Since time immemorial, Radiology or Diagnostic Imaging has played an important and central role in disease management, says DR SANDEEP SHARMA
In December 2019, China reported cases of an acute respiratory disease of unknown etiology in Wuhan, and a few weeks later, the outbreaks spread to many other countries with the World Health Organisation (WHO) declaring it as a pandemic ( a disease, usually of an infectious nature prevalent across multiple continents or worldwide) on 11th March 2020.
The virus — SARS-COV-2 popularly known as COVID-19 or simply Coronavirus soon became the biggest healthcare crisis in most of our lives and the most significant geopolitical event of our generation in the modern history globally.
Since times immemorial, Radiology or Diagnostic Imaging has played an important and central role in disease management, with a wide choice of tools and techniques available for the detection, staging and defining treatment modalities for innumerable diseases.
However, with the onset of COVID-19, there lacked any reliable and accurate (read: highly specific and highly sensitive) testing for early detection and containment of this deadly infection.
The value of an imaging test relates to the production of results that are clinically workable either for establishing Diagnosis or for guiding management, or triage.
Here, the critical role of chest imaging including baseline X-ray and the High Resolution Computed Tomography (HRCT) of the Thorax or Chest became apparent as an overlooked imaging modality, a more sensitive and specific investigation compared to the Gold Standard RT PCR test (as per many studies conducted worldwide).
HRCT Chest findings in COVID-19 such as Ground Glass Opacities (GGOs), Consolidation, Crazy Pavement Pattern, Septal Thickenings etc and the CT Severity Scoring (CTSS) reveals the extent of damage to the lungs by the COVID-19 virus, a virus primarily affecting the lungs, which proved to be a useful tool to provide the physicians more options for accurate and better management in terms of — determining severity, guiding treatment, managing complications and assessing treatment response especially in patients with a high clinical suspicion of COVID-19.
However, unavailability of CT Scan machines in rural settings and dedicated machines for COVID patients, moving patients to the machine/set-up especially those on oxygen support, difficulty in disinfecting the machines and following strict infection control protocols popped up as drawbacks to this imaging technique.
Other Radiology and Imaging investigations such as Chest X-RAYs (Bedside) provided the added advantage of portability and the provision to compare baseline images to latest images in order to study the progression of the disease and guide appropriate management with minimal exposure to radiation.
Using Chest X-Ray as a method of triage is believed to be more superior than the rapid testing kits in busy healthcare set-ups. Chest Imaging including X-RAY and CT Scans also assist in detecting complications such as Pneumothorax, Pleural Effusion etc even before they manifest clinically. Also, patients unaware of underlying comorbidities such as chronic lung disease or congestive heart failure could be detected with these conditions and managed better. Hence, Radiology or Medical Imaging plays an important auxiliary role in the diagnosis and management of COVID-19 patients, particularly in those most seriously affected.
Economically, this pandemic has detrimental effects and significant loss of revenues, as the Governments across the world have partially or completely shut down all non-essential services.
Due to these measures there had been significant reduction in all imaging scans as outpatient volume had been severely reduced to 10-20 per cent in comparison to pre-COVID times. Additionally, following these guidelines all non-emergent outpatient imaging scans including ultrasound, radiographs, CT, MRI and radiological interventional procedures were postponed, which resulted in sub-normal revenue for a minimum of 5-6 months affecting mainly the stand alone centres running with limited modalities.
The writer is Director and Sr Radiologist, MRI Imaging and Diagnostics Res Centre Ltd