characteristics.

METHODS

We collected data on 461 083 screening mammograms and 112 207 diagnostic mammograms conducted during January 2019 through July 2020 at 62 radiology facilities in the Breast Cancer Surveillance Consortium. We compared monthly screening and diagnostic mammography volumes before and during the pandemic stratified by age, race and ethnicity, breast density, and family history of breast cancer.

RESULTS

Screening and diagnostic mammography volumes in April 2020 were 1.1% (95% confidence interval [CI] = 0.5% to 2.4%) and 21.4% (95% CI = 18.7% to 24.4%) of the April 2019 prepandemic volumes, respectively, but by July 2020 had rebounded to 89.7% (95% CI = 79.6% to 101.1%) and 101.6% (95% CI = 93.8% to 110.1%) of the July 2019 prepandemic volumes, respectively. The year-to-date cumulative volume of screening and diagnostic mammograms performed through July 2020 was 66.2% (95% CI = 60.3% to 72.6%) and 79.9% (95% CI = 75.4% to 84.6%), respectively, of year-to-date volume through July 2019. Screening mammography rebound was similar across age groups and by family history of breast cancer. Monthly screening mammography volume in July 2020 for Black, White, Hispanic, and Asian women reached 96.7% (95% CI = 88.1% to 106.1%), 92.9% (95% CI = 82.9% to 104.0%), 72.7% (95% CI = 56.5% to 93.6%), and 51.3% (95% CI = 39.7% to 66.2%) of the July 2019 prepandemic volume, respectively.

CONCLUSIONS

Despite a strong overall rebound in mammography volume by July 2020, the rebound lagged among Asian and Hispanic women, and a substantial cumulative deficit in missed mammograms accumulated, which may have important health consequences.

Recovery of outpatient imaging utilization during the first wave of the COVID-19 pandemic

Objective

During the COVID-19 pandemic, Radiology practices experienced marked reductions in outpatient imaging volumes. Our purpose was to evaluate the timing, rate, and degree of recovery of outpatient imaging during the first wave of the pandemic. We also sought to ascertain the relationship of outpatient imaging recovery to the incidence of COVID-19 cases.

Methods

Retrospective study of outpatient imaging volumes in a large healthcare system was performed from January 1, 2019-August 25, 2020. Dataset was split to compare Pre-COVID (weeks 1–9), Peak-COVID (weeks 10–15) and Recovery-COVID (weeks 16–34) periods. Chi-square and Independent-samples t-tests compared weekly outpatient imaging volumes in 2020 and 2019. Regression analyses assessed the rate of decline and recovery in Peak-COVID and Recovery-COVID periods, respectively.

Results

Total outpatient imaging volume in 2020 (weeks 1–34) was 327,738 exams, compared to 440,314 in 2019. The 2020 mean weekly imaging volumes were significantly decreased in Peak-COVID (p = 0.0148) and Recovery-COVID (p = 0.0003) periods. Mean weekly decline rate was −2580 exams/week and recovery rate was +617 exams/week. The 2020 Post-COVID (weeks 10–34) period had an average decrease of 36.5% (4813.4/13,178.6) imaging exams/week and total estimated decrease of 120,335 exams. Significant inverse correlation (−0.8338, p < 0.0001) was seen between positive-tested COVID-19 cases and imaging utilization with 1-week lag during Post-COVID (weeks 10–34) period.

Conclusion

Recovery of outpatient imaging volume during the first wave of COVID-19 pandemic showed a gradual return to pre-pandemic levels over the course of 3–4 months. The rate of imaging utilization was inversely associated with new positive-tested COVID-19 cases with a 1-week lag.

Decline and incomplete recovery in cancer diagnoses during the COVID-19 pandemic in Belgium: a year-long, population-level analysis

BACKGROUND

Oncological care was considerably impacted by the COVID-19 pandemic. Worrisome declines in diagnostic procedures and cancer diagnoses in 2020 have been reported; however, nationwide, population-based evidence is limited. Quantification of the magnitude and distribution of the remaining outstanding diagnoses is likewise lacking.

METHODS

Using accelerated delivery of data from pathology laboratories to the Belgian Cancer Registry, we compared the nationwide rates of new diagnoses of invasive cancers in 2020 to 2019.

