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Early-Stage Radiology Volume Effects and Considerations with the Coronavirus Disease 2019 (COVID-19) Pandemic:
Alexander M Norbash1, Arl Van Moore2, Michael P Recht3
1Chair, Department of Radiology, University of California, San Diego, California.
Insights
The COVID-19 pandemic caused significant drops in radiology imaging volumes, particularly for screening exams. Academic medical systems in high-surge areas experienced greater volume loss than those in low-surge regions.
Area of Science:
- Radiology
- Healthcare Management
- Epidemiology
Background:
- The COVID-19 pandemic led to reduced healthcare utilization due to public health measures.
- Non-urgent medical imaging services experienced significant disruptions.
- Academic medical systems (AMSs) and private practices faced challenges in maintaining service volumes.
Purpose of the Study:
- To quantify the impact of the COVID-19 pandemic on radiology imaging volumes.
- To compare volume changes across different regions (high vs. low COVID-19 surge) and practice types.
- To identify imaging modalities most affected and assess adaptive strategies.
Main Methods:
- A retrospective analysis comparing 2020 weekly imaging volumes to 2019 baseline volumes.
- Data collected from six AMSs (three high-surge, three low-surge) and a national private practice coalition.
- Calculations included overall, outpatient, emergency, and inpatient studies across 14 modalities.
Main Results:
- Radiology volumes dropped significantly, ranging from 40% to 70% in AMSs during peak pandemic weeks (weeks 11-17).
- Screening mammography and DXA scans saw the largest decreases, while PET/CT, X-ray, and interventional radiology had smaller declines.
- Inpatient imaging volume was less affected than outpatient or emergency services.
Conclusions:
- The pandemic caused substantial, albeit temporary, reductions in radiology imaging volumes, especially for screening examinations.
- High-surge areas and screening studies experienced more pronounced volume declines.
- Imaging modalities with critical diagnostic implications showed greater resilience, suggesting perceived risk influenced volume preservation.
Objective:
The coronavirus disease 2019 (COVID-19) pandemic resulted in significant loss of radiologic volume as a result of shelter-at-home mandates and delay of non-time-sensitive imaging studies to preserve capacity for the pandemic. We analyze the volume-related impact of the COVID-19 pandemic on six academic medical systems (AMSs), three in high COVID-19 surge (high-surge) and three in low COVID-19 surge (low-surge) regions, and a large national private practice coalition. We sought to assess adaptations, risks of actions, and lessons learned.
Methods:
Percent change of 2020 volume per week was compared with the corresponding 2019 volume calculated for each of the 14 imaging modalities and overall total, outpatient, emergency, and inpatient studies in high-surge AMSs and low-surge AMSs and the practice coalition.
Results:
Steep examination volume drops occurred during week 11, with slow recovery starting week 17. The lowest total AMS volume drop was 40% compared with the same period the previous year, and the largest was 70%. The greatest decreases were seen with screening mammography and dual-energy x-ray absorptiometry scans, and the smallest decreases were seen with PET/CT, x-ray, and interventional radiology. Inpatient volume was least impacted compared with outpatient or emergency imaging.
Conclusion:
Large percentage drops in volume were seen from weeks 11 through 17, were seen with screening studies, and were larger for the high-surge AMSs than for the low-surge AMSs. The lowest drops in volume were seen with modalities in which delays in imaging had greater perceived adverse consequences.
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