por Valerie Dimond
, Contributing Reporter | June 04, 2020
Practical updates released for radiologists performing cross-sectional interventional procedures during coronavirus contain numerous measures to help minimize risk for patients and healthcare workers.
An open-access article published in the American Journal of Roentgenology (AJR)
suggests several steps should be followed by radiologists, including screening referred patients to decide which procedures can be postponed, using appropriate personal protective equipment (PPE), minimizing the number of people involved in procedures, preserving PPE when possible, and applying proper room and equipment cleaning measures.
“Cross-sectional interventional procedures are performed under CT, ultrasound, fluoroscopy, or MR guidance and include fluid aspiration, (thoracentesis, paracentesis, and fluid collections), drainage catheter placement, percutaneous biopsy, and tumor ablation,” said lead author Ghaneh Fananapazir, an abdominal radiologist who practices MR, CT, and ultrasound, as well as nonvascular interventional procedures at the University of California Davis Medical Center.
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A tiered approach for outpatient and inpatient settings was provided in the AJR article to help radiologists determine which procedures are urgent and which could be delayed without causing patient harm (see TABLE I).
“As the peak of the pandemic passes and consideration is given to a gradual and safe increase in procedural volume, careful discussion of how preprocedure testing for COVID-19 or how PPE is used should be part of planning at the departmental and institutional levels,” the authors stated. “Situations in which preprocedure testing or more intensive PPE use is warranted remain a subject of debate at many institutions because both test reagents and PPE may still be of limited supply.”
Nonetheless, acknowledging the latest modifications, the American Roentgen Ray Society said in a news release that “all of these procedures require appropriate donning and doffing of personal protective equipment by every member of the IR team — physician, trainee, nurse, technologist — and some procedures may require admitting the patient for management of postprocedure complications, necessitating a hospital bed and auxiliary resources.”
Meanwhile, a panel of radiology experts from Washington, New York, Georgia, California, Wisconsin and Singapore have already developed policies
in conjunction with infection control experts at their own practices to avoid pandemic-related complications. They say top priorities for radiologists, which were published in the journal Radiology, should be early detection, limiting virus exposure to others, safety precautions, cleaning protocols, training, and maintenance of operations and staffing.