RESULTS

We observed a 44% reduction in total diagnoses of invasive cancers in April 2020 compared with April 2019, coinciding with the first wave of the COVID-19 pandemic. The reduction was largest in older patients and for skin cancers (melanoma and nonmelanoma). Reductions in diagnosis were less pronounced among children and adolescents (0-19 years). A smaller decline was observed for most cancers with typically poorer prognosis or obvious symptoms, including some hematological malignancies, lung, and pancreatic cancer. Suspension of organized population screening programs was reflected in a strong decline in diagnosis in the screening age groups for female breast cancer (56%) and for colorectal cancer in both men (49%) and women (60%). The number of diagnoses began to increase from the end of April and stabilized at the beginning of June at or just above 2019 levels. There has yet to be a complete recovery in cancer diagnoses, with an estimated 6%, or ∼4000 diagnoses, still outstanding for all of 2020. Among solid tumors, head and neck cancers have the largest remaining year-over-year decrease in diagnoses at 14%.

CONCLUSION

These results add to the evidence of a profound impact of the COVID-19 pandemic on oncological care and identify groups at risk for continuing diagnostic delays. These data should stimulate health care providers worldwide to facilitate targeted, accessible, and efficient procedures for detection of cancers affected by this delay.

Emergency teleradiological activity is an epidemiological estimator and predictor of the covid-19 pandemic in mainland France

Background

COVID-19 pandemic highlighted the need for real-time monitoring of diseases evolution to rapidly adapt restrictive measures. This prospective multicentric study aimed at investigating radiological markers of COVID-19-related emergency activity as global estimators of pandemic evolution in France. We incorporated two sources of data from March to November 2020: an open-source epidemiological dataset, collecting daily hospitalisations, intensive care unit admissions, hospital deaths and discharges, and a teleradiology dataset corresponding to the weekly number of CT-scans performed in 65 emergency centres and interpreted remotely. CT-scans specifically requested for COVID-19 suspicion were monitored. Teleradiological and epidemiological time series were aligned. Their relationships were estimated through a cross-correlation function, and their extremes and breakpoints were compared. Dynamic linear models were trained to forecast the weekly hospitalisations based on teleradiological activity predictors.

Results

A total of 100,018 CT-scans were included over 36 weeks, and 19,133 (19%) performed within the COVID-19 workflow. Concomitantly, 227,677 hospitalisations were reported. Teleradiological and epidemiological time series were almost perfectly superimposed (cross-correlation coefficients at lag 0: 0.90–0.92). Maximal number of COVID-19 CT-scans was reached the week of 2020-03-23 (1 086 CT-scans), 1 week before the highest hospitalisations (23,542 patients). The best valid forecasting model combined the number of COVID-19 CT-scans and the number of hospitalisations during the prior two weeks and provided the lowest mean absolute percentage (5.09%, testing period: 2020-11-02 to 2020-11-29).

Conclusion

Monitoring COVID-19 CT-scan activity in emergencies accurately and instantly predicts hospitalisations and helps adjust medical resources, paving the way for complementary public health indicators.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13244-021-01040-3.

The impact of the COVID-19 pandemic on diagnostic imaging services in Australia

Introduction

The COVID‐19 pandemic is driving unprecedented changes in healthcare services worldwide. This study aimed to quantify the impact of the first wave of the COVID‐19 pandemic on diagnostic imaging services in Australia using an interrupted time series model.

Methods

Monthly data were extracted from the Australian Medicare Benefits Schedule for all diagnostic imaging services performed between January 2016 and December 2019. Holt‐Winters forecasting models were developed for total imaging services as well as for each imaging modality. The models were used to predict monthly data between January 2020 and June 2020 with a 95% confidence interval (P < 0.05). Absolute and percentage residual differences (RD) between observed and predicted services for this time period were calculated.

Results

There were statistically significant reductions in total imaging services performed in March 2020 (RD: −332260, −13.1%, 95% CI: −17.5% to −8.4%), April 2020 (RD: −716957, −32.4%, 95% CI: −36.2% to −28.1%) and May 2020 (RD: −571634, −21.4%, 95% CI: −25.1% to −17.3%). Nuclear medicine and CT services were relatively less impacted than general radiography, ultrasound, and MRI services. There was also a statistically significant increase in nuclear medicine and CT services performed in June 2020 compared to predicted values.

Conclusions

During the first wave of COVID‐19 in Australia, there was a significant reduction in total diagnostic imaging services, with variable impacts on different imaging modalities. These findings may have significant public health implications and can be used to inform evidence‐based strategies in the recovery phase of the pandemic.

