“Clearly, none of the things that happened in 2020 were at all on our radar,” says Dana H. Smetherman, MD, MPH, MBA, FACR, chair of the department of radiology and associate medical director at Ochsner Medical Center in New Orleans. “We know how to handle the diseases that we usually treat: We know cancer, we know the flu, we know strep infections. I think the entire country struggled and is still struggling with COVID-19 because it’s an entirely new pathogen. We had so much to learn, all of us — and we had to learn it quickly.”
Looking back over the last year, how did radiology fare? Three leaders in the field take stock of the first year of COVID-19 and discuss where healthcare goes from here.
What Worked: Response Time
“I think a lot of the workflows we implemented early on really did work,” says Mahmud Mossa-Basha, MD, associate professor and vice chair in the radiology department at the University of Washington (UW) Medical Center. “Within healthcare systems across the nation, when we implemented changes at a rapid rate, they really were successful.”
Michael P. Recht, MD, Louis Marx professor and chair of the department of radiology at NYU Langone Health in New York City, agrees. “The pandemic allowed us to take that time to really look at everything we were doing, and we found some things that we could do better,” he says. “The urgency brought on by the pandemic forced us to accelerate our MR protocols, and we were able to go faster — which is going to be better for patients and radiology departments as we go forward.”
What Worked: Adaptability to Virtual Platforms
According to Recht, at NYU Langone Health, everyone who wanted one was provided with a home workstation at the beginning of the pandemic. “Over the past year, we’ve learned that we can work remotely and still get our work done,” Recht says. “That’s going to have real benefits, namely for work-life balance.” Smetherman agrees. “I think we’ve had our eyes opened as to how we might actually incorporate people working remotely in our department,” she says. “The last year has forced us to do things in ways we hadn’t earnestly considered before.”
Mossa-Basha expects the flexibility around remote work to stick, too. “It’s a balance of providing the best care you can, while keeping both patients and healthcare workers safe,” he says. “And beyond their personal health and preventing COVID-19 exposure, it’s also important to keep people’s morale up, keep them focused, and make sure they stay happy, healthy, and productive.”
According to Smetherman, remote radiology education has also exploded. “We used to think that the only way we could teach a resident was to sit right next to them and go through the cases together,” she says. “I realized there’s more than one way to be an effective educator and provide real value through virtual education.” Smetherman envisions this will continue post-pandemic. “I definitely see our department continuing to use remote educational tools — things like virtual visiting professors, expanding our multidisciplinary conferences to include other facilities or experts in other regions — in the future,” she says. “We are even considering recruiting attending radiologists who could work for our department from other geographic regions, but still be involved in our academic activities, including resident teaching.”
Along with increased remote options for work and education, remote meetings have gained traction at many institutions — and this holds potential for increased engagement, Mossa-Basha says. “Being able to engage a larger group of people that may be geographically dispersed allows people to attend meetings they otherwise couldn’t and contribute to those discussions, which is definitely a positive step,” he says.
What Worked: Increased Communication
According to Mossa-Basha, “Overall, engagement and communication within departments, from all faculty, have increased in a lot of places. We changed our operational structure and there is a lot more input that goes into decisions than there previously was,” he says. “I think the lesson learned is really to just maximize communication. Regardless of how many times you’ve communicated — more communication is usually needed.”
Radiologists didn’t just boost communication within their institutions, but with patients and families as well. NYU Langone initiated a program called NYU Family Connect, says Recht, to keep patients’ and their loved ones updated while visitations were restricted due to COVID-19 protocols. The program, which was discontinued once visitor restrictions were modified, paired radiologists with medical students to review patient charts, virtually attend interdisciplinary rounds, and proactively call families with daily patient updates. Program volunteers spoke with more than 3,000 families as part of the program, ensuring that family members remained involved in care decisions during the height of visitor restrictions (learn more at acr.org/family-connect).
At UW Medical Center, they disseminated COVID-19 information to patients through avenues like social media videos, says Mossa-Basha. “These videos highlighted COVID-related precautions being taken to protect patient health, and were shared via the UW Radiology YouTube site (bit.ly/UW_ForOurPatients), Twitter, and in a video link texted to patients as part of the scheduling confirmation text sent through our automated patient texting portal, CareWire®,” he says.
While we can do our basic jobs working from home, it’s not the same as it was before. We’ve lost something significant as an academic culture — and that’s the collaboration.
