Policies and Guidelines for COVID-19 Preparedness: Experiences from the University of Washington

Abstract

The Coronavirus Disease 2019 pandemic initially presented in the United States in the greater Seattle area, and has rapidly progressed across the nation in the past 2 months, with the United States having the highest number of cases in the world. Radiology departments play a critical role in policy and guideline development both for the department and for the institutions, specifically in planning diagnostic screening, triage, and management of patients. In addition, radiology workflows, volumes and access must be optimized in preparation for the expected COVID-19 patient surges. This article discusses the processes that have been implemented at the University of Washington in managing the COVID-19 pandemic as well in preparing for patient surges, which may provide important guidance for other radiology departments who are in the early stages of preparation and management. Essentials Radiology policy goals are to reduce COVID-19-related morbidity and mortality through early diagnosis, appropriate treatment and prevention of disease dissemination.  Imaging currently is not routinely used to screen for COVID-19 unless access to RT-PCR results for COVID-19 is limited.  Postponing elective imaging and procedures will preserve resources and hospital beds, while also limiting patient population exposures.  Determination of time-sensitivity of procedures and imaging tests is by consensus with input from radiologists, patients, and/or ordering clinicians.  Radiology departments must prepare for patient surges through streamlined approaches to imaging that will limit exposures to healthcare workers and patients.

Interobserver and Intraobserver Variability in the CT Assessment of COVID-19 Based on RSNA Consensus Classification Categories

“…Most professional radiological societies, as well as the Center for Disease Control, have recommended against the use of screening chest CTs for the detection of COVID-19. Despite this, chest CTs are performed frequently on patients with suspected or confirmed COVID-19 (4)(5)(6)(7)(8)(9)(10). To best equip clinicians with the necessary tools to make informed decisions with regards to the management of COVID-19, there exists a need for accurate and precise reporting of imaging findings.…”

Current Status of Computed Tomography in Novel Coronavirus Disease 2019 Pneumonia

“…All CT scans when done for a SARS-CoV2 positive patient should be done by a technologist after donning the personal protective equipment. 16 Two technologists are needed for performing a CT scan, one to position the patient and the other in the console room. 17 Entry of personnel into the CT room should be restricted.…”

Real-world evaluation of a computed tomography-first triage strategy for suspected coronavirus disease 2019 in emergency outpatients in Japan: an observational cohort study

“…Several triage protocols and their e ciency have been reported. 9,11,12 However, because COVID-19 symptoms are not speci c to that disease, there might be many differential diagnoses in patients with suspected COVID-19. Recently, radiological ndings of COVID-19 have been reported.…”

“…Recently, radiological ndings of COVID-19 have been reported. [12][13][14] Generally, chest X-ray is useful to diagnose pneumonia; however, it is unsuitable for COVID-19. Because the characteristics of chest radiological images in COVID-19 mainly appear in the interstitium, revealing ground-glass opacities (GGO), it is di cult to diagnose COVID-19 using chest X-ray alone, especially in mild cases.…”