National and regional trends in MRI utilization in the face of the ongoing COVID-19 pandemic

BACKGROUND AND PURPOSE

Marked reductions in imaging exams have been documented during the COVID-19 pandemic. The study aimed to examine the effect of the two waves of COVID-19 on magnetic resonance imaging (MRI) utilization at the national and regional level.

MATERIALS AND METHODS

A retrospective-archive study was conducted in Israel, comparing March-December 2020 with March-December 2018 and 2019. Data on MRI utilization were obtained from the national MRI registry, while data on confirmed COVID-19 cases, by place of residence, were obtained from the Israeli Ministry of Health open COVID-19 database.

RESULTS

The number and rate of MRI examinations decreased during the first COVID-19 wave, with the steepest drop in April 2020: 47.5% relative decrease compared to April 2019, and 42.2% compared to 2018. This was followed by a compensatory increase between the waves and a return to almost pre-pandemic levels of use, with just a modest decrease, during the second, more intense COVID wave, compared with the previous year. Existing differences between regions increased during the pandemic. The rate ratio of MRI exams between Tel-Aviv and the Northern periphery increased from 2.89 in April 2019 to 3.94 in April 2020. Jerusalem metropolitan region, with the largest burden of COVID disease, demonstrated only a modest decrease (1%) in MRI utilization during the first 10 months of the pandemic.

CONCLUSIONS

At the national level, time trends in reduced MRI utilization followed the first wave of COVID-19, and were accompanied by increased regional disparities. These changes were not explained by differences in the burden of COVID-19 disease but might be explained by unequal distribution of MRI scanners among regions. Reduced utilization was not evident during the second wave, nor at the beginning of the third wave, despite higher COVID-19 case load, demonstrating adaptation to the new normal. Patterns of MRI utilization might help policy-makers and healthcare managers predict the behavior of imaging as well as other sectors, such as elective surgical procedures, during an ongoing pandemic. This forecast might help to manage the lasting effects of the pandemic, including extended waiting times, in the months and years following its remission. In preparation for future national emergencies, timely and detailed data on MRI utilization can serve as a "sensor" for a wide array of diagnostic and interventional medical activities, providing policy-makers with an updated snapshot to guide their response at the regional and national levels.

Cancer screenings during the COVID-19 pandemic: An analysis of public interest trends

INTRODUCTION

The Coronavirus Disease 2019 (COVID-19) pandemic has impacted breast, colon, prostate, and lung cancer screenings in the U.S. by decreasing screening numbers.​We believe multiple types of cancer screenings may have been impacted during the pandemic as a result of cancellations of elective procedures and patient fear of seeking cancer screenings during a pandemic and that Google Trends may be a marker to estimate screening usage.

METHODS

Google Trends (trends.google.com) was utilized to assess public interest in multiple cancer types. We then constructed a forecasting model to determine the expected search interest had the pandemic not occurred. We then compared our models to actual screening usage during the pandemic.

RESULTS

Public interest in cancer screenings decreased precipitously at the onset of the COVID-19 pandemic. We found that the Google Trends estimated the decrease in mammogram usage 25.8% below the actual value. Similarly, Google Trends estimated the decrease in colon cancer screening usage 9.7% below the true value.

DISCUSSION

We found the decrease in public interest in breast and colon cancer screenings slightly underestimated the actual screening usage numbers, suggesting Google Trends may be utilized as an indicator for human behavior regarding cancer screening, particularly with colon and breast cancer screenings. If the negative trend in cancer screening continues and missed screenings are not appropriately corrected for, socioeconomic and racial disparities in cancer diagnoses, morbidity, and mortality will widen.

Exacerbation of Inequities in Use of Diagnostic Radiology During the Early Stages of Reopening After COVID-19

OBJECTIVE

Assess diagnostic radiology examination utilization and associated social determinants of health during the early stages of reopening after state-mandated shutdown of nonurgent services because of coronavirus disease 2019 (COVID-19).

