Navigating the iodinated contrast media shortage: A review

The current COVID-19 climate has caused an unforeseen supply shortage of iodinated contrast media (ICM) worldwide, disrupting global distribution.1 In addition, the scarcity has resulted in a ripple effect in healthcare facilities such as radiology departments where ICM is required to perform contrast-enhanced examinations. ICM plays a significant part in contrast-enhanced CT, angiography and fluoroscopic procedures within the radiology department, holding a primary role in the differentiation and diagnosis of pathologies which range from pulmonary emboli to tumours.1 Its use extends beyond radiology, where ICM is heavily relied on in cardiology, urology and gastrointestinal studies, further highlighting the heavy dependence on the critical agent.2 With the global increase in the number of CT examinations requested, where approximately 60% of studies require ICM, optimal usage of ICM must be considered to meet heightened demand.3 The shortage has represented an opportunity for imaging providers to re-examine current imaging protocols and identify whether non-contrast imaging, alternative contrast agents and other imaging modalities could be viable options moving forward.1,2 Additionally, current literature has discussed volume-reduction strategies and dual-energy use in newer-generation CT scanners to conserve ICM.1,4 This review will explore currently proposed solutions that can be implemented in the radiology department to maximise ICM supply with minimal impact on patient care.

Everybody hurts - What can physical health professionals learn about how mental health professionals support their own emotional resilience and mental health?

The physical aspects of ultrasonography, difficult posture with prolonged pressure exertion, have been extensively researched and addressed with advances in machine ergonomics, operator awareness of posture and positioning and workplace tools to identify musculoskeletal problems. The mental stresses are less well recognized and have only recently started getting investigated. Ultrasonography is a mentally challenging activity requiring long periods of intense concentration, empathy and communication of complex and often difficult information to patients and clinicians, all of which carries an emotional toll. Practitioners are also under increasing time and caseload pressures exacerbated by COVID recovery and chronic fatigue from two years of pandemic. A survey of UK obstetric sonographers showed 92.1% and 91.0% met the burnout thresholds for exhaustion and disengagement, respectively).1 While many Trusts provide training to support physical health, few radiology departments educate their staff on emotional resilience or offer regular support to either promote or maintain mental wellbeing. Training, when available, is often focused on the receiver and not on the impact of vicarious traumas experienced as a result of repeatedly discovering/delivering difficult outcomes to patients on a regular and prolonged basis. Few health professionals are face-to-face with their patient at point of significant discovery whether that information is imparted to the patient or not. Mental health professionals have adopted a traumainformed stance into their working practices. This has not only informed the direct clinical work with patients but is also evident in the way the workforce is supported by the trust. Regular supervision, reflective practice and debriefs are required and monitored by the trust, based on research in clinical psychology to inform best practice. Some of these practices could be applied to physical health professionals to address some of the emotional burdens experienced as part of day-to-day delivery of care.

A Global Review of the Impacts of the Coronavirus (COVID-19) Pandemic on Radiology Practice, Finances, and Operations.

The Coronavirus Disease 2019 (COVID-19) pandemic ushered in rapid changes in healthcare, including radiology, globally. This review discusses the impact of the pandemic on various radiology departments globally. We analyze the implications of the COVID-19 pandemic on the imaging volumes, finances, and clinical operations of radiology departments in 2020. Studies from health systems and outpatient imaging centers were analyzed, and the activity throughout 2020 was compared to the pre-pandemic activity, including activity during similar timeframes in 2019. Imaging volumes across modalities, including MRI and CT scans, were compared, as were the Relative Value Units (RVUs) for imaging finances. Furthermore, we compared clinical operations, including staffing and sanitation procedures. We found that imaging volumes in private practices and academic centers decreased globally. The decreases in volume could be attributed to delayed patient screenings, as well as the implementation of protocols, such as the deep cleaning of equipment between patients. Revenues from imaging also decreased globally, with many institutions noting a substantial decline in RVUs and revenue compared with pre-COVID-19 levels. Our analysis thus found significant changes in the volumes, finances, and operations of radiology departments due to the COVID-19 pandemic.

