Diagnostic and Interventional Radiology Case Volume and Education in the Age of Pandemics: Impact Analysis and Potential Future Directions

Abstract

Rationale and Objectives: To assess the immediate impact of the COVID-19 pandemic on Diagnostic and Interventional Radiology education, and to propose measures to preserve and augment trainee education during future crises. Materials and Methods: Diagnostic Radiology (DR) studies and Interventional Radiology (IR) procedures at a single tertiary-care teaching institution between 2015 and 2020 were reviewed. DR was divided by section: body, cardiothoracic, musculoskeletal (MSK), neuroradiology, nuclear medicine, pediatrics, and women's imaging. IR was divided by procedural types: arterial, venous, lymphatic, core, neuro, pediatrics, dialysis, cancer embolization or ablation, noncancer embolization, portal hypertension, and miscellaneous. Impact on didactic education was also assessed. ANOVA, t test, and multiple comparison correction were used for analysis. Results: DR and IR caseloads decreased significantly in April 2020 compared to April of the prior 5 years (both p < 0.0001). Case volumes were reduced in body (49.2%, p < 0.01), MSK (54.2%, p < 0.05), neuro (39.3%, p < 0.05), and women's imaging (75.5%, p < 0.05) in DR, and in arterial (62.6%, p < 0.01), neuro IR (57.6%, p < 0.01) and core IR (42.6%, p < 0.05) in IR. IR trainee average caseload in April 2020 decreased 51.9% compared to April of the prior 5 years (p < 0.01). Utilization of online learning increased in April. Trainees saw significant increases in overall DR didactics (31.3%, p = 0.02) and no reduction in IR didactics, all online. Twelve major national and international DR and IR meetings were canceled or postponed between March and July. Conclusion: Decreases in caseload and widespread cancellation of conferences have had significant impact on DR/IR training during COVID-19 restrictions. Remote learning technologies with annotated case recording, boards-style case reviews, procedural simulation and narrated live cases as well as online lectures and virtual journal clubs increased during this time. Whether remote learning can mitigate lost opportunities from in-person interactions remains uncertain. Optimizing these strategies will be important for potential future restricted learning paradigms and can also be extrapolated to augment trainee education during unrestricted times.

The Role of Telemedicine in the Maintenance of IR Outpatient Evaluation and Management Volume During the COVID-19 Global Pandemic

“…The recovery period demonstrated a gradual increase in outpatient E&M, with a decline in telehealth encounters balanced by the growth of in-person visits. Outpatient E&M volume fell by 50.0% overall compared with the same period in 2019, similar to prior studies, which have reported declines ranging from 42.6%–57.6% ( 1 , 2 ).…”

“…Early in the course of the COVID-19 pandemic, state and local governments began to institute stay-at-home orders, effectively prohibiting nonurgent patient care. Prior studies performed at the beginning of the pandemic focused on quantifying the loss in interventional radiology (IR) volume by procedure category and modeling expected recovery ( 1 , 2 ). Telemedicine rapidly emerged as a viable alternative for IR consultations while in-person consultation volumes decreased ( 3 ).…”

COVID-19 and Radiology Resident Imaging Volumes–Differential Impact by Resident Training Year and Imaging Modality

“…As such, inadequate imaging volumes or lack of in-person teaching significantly hampers the resident educational experience (6). A recent study found a significant decrease in total imaging case volume among residents and divisions (10). Our study expands upon these findings, evaluating the differential impact by resident training year and imaging modality.…”

Sources of Revenue Loss and Recovery in Radiology Practices During the Coronavirus Disease 2019 (COVID-19) Pandemic

“…Prior studies have also quantified the influence of the first wave of the virus and measures taken to contain it on imaging volume ( 6 , 7 , 8 , 9 ). The decline in volume, however, incompletely characterizes the true financial effect on radiology practices, as the types of imaging studies performed also shifted.…”