METHODS

This institutional review board-approved, retrospective study assessed all patients with diagnostic radiology examinations performed at an academic medical center with eight affiliated outpatient facilities before (January 1, 2020, to March 8, 2020) and after (June 7, 2020, to July 15, 2020) the COVID-19 shutdown. Examinations during the shut down (March 9, 2020, to June 6, 2020) were excluded. Patient-specific factors (eg, race, ethnicity), imaging modalities, and care settings were extracted from the Research Data Warehouse. Primary outcome was the number of diagnostic radiology examinations per day compared pre- and post-COVID-19 shutdown. Univariate analysis and multivariable logistic regression determined features associated with completing an examination.

RESULTS

Despite resumption of nonurgent services, marked decrease in radiology examination utilization persisted in all care settings post-COVID-19 shutdown (869 examinations per day preshutdown [59,080 examinations in 68 days] versus 502 examinations per day postshutdown [19,594 examinations in 39 days]), with more significantly decreased odds ratios for having examinations in inpatient and outpatient settings versus in the emergency department. Inequities worsened, with patients from communities with high rates of poverty, unemployment, and chronic disease having significantly lower odds of undergoing radiology examinations post-COVID-19 shutdown. Patients of Asian race and Hispanic ethnicity had significantly lower odds ratios for having examinations post-COVID-19 shutdown compared with White and non-Hispanic patients, respectively.

DISCUSSION

The COVID-19 pandemic has exacerbated known pre-existing inequities in diagnostic radiology utilization. Resources should be allocated to address subgroups of patients who may be less likely to receive necessary diagnostic radiology examinations, potentially leading to compromised patient safety and quality of care.

Referral pattern for urologic malignancies before and during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic has required significant restructuring of healthcare with conservation of resources and maintaining social distancing standards. With these new initiatives, it is conceivable that the diagnosis of cancer care may be delayed. We aimed to evaluate differences in patient populations being evaluated for cancer before and during the COVID-19 pandemic.

METHODS AND MATERIALS

We performed a retrospective review of our electronic medical record and examined patient characteristics of those presenting for a possible new cancer diagnosis to our urologic oncology clinic. Data was analyzed using logistic and linear regression models.

RESULTS

During the 3-month period before the COVID-19 pandemic began, 585 new patients were seen in one urologic oncology practice. The following 3-month period, during the COVID-19 pandemic, 362 patients were seen, corresponding to a 38% decline. Visits per week increased to pre-COVID-19 levels for kidney and bladder cancer as the county entered the green phase. Prostate cancer visits per week remained below pre-COVID-19 levels in the green phase. When the 2 populations pre-COVID-19 and COVID-19 were compared, there were no notable differences on regression analysis.

CONCLUSION

The COVID-19 pandemic decreased the total volume of new patient referrals for possible genitourinary cancer diagnoses. The impact this will have on cancer survival remains to be determined.

Risk factors associated with physician trainee concern over missed educational opportunities during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic resulted in a transformation of clinical care practices to protect both patients and providers. These changes led to a decrease in patient volume, impacting physician trainee education due to lost clinical and didactic opportunities. We measured the prevalence of trainee concern over missed educational opportunities and investigated the risk factors leading to such concerns.

METHODS

All residents and fellows at a large academic medical center were invited to participate in a web-based survey in May of 2020. Participants responded to questions regarding demographic characteristics, specialty, primary assigned responsibility during the previous 2 weeks (clinical, education, or research), perceived concern over missed educational opportunities, and burnout. Multivariable logistic regression was used to assess the relationship between missed educational opportunities and the measured variables.

RESULTS

22% (301 of 1375) of the trainees completed the survey. 47% of the participants were concerned about missed educational opportunities. Trainees assigned to education at home had 2.85 [95%CI 1.33-6.45] greater odds of being concerned over missed educational opportunities as compared with trainees performing clinical work. Trainees performing research were not similarly affected [aOR = 0.96, 95%CI (0.47-1.93)]. Trainees in pathology or radiology had 2.51 [95%CI 1.16-5.68] greater odds of concern for missed educational opportunities as compared with medicine. Trainees with greater concern over missed opportunities were more likely to be experiencing burnout (p = 0.038).

CONCLUSIONS

Trainees in radiology or pathology and those assigned to education at home were more likely to be concerned about their missed educational opportunities. Residency programs should consider providing trainees with research or at home clinical opportunities as an alternative to self-study should future need for reduced clinical hours arise.

Interventional radiology procedural volume changes during COVID-19 initial phase: A tertiary level Midwest health system experience

BACKGROUND

To evaluate Interventional Radiology (IR) procedural volume changes at a large Midwest health system between March 17, 2020 and April 30, 2020 following a state-mandated shutdown of nonessential procedures during the initial phase of COVID-19.