Patients Satisfaction with Diagnostic Radiology Services at Radiological Department of Brcko Health Centar

Aim: The satisfaction of proffering radiological health care considerably contributes to the improvement and quality of health care in health care institutions, especially in the extraordinary situations, such as the viral Coronavirus disease infection where patients are being treated under special conditions. Very often, the problem regarding the understanding among the patients and the healthcare workers can occur. The primary purpose of the research is to determine the contentment of infected Covid-19 patients with the provided service of the radiological diagnostics department. Method(s): The study was conducted at the Public Health Institution Brcko District Health Center" (Dispensary for lung diseases) and TBC (ATD). The number of partic-ipants was 700. The questionnaire consisted of 19 questions. Laschinger's customised and standardized questionnaire called HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), a questionnaire about the patient's contentment with the quality of health care, was used for the purpose of research analysis(1). The Pearson correlation coefficient and the ANOVA test were used for statistical data pro-cessing. Result(s): The given results have shown that the patients rated the quality of health care with a number 4 which indicates that they are somewhat satisfied with the provided quality. When asked about level of adequate care during their imaging, patients were less satisfied with nurses and technicians in comparison to the medical radiology en-gineers. Conclusion(s): The obtained results can contribute to a better understanding of patients as well as the improvement of health systems in the form of new health care reforms, as well as to make progress in educating health workers how to communicate with patients.Copyright © 2019 by Acta Medica Saliniana.

Experience about workflow of standardized cabin CT scan in module hospital during the outbreak of COVID-19.

Since the outbreak of new coronavirus infection (COVID-19) in Wuhan, Hubei in December 2019, a total of 80 424 patients have been diagnosed until March 3, 2020, which has caused significant inpact in national health and economics. Module hospital played a vital role in effectively controlling the source of infection and cutting off the transmission channels.Compared with the CT room in a conventional hospital, the cabin CT is very different in terms of infection area settings, protective isolation measures and inspection procedures. This article covers CT room design, staffing responsibilities, division of infected areas, inspection procedures, protection and disinfection, and other aspects.Copyright © 2020 by the Chinese Medical Association.

Optimizing Radiology-related workflows in an Emergency Department: a single centre experience from National University Hospital of Singapore

Introduction This article describes our experience in developing operational guideline and strategies implemented in our practice to optimize Radiology-related workflows in Emergency Department (EMD). These are pertaining to the changes that brought by global outbreak of Coronavirus disease 2019 (COVID-19) and on-boarding of Next Generation Electronic Medical Records (NGEMR) in the institution. Methods The Radiology Department (RD) has established new and efficient guidelines to ensure timely diagnosis and treatment are delivered to the patients. These were achieved with frequent review of current workflows, machines upgrade, implementations of Quality Improvement Project (QIP), innovations on radiology-related procedures radiation dose simulation and a new paperless workflow. Results The new workflows have achieved 95% of reporting TAT within 2hours, 90% in various safety indicators and eliminated the usage of hard-copy radiology request forms. Discussion Due to rapid changes in clinical and administrative needs, the department has faced challenges in up-keeping its Key Performance Index (KPI) in various areas. From our experience, this was due to multiple reasons including staffs taking longer time to familiarize with the new workflows, lack of systematic guidelines and substandard planning during the roll out of new workflows. This had potentially compromised our patient's safety and functionality of RD. The department has utilized multiple approaches and effectively resolved the challenges faced. Conclusion This article provides insights and guidelines in optimizing Radiology-related workflows in view of the changes that brought by COVID-19 and NGEMR.

Best Practices on Radiology Department Workflow: Tips from the Impact of the COVID-19 Lockdown on an Italian University Hospital.

