Variables Influencing Radiology Volume Recovery During the Next Phase of the Coronavirus Disease 2019 (COVID-19) Pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has reduced radiology volumes across the country as providers have decreased elective care to minimize the spread of infection and free up health care delivery system capacity. After the stay-at-home order was issued in our county, imaging volumes at our institution decreased to approximately 46% of baseline volumes, similar to the experience of other radiology practices. Given the substantial differences in severity and timing of the disease in different geographic regions, estimating resumption of radiology volumes will be one of the next major challenges for radiology practices. We hypothesize that there are six major variables that will likely predict radiology volumes: (1) severity of disease in the local region, including potential subsequent "waves" of infection; (2) lifting of government social distancing restrictions; (3) patient concern regarding risk of leaving home and entering imaging facilities; (4) management of pent-up demand for imaging delayed during the acute phase of the pandemic, including institutional capacity; (5) impact of the economic downturn on health insurance and ability to pay for imaging; and (6) radiology practice profile reflecting amount of elective imaging performed, including type of patients seen by the radiology practice such as emergency, inpatient, outpatient mix and subspecialty types. We encourage radiology practice leaders to use these and other relevant variables to plan for the coming weeks and to work collaboratively with local health system and governmental leaders to help ensure that needed patient care is restored as quickly as the environment will safely permit.

Imaging Volume Trends and Recovery During the COVID-19 Pandemic: A Comparative Analysis Between a Large Urban Academic Hospital and Its Affiliated Imaging Centers

“…Imaging volume at our institution began decreasing sharply starting on March 11th, following a state of emergency being declared in Massachusetts. Similarly, previous studies have shown that imaging volume decreased elsewhere in the country as well, including at institutions in the state of New York and in Santa Clara County, California, all within a week of the observed decrease at our institution (11,14). It was during this time that the WHO declared the COVID-19 outbreak a pandemic; together with subsequent CDC and American College of Radiology recommendations, this led to changes in not only our hospital system policies, but all health care systems across the United States to delay nonessential imaging studies as part of the widespread effort to slow the rate of new infections (10,16,17,20).…”

“…Various modalities were differentially affected during the COVID-19 pandemic. Previous studies in New York and Santa Clara demonstrated that mammography and nuclear medicine exhibited the greatest degree of volume reduction (11,14). Similarly, mammography and nuclear medicine also exhibited the greatest level of decrease in our study.…”

“…Towards the end of March, imaging volumes in certain regions of Europe have shown a slight increase since the nadir earlier in the month (13). Such rebound has not been extensively investigated in the United States (14).…”

Defining the Recovery

“…Although we seek to predict the future, models that project rates of service resumption make key assumptions that individual practices must validate for their own situation before implementing system responses. Multiple institutions present their data showing the magnitude and time course for imaging reduction rates that reflect their institution capacity, their local rate of COVID-19 infections, and state-level shelter-in-place regulations [2][3][4][5]. Although the shape of the curve is similar, hyperlocal variables introduce variability.…”

“…Although the shape of the curve is similar, hyperlocal variables introduce variability. One institution modeled service recovery informed by hyperlocal considerations [2].…”