METHODS

IR procedural volumes were compiled, stratified by location and compared with Diagnostic Radiology (DR) volumes during the same timeframe. Procedure volume was categorized by type, including oncology, dialysis interventions, and drainage procedures with comparisons made using Z-score test for proportions. IR and system-wide surgical procedural volume was compared with baseline values.

RESULTS

System-wide IR procedural volume decreased by 35%, with a 41% decrease in outpatient and a 25% decrease in inpatient volume during the state-mandated order. DR volume decreased by 45%, with a 57% decrease in outpatient and a 22% decrease in inpatient volume. Total IR procedural volume during the mandate was 1077 versus 1518 during the preceding six weeks. The proportion of Interventional Oncology and dialysis interventions showed no significant change (p > 0.05) while that of drainage procedures increased (p < 0.05). Compared to baseline values, system-wide procedural volumes for IR, Vascular Surgery, Urology, General Surgery, Gastroenterology and Gynecology decreased by 3%, 11%, 25%, 20%, 38% and 31% in March 2020 and 25%, 47%, 68%, 63%, 79% and 73% in April 2020 respectively.

CONCLUSION

Outpatient IR volumes were less impacted compared to DR during the initial phase of COVID-19. Oncology, dialysis and drainage interventions may be considered essential procedures due to their stability. IR volumes were less affected compared to other procedural specialties.

Operational Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic and Early Recovery Trends: University of Washington Anatomic Pathology Experience

CONTEXT.—

The coronavirus disease 2019 pandemic, caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2, has resulted in worldwide disruption to the delivery of patient care. The Seattle, Washington metropolitan area was one of the first in the United States affected by the pandemic. As a result, the anatomic pathology services at the University of Washington experienced significant changes in operational volumes early in the pandemic.

OBJECTIVE.—

To assess the impact of coronavirus disease 2019 and both state and institutional policies implemented to mitigate viral transmission (including institutional policies on nonurgent procedures) on anatomic pathology volumes.

DESIGN.—

Accessioned specimens from January to June 2020 were evaluated as coronavirus disease 2019 and institutional policies changed. The data were considered in these contexts: subspecialty, billable Current Procedural Terminology codes, and intraoperative consultation. Comparable data were retrieved from 2019 as a historical control.

RESULTS.—

There was a significant reduction in overall accessioned volume (up to 79%) from prepandemic levels during bans on nonurgent procedures when compared with 2020 pre-coronavirus disease 2019 volumes and historical controls. The gastrointestinal and dermatopathology services were most impacted, and breast and combined head and neck/pulmonary services were least impacted. Current Procedural Terminology code 88305, for smaller/biopsy specimens, had a 63% reduction during nonurgent procedure bans. After all bans on procedures were lifted, the overall volume plateaued at 89% of prepandemic levels.

CONCLUSIONS.—

A significant decrease in specimen volume was most strongly associated with bans on nonurgent procedures. Although all departmental areas had a decrease in volume, the extent of change varied across subspecialty and specimen types. Even with removal of all bans, service volume did not reach prepandemic levels.

The impact of the COVID-19 pandemic on health services utilization in China: Time-series analyses for 2016-2020

BACKGROUND

The aim of this study is to quantify the effects of the SARS-CoV-2 pandemic on health services utilization in China using over four years of routine health information system data.

METHODS

We conducted a retrospective observational cohort study of health services utilization from health facilities at all levels in all provinces of mainland China. We analyzed monthly all-cause health facility visits and inpatient volume in health facilities before and during the SARS-CoV-2 outbreak using nationwide routine health information system data from January 2016 to June 2020. We used interrupted time series analyses and segmented negative binomial regression to examine changes in healthcare utilization attributable to the pandemic. Stratified analyses by facility type and by provincial Human Development Index (HDI) - an area-level measure of socioeconomic status - were conducted to assess potential heterogeneity in effects.