PURPOSE: The workload of the radiology department (RD) of a university hospital in northern Italy dramatically changed during the COVID-19 outbreak. The restrictive measures of the COVID-19 pandemic lockdown influenced the use of radiological services and particularly in the emergency department (ED). METHODS: Data on diagnostic services from March 2020 to May 2020 were retrospectively collected and analysed in aggregate form and compared with those of the same timeframe in the previous year. Data were sorted by patient type in the following categories: inpatients, outpatients, and ED patients; the latter divided in "traumatic" and "not traumatic" cases. RESULTS: Compared to 2019, 6449 fewer patients (-32.6%) were assisted in the RD. This decrease was more pronounced for the emergency radiology unit (ERU) (-41%) compared to the general radiology unit (-25.7%). The proportion of investigations performed for trauma appeared to decrease significantly from 14.8% to 12.5% during the COVID-19 emergency (p < 0.001). Similarly, the proportion of assisted traumatic patients decreased from 16.6% to 12.5% (p < 0.001). The number of emergency patients assisted by the RD was significantly reduced from 45% during routine activity to 39.4% in the COVID-19 outbreak (p < 0.001). CONCLUSION: The COVID-19 outbreak had a tremendous impact on all radiology activities. We documented a drastic reduction in total imaging volume compared to 2019 because of both the pandemic and the lockdown. In this context, investigations performed for trauma showed a substantial decrease.

Post-pandemic era: promoting regular epidemic prevention and control in radiology department

Objectives: The novel coronavirus (COVID-19) is still recurring so far. Considering that a great number of patients do examination in the same room and thus are exposed to high risks of cross infection, we should promote the epidemic prevention in the radiology department to prevent cross infection and another outbreak. Therefore, this article aims to share the experience and protocols of the radiology department of our hospital so as to help more hospitals and their radiology medical staff in epidemic prevention. Methods: We firstly collected three major epidemic prevention policies formulated by the radiology department since the outbreak, and then drew the schematic diagrams of patients' treatment routes under each measure, including the infection control team, the reconfiguration of the radiology department and the Examination procedures for patients with COVID-19. After three stages, we finally provide a specific machine for patients with COVID-19 to examine. Results: From January 18, 2020, our hospital has received 113 patients with COVID-19, among which 112 patients were discharged and 1 were dead. The total number of outpatients with fever-CT examinations was 2870, that of inpatients were 477. The number of DR exposures was 87, that of US examinations were 207, and that of MRI examinations was 148. No medical workers in the radiology department were diagnosed with COVID-19. Conclusions: Imaging examination has been an indispensable diagnostic method for COVID-19 since the outbreak. As the global epidemic situation is still unstable at present, radiology departments need to constantly improve the corresponding epidemic prevention and control measures, and formulate effective inspection plans for the patients with COVID-19, which can help patients and staff protect themselves against a high risk of COVID-19.

A high-touch outreach model to re-engage patients in mammogram screening

Background: Disparities in cancer screening have been well documented during the Covid-19 pandemic. However, there are limited patient-reported data describing the prevalence and drivers of patient hesitancy towards cancer screening and willingness to resume screening. As health systems continue to experience pandemic-related capacity strain, there is an urgent need for innovative models of re-engaging patients in preventive screening. To address this issue, we developed a medical student-led, high-touch outreach model to re-engage primary care patients at Brookside Community Health Center in cancer screening. Methods: We iteratively optimized semi-structured call scripts and surveys in English and Spanish to contact patients overdue for mammography screening. Student callers included medical and pre-medical students with native Spanish fluency. Using the call script, students identified patient-reported barriers and facilitated mammogram scheduling for consenting patients. For consenting patients, student callers placed a telephone encounter with a pended screening mammogram order in the electronic medical record. PCP confirmation of the order triggered outreach by the radiology department for mammogram scheduling. Patients also received reminder calls from students the week of their appointment. Primary outcomes include screening consent rates, mammogram scheduling and completion rates, and screening results. Patient survey responses were securely recorded using the REDCap survey platform. Results: 198 patients were eligible for the intervention. 60% are primarily Spanish-speaking and 81% are insured by Medicaid. 145 patients (73%) have successfully been contacted, of which 129 (89%) consented for mammogram screening. 74 (57%) of the consenting patients have scheduled their mammogram and 38 (29%) have completed their mammogram. 36% of consenting Spanish-speaking patients with active mammogram orders did not have a mammogram scheduled, compared to 9% of consenting English-speaking. To date, 6 patients had abnormal mammograms requiring subsequent diagnostic imaging, and 1 patient was diagnosed with ductal carcinoma in situ requiring oncologic care. Qualitative analysis of patient surveys found that primary barriers to screening included factors associated with the Covid-19 pandemic (32.9% of contacted patients), lack of awareness of overdue status (25.9%) and patient unavailability (e.g. outside of country) (20%). Conclusions: In this single-center quality improvement study, we found that patients had a high willingness to engage in cancer screening during the pandemic and that trainees can play a vital role in re-engaging patients in preventative care. The disparity between Spanish and English-speaking patients' ability to schedule a mammogram after the consent process suggests that patients with limited English proficiency face additional challenges in accessing screenings.

