Priti Kapoor, Radiology Head, MGM medical college writes about the challenges faced by radiologists and how the radiology department and its logistics and processes have to be realigned to this new normal.
Recognised as recently as December, 2019 with the reporting of a cluster of cases of pneumonia in Wuhan, Hubei province of China, the causative agent of COVID-19, the Novel Coronavirus, possibly a hybrid virus, has risen like a mammoth Frankensteinian monster, that is today posing a challenge to every aspect of human existence and sustenance. From health to industry, education to economy, mental wellbeing to social ethos and everything else imaginable, it is posing relentless, hitherto unprecedented challenges for humanity. Given its unpredictable and indomitable march of devastation, in a matter of a couple of months, it rapidly evolved into a pandemic as declared by World Health Organization (WHO) on the 11th of March 2020. COVID-19 has earned the ominous distinction of being the most disastrous pandemic in recent history, its exit not imminent anywhere close-by in the near-future; the numbers in most countries continue to remain in epidemic proportions. Therefore, we have to learn to live with the pandemic with new innovative ways to keep ourselves safe till a cure is in sight. With easing of lockdowns and humans throwing caution to the winds, our challenges threaten now even more menacingly and forebode a gloomy path ahead even as herd immunity seems evasive yet and the efficacy of vaccines yet questionable; we just cannot afford to take this treacherous virus lightly! Prevention is the best recourse to look at, even though easy by no means!
The radiologist has a very crucial role to play in the management of the present pandemic, from the diagnosis to its active management. While clinicians shy away from auscultation in many instances, Radiology remains a key tool in the COVID workup and follow up. While workload in many departments has dwindled due to low footfall even as they struggle to stay afloat and remain relevant, Radiology has to cope with the excessive demand. Faced with the daunting task of keeping the Radiologist and technician safe, it is a challenge to balance between the demands of the clinician who wants quick answers to the queries posted by COVID, unaware of the ground realities for the Radiologist and the operational challenges faced by the department vis-à-vis the resources at hand in that particular institution. The big concerns for Radiology are two; logistics and safety. The challenge is to keep the manpower and patients and equipment safe while providing prompt services and solutions for the clinician and the patient. The onus is upon the Radiologist to reduce unwarranted investigations, especially those which require patient contact for longer periods such as USG and Doppler and bed-side Radiography and Interventional procedures as also to teach the clinical fraternity prudence in ordering investigations, to identify and to provide the correct tool at the right stage of the disease.
Departmental SOPs are mandatory to address various issues, including safety concerns, especially of the vulnerable and the immunocompromised. SOPs should be circulated to different departments to ensure compliance.
Clinicians have to be coaxed to adjust; mutual trust and dialogue is helpful, calmly dealing with roadblocks, essential.
Optimal utilization of resources is to be planned by the head of the department, communicated to the management and referring clinicians as also close monitoring of execution of the SOPs with an open-minded flexibility to change operational protocols to adjust to evolving demands of COVID or fresh new guidelines by central health agencies. For ease of operation and coordination between different departments, innovative tools can be resorted to, like Whatsapp groups which ensure prompt delivery of services 24×7.
Logistics will have to get revamped to adjust to the new normal; an empathetic management is much desirable. We have to recognize that this pandemic has economic repercussions like never before.
Human resource, the most valued asset in healthcare, has to be nurtured with a dose of empathy and encouragement, frequent counseling, pep talks, duty rotations, leave, quarantine protocols all bespoke for the department’s needs, we cannot afford to have our health care workers coming down like a pack of cards.
Given the largely closed milieu of any Radiology department with the air conditioning and a relatively higher density of people per unit area in a closed environment, the Radiology suite is definitely a vulnerable zone. The air conditioning poses challenges; all hospitals in India may not have hepa filters in their Radiology unit but all do have ACs and frequent cleaning of filters is mandatory.
OPD patients should be allowed access to the Radiology suite only after screening; infrared thermometers, a check-list questionnaire is a must. Rapid isolation should be done of outpatients suspected of having COVID 19 at screening; they should be directed to the fever clinic. Those who are allowed access should compulsorily wear a mask and if a Radiological test shows findings suspicious of COVID, be rapidly isolated and sent to the fever clinic. Exposed staff and the HCW should be directed to the infection control team for the purpose of decision on quarantine/testing protocol.
Ideally portable imaging should be resorted to as far as possible with dedicated machines marked for COVID areas and Imaging reserved only for those COVID patients where it will impact management. However, every centre will not have an exclusive machine to spare which is a major challenge for many
Strict infection control protocols have to be adhered to like proper hand sanitization, appropriate PPEs for different areas of work, proper training for donning and doffing, facility for technician to shower, change to fresh scrubs/fresh clothes after exposure to positive cases, regular surface disinfection with freshly prepared one percent hypochlorite solution, after every patient, a contact period of 20min, hence a gap of 30 minutes between each X ray or USG case, and of 1 hr in CT/ MRI as the process on the larger machines will be more time consuming, use of five per cent glutaraldehyde for ultrasound transducers. Fumigation with non formaldehyde agents like D-125 that helps cut down the aerosol viral load in closed spaces, should be done during silent hours. Company clearance and directives should be taken from respective equipment manufacturers regarding safety of machines during disinfection and fumigation. Moisture due to surface disinfection by hypochlorite is a challenge so if one can afford it, Bacillol or Sterillium or spirit can be resorted to for surface decontamination and UV light for aerosol decontamination, the latter with a timer and motion sensor to handle its safety concerns.
Suddenly, this is the new world, the Radiology department and its logistics and processes have to be realigned to this new normal. All healthcare workers should strictly practice safe-distancing and following proper mask etiquette along with supplementation to boost their immunity. The path ahead is tough but with adherence to strict protocol and firm resolve and commitment we shall hopefully overcome