FINDINGS

In the months before the SARS-CoV-2 outbreak, a positive secular trend in patterns of healthcare utilization was observed. After the SARS-CoV-2 outbreak, we noted statistically significant decreases in all indicators, with all indicators achieving their nadir in February 2020. The magnitude of decline in February ranged from 63% (95% CI 61-65%; p<0•0001) in all-cause visits at hospitals in regions with high HDI and 71% (95% CI 70-72%; p<0•0001) in all-cause visits at primary care clinics to 33% (95% CI 24-42%; p<0•0001) in inpatient volume and 10% (95% CI 3-17%; p = 0•0076) in all-cause visits at township health centers (THC) in regions with low HDI. The reduction in health facility visits was greater than that in the number of outpatients discharged (51% versus 48%; p<0•0079). The reductions in both health facility visits and inpatient volume were greater in hospitals than in primary health care facilities (p<0•0001) and greater in developed regions than in underdeveloped regions (p<0•0001). Following the nadir of health services utilization in February 2020, all indicators showed statistically significant increases. However, even by June 2020, nearly all indicators except outpatient and inpatient volume in regions with low HDI and inpatient volume in private hospitals had not achieved their pre-SARS-COV-2 forecasted levels. In total, we estimated cumulative losses of 1020.5 (95% CI 951.2- 1089.4; P<0.0001) million or 23.9% (95% CI 22.5-25.2%; P<0.0001) health facility visits, and 28.9 (95% CI 26.1-31.6; P<0.0001) million or 21.6% (95% CI 19.7-23.4%; P<0.0001) inpatients as of June 2020.

INTERPRETATION

Inpatient and outpatient health services utilization in China declined significantly after the SARS-CoV-2 outbreak, likely due to changes in patient and provider behaviors, suspension of health facilities or their non-emergency services, massive mobility restrictions, and the potential reduction in the risk of non-SARS-COV-2 diseases. All indicators rebounded beginning in March but most had not recovered to their pre-SARS-COV-2 levels as of June 2020.

FUNDING

The National Natural Science Foundation of China (No. 72042014).

Sources of Revenue Loss and Recovery in Radiology Practices During the Coronavirus Disease 2019 (COVID-19) Pandemic

Rationale and Objectives

This study seeks to quantify the financial impact of COVID-19 on radiology departments, and to describe the structure of both volume and revenue recovery.

Materials and Methods

Radiology studies from a large academic health system were retrospectively studied from the first 33 weeks of 2020. Volume and work relative value unit (wRVU) data were aggregated on a weekly basis for three periods: Presurge (weeks 1–9), surge (10–19), and recovery (20–33), and analyzed compared to the pre-COVID baseline stratified by modality, specialty, patient service location, and facility type. Mean and median wRVU per study were used as a surrogate for case complexity.

Results

During the pandemic surge, case volumes fell 57%, while wRVUs fell by 69% relative to the pre-COVID-19 baseline. Mean wRVU per study was 1.13 in the presurge period, 1.03 during the surge, and 1.19 in the recovery. Categories with the greatest mean complexity declines were radiography (−14.7%), cardiothoracic imaging (−16.2%), and community hospitals overall (−15.9%). Breast imaging (+6.5%), interventional (+5.5%), and outpatient (+12.1%) complexity increased. During the recovery, significant increases in complexity were seen in cardiothoracic (0.46 to 0.49), abdominal (1.80 to 1.91), and neuroradiology (2.46 to 2.56) at stand-alone outpatient centers with similar changes at community hospitals. At academic hospitals, only breast imaging complexity remained elevated (1.32 from 1.17) during the recovery.

Conclusion

Reliance on volume alone underestimates the financial impact of the COVID-19 pandemic as there was a disproportionate loss in high-RVU studies. However, increased complexity of outpatient cases has stabilized overall losses during the recovery.

Impact of COVID-19 on Breast Imaging Practice Operations and Recovery Efforts: A North American Study

OBJECTIVE

To assess the impact of the COVID-19 pandemic on breast imaging facilities' operations and recovery efforts across North America.

METHODS

A survey on breast imaging facilities' operations and strategies for recovery during the COVID-19 pandemic was distributed to the membership of the Society of Breast Imaging and National Consortium of Breast Centers from June 4, 2020, to July 14, 2020. A descriptive summary of responses was performed. Comparisons were made between demographic variables of respondents and questions of interest using a Pearson chi-square test.