HRCT Pattern in COVID-19 Patients

Background: In December 2019, a group of cases of pneumonia of unknown cause was found in Wuhan, China, now known as coronavirus disease 2019, and the coronavirus was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). High-resolution computed1tomography (HRCT) is currently regarded as a significant imaging technique for aiding in the diagnosis & management of COVID-19 patients. Objective: To find the different patterns of1manifestation in HRCT chest in COVID-19 patients. Study Design: Descriptive Cross-Sectional Setting: University of Lahore Teaching Hospital, Lahore Methodology: A descriptive, cross-sectional study was conducted in Radiology Department in University of teaching hospital, Lahore. 240 participants' medical histories were thoroughly reviewed, both directly from them and on case sheets. All patients with confirmed cases of COVID-19 pneumonia were admitted to the hospital and received a chest HRCT. Three follow-up HRCT chest scans were performed on one patient. The distribution and patterns of lung involvement were studied. Each of the five lung lobes was evaluated visually for degree of involvement and categorized as mild (26-50 percent), moderate (51-75 percent), or severe (75 percent) (76-100 percent). Data was analyzing in SPSS. Age was presented as mean + SD. Gender and other HRCT patterns were presented as frequency & percentage. Result: Total 240 COVID-19 patients included. There were 142(59.4%) male and 97(40.6%) female. The mean age was 54.0+15.71 with age range of 4 to 84 years. Large number of patients 114(47.7%) were in the age group 45-64 years. Ground glass opacity was the most common CT abnormality, with 236(99.2%) cases. Among them 49(20.5%) cases had GGO plus consolidations. Crazy paving pattern was seen in 136(56.9%) cases. Only 10(4.2%) patients with GGO pulmonary nodules and pleural effusion were involved. The majority of the patients had a fever 114(47.5%), while the least frequent symptom was a runny nose (7(2.9%). Conclusion: Pure GGO pneumonia is the most prevalent pattern of COVID-19 pneumonia seen on HRCT scans, GGO consolidation, with crazy paving with prominent distribution in the lung posterior & peripheral area.

SPECTRUM OF CT FINDINGS IN CLINICALLY SUSPECTED CASES OF MUCORMYCOSIS - A STUDY AT TERTIARY HEALTH-CARE CENTER (RAJINDRA HOSPITAL PATIALA) DURING SECOND WAVE OF COVID PANDEMIC

Objective: Rhinocereberal mucormycosis is an acute, fulminant, and often lethal opportunistic infection typically affecting diabetic or immunocompromised patients. Early diagnosis is vital in these infections because delay in initiation of the treatment can be life-threatening. Computed tomography (CT) with axial and coronal sections is a highly accurate and non-invasive modality to accurately image sinonasal mycosis. The aim of the study was to describe the imaging findings in suspected cases of mucormycosis on CT. Methods: This study was conducted in Radiodiagnosis Department of Rajindra Hospital, Patiala. The data of 22 patients who were referred for CT with a clinical suspicion of mucormycosis were collected and all these patients were followed up to know about the prognosis of the disease. Results: In our study, there were 54.60% females and 45.40% males. Maximum number of patients (45.45%) belonged to 40-49 year age group. Diabetes mellitus was found to be the most commonly (90.90%) found comorbidity followed by hypertension (36.36%). In our study, involvement of unilateral nasal cavity was observed in 36.36% cases. Among the paranasal sinuses, maxillary and ethmoid sinuses were the most commonly involved in 95.45% and 77.27% cases. Conclusion: Prompt diagnosis and treatment of rhino-orbital mucormycosis are the sine qua non as antifungal drugs and surgical debridement can successfully control the infection and thus reduce the high mortality and morbidity associated with mucormycosis.

