National survey for investigating the diagnostic imaging departments reorganization and management during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has had a profound impact on radiography services globally. The objective of this study was to evaluate the impact of the COVID-19 pandemic on the management of radiology departments in Italy.

Methods

An online survey with 32 questions was developed and promoted by the Italian Federation of Scientific Radiographer Societies (FASTeR) and sent to all Radiology Service Managers (RSM) identified in the RSM committee of the Italian Federation of Radiographers and Health Professionals, counting for 39 Italian RSM, representing more than 1,200 radiographers. The survey included questions regarding RSM demographics data, the number of radiographers and specialties managed, the effects of the pandemic on the diagnostic imaging service, and any reorganizations that had been implemented, such as the partial or total suspension of diagnostic activities and the number of radiographers tested as positive to COVID-19.

Results

Twenty (52%) RSM from different Italian regions completed the questionnaire. A total of 70% of respondents had implemented reorganizations in terms of space, equipment, and pathways dedicated to COVID-19-infected patients, including an extension of the timing of acquisition of the exams. More than half of the respondents reported breast and DXA imaging unit had suffered the most suspension of activities. 70% of respondents reported that more than 50% of radiographers were resulted as COVID-19 positive.

Conclusion

These data show how challenging was of the reorganization of Italian diagnostic imaging departments during the COVID-19 pandemic, with impact on the suspension of some exams and the rescheduling of breast and DXA imaging. The reorganization of the services also had to consider the high number of radiographers suspended from activity due to the positivity to COVID-19, and the lengthening of the duration of the examinations due to the sanitation of the spaces.

Risk and predictive factors of prolonged viral RNA shedding in upper respiratory specimens in a large cohort of COVID-19 patients admitted to an Italian reference hospital

Background

Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS).

Methods

A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model.

Results

The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000 ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation.

Conclusions

Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present.

Management of patients with suspected or confirmed COVID-19, in the radiology department

OBJECTIVES

From December 2019, a novel coronavirus disease named COVID-19 was reported in China. Within 3 months, the World Health Organization defined COVID-19 as a pandemic, with more than 370,000 cases and 16,000 deaths worldwide. In consideration of the crucial role of diagnostic testing during COVID-19, the aim of this technical note was to provide a complete synthesis of approaches implemented for the management of suspected or confirmed COVID-19 patients.

KEY FINDINGS

The planning of a robust plan to prevent the transmission of the virus to patients and department staff members should be fundamental in each radiology service. Moreover, the speed of spread and the incidence of the pandemic make it necessary to optimize the use of personal protective devices and dedicated COVID-19 equipment, given the limited availability of supplies.

CONCLUSION

In the management of radiographic and CT imaging, staff should take special precautions to limit contamination between patients and other patients or professionals.

IMPLICATIONS FOR PRACTICE

An isolated imaging room should be dedicated to suspected or confirmed COVID-19 cases, including radiography and CT scanners. This paper will provide guidance concerning disposable protective gear to be utilized, as well as on the cleaning and sanitation of radiology room and equipment.