RESULTS

There were 473 survey respondents (response rate of 13%). The majority of respondents (70%; 332/473) reported 80%-100% breast imaging volume reduction, with 94% (447/473) reporting postponement of screening mammography. The majority of respondents (97%; 457/473) continued to perform biopsies. There were regional differences in safety measures taken for staff (P = 0.004), with practices in the West more likely reporting no changes in the work environment compared to other regions. The most common changes to patients' experience included spacing out of furniture in waiting rooms (94%; 445/473), limiting visitors (91%; 430/473), and spacing out appointments (83%). A significantly higher proportion of practices in the Northeast (95%; 104/109) initiated patient scheduling changes compared to other regions (P = 0.004).

CONCLUSION

COVID-19 had an acute impact on breast imaging facilities. Although common national operational patterns emerged, geographic variability was notable in particular in recovery efforts. These findings may inform future best practices for delivering breast imaging care amid the ongoing and geographically shifting COVID-19 pandemic.

Population-level impact of coronavirus disease 2019 on breast cancer screening and diagnostic procedures

BACKGROUND

To understand how health care delays may affect breast cancer detection, the authors quantified changes in breast‐related preventive and diagnostic care during the coronavirus disease 2019 (COVID‐19) pandemic.

METHODS

Eligible women (N = 39,444) were aged ≥18 years and received a screening mammogram, diagnostic mammogram, or breast biopsy between January 1, 2019 and September 30, 2020, at 7 academic and community breast imaging facilities in North Carolina. Changes in the number of mammography or breast biopsy examinations after March 3, 2020 (the first COVID‐19 diagnosis in North Carolina) were evaluated and compared with the expected numbers based on trends between January 1, 2019 and March 2, 2020. Changes in the predicted mean monthly number of examinations were estimated using interrupted time series models. Differences in patient characteristics were tested using least squares means regression.

RESULTS

Fewer examinations than expected were received after the pandemic's onset. Maximum reductions occurred in March 2020 for screening mammography (−85.1%; 95% CI, −100.0%, −70.0%) and diagnostic mammography (−48.9%; 95% CI, −71.7%, −26.2%) and in May 2020 for biopsies (−40.9%; 95% CI, −57.6%, −24.3%). The deficit decreased gradually, with no significant difference between observed and expected numbers by July 2020 (diagnostic mammography) and August 2020 (screening mammography and biopsy). Several months after the pandemic's onset, women who were receiving care had higher predicted breast cancer risk (screening mammography, P < .001) and more commonly lacked insurance (diagnostic mammography, P < .001; biopsy, P < .001) compared with the prepandemic population.

CONCLUSIONS

Pandemic‐associated deficits in the number of breast examinations decreased over time. Utilization differed by breast cancer risk and insurance status, but not by age or race/ethnicity. Long‐term studies are needed to clarify the contribution of these trends to breast cancer disparities.

In this observational study, the use of screening mammography, diagnostic mammography, and breast biopsy is significantly lower than expected after the onset of the COVID‐19 pandemic in North Carolina, but the deficits decrease over time. Health insurance status and predicted breast cancer risk are identified as predictors of mammography and biopsy receipt during the pandemic.

The COVID-19 pandemic: impact on NHS England PET-CT services and lessons learnt

PURPOSE

The purpose of the study was to examine the impact of the first wave of COVID-19 on National Health Service (NHS) 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET-CT) scanning activity across England.

METHODS

Monthly FDG PET-CT scanning activity was collected from 41/48 NHS England provider sites. Data from 31/41 sites were stratified by nononcology/oncology, cancer type, with lung cancer and lymphoma split into specific indications, turn-around times and delays due to radiotracer.

RESULTS

In April and May 2020, a 32 and 31% decrease in activity was observed, a larger decrease for noncancer compared with cancer FDG PET-CT. In June 2020, activity started to recover with 6% fewer scans recorded compared with June 2019. Of the six most common indications, lung and oesophageal cancer had the largest decrease in activity and slowest recovery. Lymphoma and melanoma showed the smallest decrease and fastest recovery. Lung cancer scans for initial diagnosis/staging saw the largest fall and slowest recovery compared with scans for known lung cancer. There was no percentage increase in overall turn-around time compared with the same months in 2019, and no increase in turn-around time of more than 7 working days due to FDG supply during April and May 2020 compared with the 3 previous months.

CONCLUSIONS

There is no correlation between FDG PET-CT activity (fall and recovery) in England and the ability to provide the service by NHS England. It most likely reflects a combination of changes in health-seeking behaviour, NHS health policy and a decrease in the use of investigations that carry a high risk of COVID-19 transmission.