Challenges and Coping Strategies of Radiology Doctors During COVID-19 Era, Lahore, Pakistan

Objective: To evaluate the challenges and coping strategies by Radiology Doctors during the COVID-19 Era. Materials and Methods: It is a mixed-method cross-sectional study done over one month in Radiology Department, Shaikh Zayed Hospital, Lahore, Pakistan with a convenient sampling technique. Results: 80% of the radiologists faced challenges during the pandemic. Age, gender, marital status, monthly income, residents, and years of residency showed significant associations with challenges faced by doctors in the radiology department during the COVID-19 pandemic. Many challenges in terms of management, psychological aspects, training education, and research work were faced by the radiologists but they coped with them heroically. Conclusion: COVID-19 posed a spectrum of unforeseen challenges to the radiologists of Shaikh Zayed Hospital, Lahore. Challenges related to management, psychological aspects for doctors, research work and training education were all tackled by the senior and junior doctors by using various coping strategies.

High Resolution CT Chest Findings in PCR Positive or Clinically Suspected patients of Covid-19 Infection

Aim: HRCT chest findings in PCR positive or clinically suspected patients of COVID-19 infection. Methods: Retrospective study recruited 207 clinically suspected patients of COVID disease with duration of 1-14 days from the radiology department of Shalamar Hospital Lahore. Patients were categorized into two groups on the basis of PCR +ve (123) and PCR -ve group (84). Results: Among 123 PCR +ve patients, 107 patients were CT Positive and 16 were CT negative. While from 84 PCR -ve patients, 38 patients were CT positive. Among PCR Positive patients, most prevalent finding was GGO (84.5%), followed by lymphadenopathy(48.8%), interlobular septal thickening (41.5%), consolidation (5.7%) on HRCT chest. The GGO was mostly bilateral (82.2%) and Peripheral (47.8%). Among 84 PCR negative patients, GGO (45.3%), followed by interlobular septal thickening (28.6%), lymphadenopathy (19.1%). The GGO was mostly bilateral (26.2%) and Peripheral (25%). HRCT Chest has Sensitivity (86%), specificity (54%) and accuracy 74%. Conclusion: GGOs with bilateral and peripheral distribution was the most common finding in both PCR positive and negative patients, whereas lymphadenopathy in PCR positive and Interlobular septal thickening in PCR negative patients was the second common finding. High resolution CT Chest performs a significant role in early diagnosis of patients with COVID-19 due to its high sensitivity and specificity.

Changing practice in the management of non-palpable breast lesion during pandemic;Early experience using Magseed markers

Background: The Covid Pandemic has influenced how cancer surgeries are performed and their pre-operative management to allow appropriate social distancing and self-isolation prior to Surgery. With the requirement of wire localisation of non-palpable breast cancers/ lesions on the day of surgery and non-availability of mammogram and ultrasound machine in an isolated zone, we embarked on localisation of non-palpable breast lesions using MagseedR markers and SentimagR localisation system. We describe our initial experience in the management of these cancers and diagnostic excision biopsies using Magseed. Materials and Methods: Forty consecutive female patients, median age 61 (range 36-84) years underwent Magseed insertion for diagnostic excision biopsy (n=4) and breast conservation surgery (WLE;n= 36). Check mammograms were performed following Magseed insertion to confirm appropriate localisation. During the initial audit of 16 patients, one Magseed guided WLE and sentinel node biopsy was abandoned due to erratic signal strength on the day of surgery and underwent surgery with wire localisation on a later date. Subsequently all cases had Magseed signals confirmed following insertion in the radiology department along with check mammograms. Results: Thirty-nine patients underwent successful breast surgery (Magseed in intra-operative specimen X-ray) with standard axillary procedures (29 sentinel node biopsy, 2 axillary node clearance). The median time from magseed insertion to surgery was 13 (range 3-38) days. The lesions were invasive neoplasm +/- insitu (DCIS) disease (n= 32), DCIS (n=5), and papilloma (n=3). The median overall tumour size was 20 (range 3-38) mm and on postop histology was 17 (2-50) mm. Six patients required further re-excision for margin positivity with DCIS;margins were clear after single cavity shave(n=4) and two patients underwent mastectomy subsequently. Conclusions: Magseed localisation have given us significant flexibility in the management of non-palpable breast cancer and indeterminate lesions requiring diagnostic biopsy during the Covid pandemic. Initial audit suggests usefulness of confirming adequate Magseed signal in the radiology department along with check mammogram during the early learning curve.

