While helpful in protecting staff and patient health, tactics employed to reduce the spread of COVID-19 have disrupted clinical workflows and led to high levels of anxiety for radiologists across the U.S.

That’s what researchers at the University of Southern California found in survey responses from nearly 700 radiologists in 44 states, which indicated high levels of anxiety among a majority of radiologists, as well as decreases in workload and uncertainty regarding some of their facility’s preparedness against the pandemic.

“COVID-19 has had a significant impact on radiologists across the nation,” wrote the authors in their study. “As these unique stressors continue to evolve, further attention must be paid to the ways in which we may continue to support radiologists working in drastically altered practice environments and in remote settings.”

The use of chest CT for diagnosis and screening of the virus has come under scrutiny, resulting in conflicting guidelines from different societies. Heightened infection control protocols have also made it harder to meet demand for urgent imaging in many facilities, as cleaning protocols for persons under investigation (PUI) may require up to an hour of downtime in between scans.

Of the 1,521 radiologists contacted, 689 responses met the criteria for inclusion in the analysis, which assessed answers given to 43 questions, participants' general demographics and their perceived influence of the pandemic on broad impact, clinical duties, institutional preparedness, research and education, finances, and psychological impact.

As many as 61% rated their level of anxiety as 7 out of 10 or greater. Higher scores positively correlated the standardized number of COVID-19 cases in a respondent’s state. High levels of anxiety were commonly attributed to family health (71%), personal health (47%), and financial concerns (33%). The most common coping strategies were family time (59%) and exercise (57%). Participants who reported needing no coping methods were more likely to self-report lower anxiety scores.

Almost 43% of radiologists indicated they either did not know about or had no access to COVID-19 testing. On an institutional level, 76% felt their medical center was adequately prepared for the chance of a surge, compared to 23% who did not. Only 40% reported their facility to have a mass casualty imaging plan in place, while 60% said there was an increase in utilization of portable imaging. Sixty-five percent said they had adequate teleradiology support, and even fewer reported their medical center had adequate PPE for staff (51%) and patients (46%).

Nearly all respondents (99%) saw a decrease in their workload, with 60% seeing reductions greater than 50%. Almost 60% said their medical centers were no longer performing non-emergent imaging or procedures, and despite limited availability of PPE, 78% reported that being asked to or already performing duties outside their usual scope. The most common primary diagnostic approaches to PUI for COVID-19 were chest X-ray (46%) and RT-PCR (43%), though 16% were not aware of their medical center's primary screening modality. On a personal level, 86% felt they had adequate knowledge for interpreting COVID-19-related images.

Another decrease was seen in overall income among 56%, though 60% expected less than 25% change. A small number (11%) experienced partial or complete layoffs due to the outbreak, and one third said it would take more than two months to return to normal capacity after transitioning back to usual business routines.

The majority of respondents (84%), however, felt responses from their medical center’s leadership were appropriate, and 72% indicated their leadership was providing them with adequately frequent updates regarding the pandemic.

More than 77% felt their perception of the medical center’s ability to handle future public health concerns were either unchanged or positively impacted by the pandemic. The most frequently cited anticipated effects on future clinical practice included heightened awareness of infection control (62%); increased remote work options (52%); and increased use of telecommunication (49%).

“The challenges faced by U.S. radiologists will undoubtedly continue to evolve as the numbers of COVID-19 cases continue to rise,” wrote the authors. “Notable areas of future research include investigations into institutional policies surrounding the use of imaging in COVID-19, economic impact as practices continue to adjust to decreased revenues, and provisions to support radiologists working remotely in times of crisis and demand.”

The findings were published in Clinical Imaging.

The authors did not respond for comment.