The Effect of COVID-19 on Imaging in Veterinary Practice in the UK
In our previous article we discussed the impact that the outbreak of SARS-CoV-2 has had on veterinary practice in the UK. This article follows on from that and examines the impact of the pandemic on imaging specifically.
Imaging workflow in the majority of practices could reasonably be divided into two categories: procedures for which staff, and potentially owners, would typically be present with the animal throughout the process, and procedures for which they would not. In most instances this will correlate to ultrasonography in the case of the former, and radiography, CT, MR, and fluoroscopy (plus scintigraphy in certain equine practices) in the case of the latter. It is likely that the impact of COVID-19 will be different in each ‘category’.
Many practices allow owners to remain with their pets for ultrasound examinations, particularly in the case of quicker procedures such as pregnancy diagnosis and ultrasound-guided centesis. Staff now need either to preclude this owner attendance, with its associated hurdles of expectation management, or they need to take necessary precautions with PPE and social distancing, making the process slower, and potentially difficult from a practical standpoint. Where owners would not be present, there are still the difficulties associated with staff having to spend protracted periods of time in close proximity to one another, often in quite confined spaces, restraining animals for the scan. This is likely to be not only physically arduous for the staff but may also lead to stress in the patients – rustling aprons and plastic visors might not be appreciated by an already-anxious cat!
Any imaging in which owners, and in most cases staff, would not remain by the animal throughout, are likely to be impacted less when it comes to the requirement for PPE, especially for owners who may be unaccustomed to, or hesitant about, wearing it. However, these procedures are often more involved, requiring more staff members and potentially taking longer, even in the pre-COVID-19 world. Further delays associated with the various preventative measures now in place across the country are almost certainly going to exacerbate this time cost, and ultimately lead to a dip in throughput.
Given the necessary delays to allow appropriate use of protective equipment and adequate biosecurity, it is important to ensure our diagnostic equipment is being used as efficiently and safely as possible.
For radiography systems, direct radiography (DR or digital direct radiography (DDR)) offers many advantages. Images are captured faster than film or computed radiography (CR) systems, and there is less handling of the equipment involved. This streamlines workflow and reduces the contact staff have with any contaminated surfaces. In addition, DR systems lack the moving components present in CR systems, this reduces the need for maintenance and, when maintenance is required, DR systems allow much of it to be done remotely. This can reduce the need for site visits from engineers.
In the case of ultrasonography systems, making full use of the system functionality can be of great benefit. The creation and use of system pre-sets for routine examinations can reduce the time spent optimising images during examinations. Unlike radiography, ultrasound transducers are in constant contact with the operator; even with the use of PPE and routine hand cleaning there are risks of pathogen transmission. Like any equipment, it is important to have a routine cleaning protocol in place. Unfortunately, different systems have different requirements for cleaning and maintenance. Your equipment supplier and/or manufacturer can help with advice on how maintain and disinfect equipment.
Any equipment, from ultrasound through to computed tomography (CT) or magnetic resonance imaging (MRI), takes time and experience to use as efficiently as possible. Especially in the present climate where staff numbers may be reduced, making sure every team member is familiar with the diagnostic equipment available is important. Here, the use of any remote support or training from suppliers or telemedicine companies can help staff use equipment to its full potential.
Similarly, having a properly integrated picture archiving and communication system (PACS) can allow any images acquired to be quickly stored and shared. This reduces the need for staff to handle computer equipment or storage drives.
Diagnostic imaging is an excellent tool in our toolkit when it comes to disease investigation and can act as a valuable revenue stream for practices. . Careful consideration about the imaging workflows in practice, including a review on the available technology and its ability to minimise the time taken to perform imaging procedures, may well pay dividends in what is likely to be our ‘new normal’ for a good while yet.
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