Study of the vulnerability and risk of exposure to SARS-CoV-2 of interns and residents in the Ibn Rochd University Hospital Center (IR-UHC) in Casablanca

Introduction: Healthcare workers are very exposed to SARS-CoV-2, that’s causing a vulnerability issue for some of them. The presence of certain risk factors in these workers requires an assessment of the risk of exposure. Patients and methods: Our study is a cross-sectional descriptive survey by self-questionnaire posted on Google Forms from June 1st to July 31, 2021, intended for residents and interns at IR-UHC. Our objective is to assess the vulnerability and degree of exposure to SARS-CoV-2 through an appropriate risk level matrix. Results: 280 physicians responded, 36% were vulnerable, mainly asthma (39%), or on corticosteroid therapy (37%). 95% were at high risk of exposure. The level of risk was classified as critical among two-thirds of physicians, of which 67.7% were working shifts in Covid-19 units, 19% were working in a radiology department, 10% in an intensive care unit and 2% in a biology department;less than a third of the doctors presented an unacceptable level of risk of which 72.2% were on Covid-19 shifts, 7% were working in a radiology department and 2% in a biology department.The lack of availability of PPE was found in 64% of doctors. 65.4% of the doctors questioned were infected with Covid 19, of which 70.2% had moderate infection and 6.1% severe one. Conclusion: The high-risk level of exposure to SARS-CoV-2 among physicians requires the strengthening of preventive measures, and especially the involvement of occupational physicians in the decision of medical aptitude for the post of vulnerable staff.

Role of HRCT chest in diagnosing Covid-19 disease in initially RT-PCR negative patients

Objective: To analyze CTSS score in clinically symptomatic COVID-19 patients having initial negative RT-PCR report. Design of the Study: It’s a retrospective cross sectional descriptive study. Study Settings: This study was carried out at Radiology Department, CMH Lahore from July to December 2021. Material and Methods: A total of 1000 patients presented with suspected clinical symptoms of covid-19. 770 were male patients (average of 52±15yrs) and 230 were female patients (49±15 years).Out of which 235 (23.5%) patients had initial negative PCR report & 765 patients had initial PCR positive report. 235 initial PCR negative patients got positive PCR report on subsequent repeat testing. All the patients underwent HRCT chest. Results of the Study: CTSS score of 765 PCR positive patients was determined as 545 (71.2%) having mild to moderate disease (<19.5 CTSS) and 220 (28.7%) as having severe disease (>19.5 CTSS).CTSS score of 235 PCR negative patients was determined on HRCT chest and classified as 210 (89.3%) having mild to moderate disease (<19.5 CTSS) and 25 (10.6%) as having severe disease (>19.5 CTSS). CO-RADS scoring were done and HRCT pattern analyzed in all the patients according to the standard protocol. Multivariate analysis was performed and showed significant correlation between CTSS score and initial PCR negative patients. Sensitivity and specificity of CT chest in determining covid-19 findings was 89.3% and 28.7%.PPV was 89.8% and NPV was 27.8%. Conclusion: HRCT with CTSS scoring is an important tool for diagnosis of COVID-19 infection despite initial negative PCR, having sensitivity and specificity of 89.3% and 28.7% respectively. Timely identification and isolation of COVID-19 patients is helpful in preventing the spread of infection and also aid in prompt symptomatic management.

Challenges of oral radiography prescriptions during the COVID-19 outbreak in Shiraz, Iran