What Didn’t Work: Inconsistent/Ineffective Messaging
“Nationally, it has been a challenge that all of these issues became politicized,” Smetherman says. “The lack of a uniform message that we’re all in this together; that we’re all fighting a common enemy — around things like mask wearing, lockdowns, potential treatments, vaccine development and access — that hasn’t been as effective as it could have been.”
“We weren’t able to communicate as effectively as we needed to just how important it was to follow the CDC’s guidelines,” Recht says. “As healthcare providers, we just haven’t found a way of convincing people. Part of that is politics, part of that is just communicating how to follow these guidelines — so we can beat this pandemic.”
What Didn’t Work: Decreased Collaboration
While the pandemic ushered in new pathways for increased communication at some institutions, at others teamwork took a hit. “I think we learned to appreciate what we already had that maybe we took for granted at the time,” Recht says. “At NYU Langone Health, we have always had a special culture. As academic radiologists, we work in teams. We’re in reading rooms together, we have residents and fellows, and we interact with our referring clinicians. While we can do our basic jobs working from home, it’s not the same as it was before. We’ve lost something significant as an academic culture — and that’s the collaboration.”
Mossa-Basha agrees. “Academic radiology environments are collaborative and social working environments, where we work with other radiologists on a daily basis, seeking help on difficult cases, reviewing cases side by side with residents and fellows, taking part in multidisciplinary conferences with ordering providers, and meeting with these ordering providers to individually discuss cases, specifically diagnoses, next steps, and treatment approaches,” he says. “Radiology directly engages with so many facets of the hospital system due to our central role in diagnosis and treatment.” Unfortunately, some elements of this uniquely collaborative and social culture simply can’t be replicated virtually, Mossa-Basha says.
Smetherman echoes this concern. “I think the pandemic challenged us to rethink how we could collaborate,” she says. “Meeting together in a conference room, sitting next to a trainee to teach, and giving a lecture to a live audience are natural and familiar. Human beings are social animals, and we need to be very careful that we do not lose our empathy, connection with one another, and the creative energy that comes from working with others while in-person opportunities are not safe.”
What Didn’t Work: Cancelled/Deferred Imaging
According to a JACR® study on the impact of the pandemic on imaging case volumes, many patients decided to delay imaging last year out of fear of contracting COVID-19. Mammography was down by 59% at the beginning of the pandemic, for example, and reached a 94% decline at one point in the summer.1 The downstream consequences of this delayed or missed imaging have yet to be fully understood, says Smetherman. “We’ve experienced three surges, and we’ve seen the consequences to patient care each time,” Smetherman says. “If you don’t have patients coming in for their mammograms, you have this backlog of exams. And then you have patients presenting at more advanced stages of their disease.”
Recht shares this concern. “I think people realize that the risk of not getting imaged when it’s necessary, is greater than the risk of contracting COVID-19,” Recht says. “The effects of delaying or skipping screening altogether is that you don’t pick up a cancer in time.”
Looking Beyond the Pandemic
Smetherman, Recht, and Mossa-Basha are all optimistic about what the rest of 2021 will look like for radiology and healthcare in general. Radiology’s response to the pandemic shows that many —often long-awaited — changes can happen faster than previously imagined. “It was really nice to see, in the setting of a crisis, how quickly people who normally may not band together can convene to accomplish something,” Mossa-Basha says. “Normally it may take a long time for a decision to go through bureaucratic processes, but in the last year, those changes became rapid. That was a big victory and I hope we can maintain that.”
Smetherman also expects her institution to maintain many of the new safety protocols that have been instituted due to COVID-19, like mask requirements, social distancing, and sanitizing equipment, which will need to continue for the time being. And, she points out, it’s important to not let your guard down when it comes to safety protocols — and to communicate this to patients. “We have to make sure that patients really understand that it is safe for them to come in, because I do think we run the risk of seeing imaging not being utilized as strongly,” she says. Mossa-Basha agrees. “Institutions should continue to create infrastructures that facilitate and support patient safety,” he says, “like one-way entries and exits or continued growth of portable imaging to be used for patients with communicable diseases.”
According to Smetherman, the last year was a learning experience for radiology — and now there is work to be done to implement the lessons learned. “I think it would be a mistake to try to go back to where we were on Jan. 1, 2020,” she says. “My hope is that we will come out of this crisis with a greater focus on overall wellness, a firmer commitment to helping our patients have better access to preventive screenings, and a stronger emphasis on continuing all the process and safety improvements we’ve made over the last year.”