Background: Considering the severity of the COVID-19 outbreak and its rapid person-to-person transmission and the challenges it has brought about in dentistry, especially in intraoral radiography, following the established guidelines in prescribing radiographs is of great prominence. Objectives: We aimed to evaluate the necessity of prescribed intraoral radiographs and to estimate the number of unnecessary prescriptions during the COVID-19 pandemic. Methods: This cross-sectional study was conducted among 143 patients with a mean age of 29.36 ± 14.11 years who visited the Radiology Department of Shiraz Dental School during the peak of the COVID-19 outbreak. Information, including gender, age, systemic diseases, referring department, and type and urgency of radiography, was collected using a checklist. Chi-squared test and Fisher’s exact test were run to assess the relationships between variables. Results: Among all the patients referred to the Radiology Department, the endodontics and oral medicine departments accounted for the highest percentage of referrals. The relationship between the necessity of radiography prescriptions and dental departments was significant (P < 0.05). The lowest rate of unnecessary referrals was reported in the Department of Endodontics (13.3%), whereas the highest rate of unnecessary referrals was attributed to the aesthetic and restorative dentistry departments (73.3%). There was a significant association between dental department and the type of prescribed radiographs (extraoral/intraoral). The Orthodontics Department was the only department with more extraoral radiograph prescriptions than intraoral radiographs. One-third of the prescribed intraoral radiographs and half of the extraoral radiographs were unnecessary, with a significant difference during the pandemic (P = 0.019). Conclusions: Although there has been some success in the development of COVID-19 vaccines, this pandemic will not be easily eradicated. Therefore, it is crucial to follow the established guidelines and postpone unnecessary dental procedures to improve the safety of our community and the world in general. © 2021, Author(s).

Challenges and optimization strategies in medical imaging service delivery during COVID-19.

In coronavirus disease 2019 (COVID-19), medical imaging plays an essential role in the diagnosis, management and disease progression surveillance. Chest radiography and computed tomography are commonly used imaging techniques globally during this pandemic. As the pandemic continues to unfold, many healthcare systems worldwide struggle to balance the heavy strain due to overwhelming demand for healthcare resources. Changes are required across the entire healthcare system and medical imaging departments are no exception. The COVID-19 pandemic had a devastating impact on medical imaging practices. It is now time to pay further attention to the profound challenges of COVID-19 on medical imaging services and develop effective strategies to get ahead of the crisis. Additionally, preparation for operations and survival in the post-pandemic future are necessary considerations. This review aims to comprehensively examine the challenges and optimization of delivering medical imaging services in relation to the current COVID-19 global pandemic, including the role of medical imaging during these challenging times and potential future directions post-COVID-19.

Imaging Appropriateness in Pediatric Radiology during COVID-19 Pandemic: A Retrospective Comparison with No COVID-19 Period.

During the COVID-19 pandemic, the number of accesses to the Pediatric Emergency Department (pED) in Italy sharply decreased by 30%. The purpose of this study is to evaluate how this novel setting impacted on management of children with trauma, and the use and appropriateness of imaging studies in such patients at the pED. All imaging studies performed in patients with trauma at the pED of a tertiary children's Hospital during the first wave of the COVID-19 pandemic (between March and May 2020) were reviewed, in comparison with a control time interval (March to May 2019). In the pre-COVID control era, 669 imaging studies documented bone fractures in 145/568 children (25.5%). In the COVID-era, 79/177 (44.6%) pediatric patients showed bone fractures on 193 imaging studies. Comparative analysis shows a 71% decrease in imaging studies, and the proportion of negative imaging studies (with no evidence of bone fractures) dropped in 2020 by 19% compared to the 2019 control era (p < 0.001). The sharp decrease of negative studies suggests that the rate of appropriateness was higher during COVID-era, suggesting some attitude toward defensive medicine in the previous control year, as a result of some degree of imaging inappropriateness. The impact of a pandemic on emergency medicine may offer a unique opportunity to revisit diagnostic and therapeutic protocols in pediatrics.

Management of a diagnostic radiology department amid Coronavirus disease-19 (COVID-19) pandemic.

Severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) is a highly contagious infectious disease and spreads through aerosols and fomites. Health care personnel who are at the forefront of the fight against coronavirus disease-19 (COVID-19) pandemic are also at greater risk of contracting the infection. Mixing of uninfected people with infected people is potentially hazardous, especially in a radiology department. Implementation of meticulous operational changes, curtailment of nonurgent radiological work, rationalization of staff, equipment disinfection, use of personal protection equipment, and psychological support are needed to combat COVID-19 or any such infectious disease outbreak. This technical note will familiarize radiology workers with infectious disease outbreak-response to be adopted to ensure the safety of staff and patients.