COVID-19: Position Statements and Guidance

College Position Statements

Re-introduction of Interventional Radiology and Interventional Neuroradiology services during COVID-19

Updated 18 May 2020
Published 30 March 2020

This revised statement is designed to support hospitals and health service organisations with re-introduction of essential non-emergency Interventional Radiology (IR) and Interventional Neuroradiology (INR) services following the decision to implement a staged easing of restrictions on elective surgery and clinical procedures. IR and INR possess many characteristics that are complimentary to the ongoing COVID-19 restrictions, and therefore make it a valuable service in the recovery of clinical care alongside the mandatory requirements for safely managing the COVID-19 pandemic.

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Safety must come first when resuming clinical radiology and radiation oncology services during COVID-19

5 May 2020

Given the success seen in Australia and New Zealand to flatten the COVID-19 incidence curve, RANZCR strongly recommends a cautious, gradual and safety-first return to normal service provision. COVID-19 will continue to impact on delivery of healthcare for some time, likely until the availability of a vaccine. In Australia and New Zealand, the number of new cases has been declining and there have been continued low rates of hospitalisation. As such, restrictions are continually being reviewed and we have already seen restrictions begin to be relaxed across some jurisdictions. It is prudent as we move from containment efforts to short-term recovery that plans to scale-up operations are carefully balanced.

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Impact of COVID-19 Pandemic on Availability of Clinical Radiology in Australia

Published 24 April 2020, updated 7 May 2020

Australia is facing one of our toughest tests in history. Clinical radiology is facing major challenges playing its role, during this public health crisis. RANZCR’s role is to ensure that Australians all have timely and appropriate access to clinical radiology services. The viability of individual businesses is neither the concern nor mandate for RANZCR. However, the sustainability of private radiology practices and overall access to public clinical radiology services are inextricably linked: private radiology practices form the backbone of outpatient service provision, protecting the public health system from overload. In addition, many radiology services in critically located public hospitals are outsourced to private radiology providers.

In these unique times the biggest threat to ongoing patient access is availability of radiology services. The COVID-19 pandemic has rapidly and severely affected private and community-based radiology services throughout Australia, many diagnostic and interventional practices may cease to exist. Unaddressed, the loss of community-based practices is likely to disrupt and diminish the quality and availability of healthcare: this will be magnified in rural and remote areas where there may be only one practice. It is crucial these services are resourced and supported to maintain service provision in the short term and to ensure the radiology sector can continue to provide these essential services now, and in the years ahead.

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Guidelines for CT Chest and Chest Radiograph Reporting in Patients with Suspected COVID-19 Infection 

24 April 2020

Endorsed by the Australia and New Zealand Society of Thoracic Radiology and Royal Australian and New Zealand College of Radiologists, April 2020 

These guidelines have been produced based on the available medical literature (at 28 March 2020), and after careful consideration of guidelines issued by the Radiological Society of North America and the British Society of Thoracic Imaging (BSTI). 

Whilst screening for COVID-19 infection with chest CT is not recommended at this time, the number of chest CT examinations performed for clinical assessment of patients with proven or suspected infection is increasing as the prevalence of disease within the Australia and New Zealand communities increases. Chest radiographs performed throughout the course of COVID-19 infection, particularly in hospitalised patients, are used to identify the typical and atypical features of COVID-19 infection, monitor the extent of lung involvement, inform management decisions and may identify other processes.

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Prioritising Imaging during COVID-19

20 April 2020

Delivery of care in clinical radiology requires close personal contact with patients who may be suspected or known cases of COVID-19 receiving care related to COVID-19 or related to other disease(s). Furthermore, delivery of care in clinical radiology in both hospital and community settings also involves patients attending health services for a period of time, which increases their risk of potential exposure to infection.

As our health systems are impacted by COVID-19, it is crucial that radiology services in both public and private settings, are prioritised according to clinical need to ensure that patients requiring urgent imaging procedures (<24 hours) are seen promptly. Where local circumstances require, the prioritisation of those patients whose imaging cannot be deferred will significantly reduce the need for patients to be in hospital or private practice, protect health care workers from potential COVID-19 infection and conserve health resources, particularly PPE. Procedures that cannot be postponed include but are not limited to procedures to save life and limb or prevent permanent disability.

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Patient Access to Imaging Services in New Zealand – During and After COVID-19 Social Distancing

15 April 2020

New Zealand is focused on stopping the spread of COVID-19 and the District Health Boards (DHB) have been focused on preparing for the care of large numbers of COVID-19 patients. This has meant deferring care deemed not urgent. The Royal Australian and New Zealand College of Radiology (RANZCR) understands that decisions to defer radiology services might be more frequent than is appropriate for some patients. Deferring imaging may be delaying critical diagnosis and treatment with significant implications for patient outcomes. Moreover, it exacerbates already significant waiting lists once the social distancing restrictions are lifted. RANZCR requests that all available imaging services be used to maximise available care for patients during each Level of COVID-19 Alert.

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Artificial Intelligence and COVID-19

14 April 2020

RANZCR supports research into Artificial Intelligence (AI) and other advanced medical imaging technologies to assist in the clinical care of patients with COVID-19. However, RANZCR does not recommend the use of CT imaging to screen for or diagnose COVID-19 with or without the use of AI to assist diagnosis. As detailed in RANZCR’s statement on the use of imaging in COVID-19 disease (with similar statements from the American College of Radiology (ACR), and Society of Thoracic Radiology (STR)), CT is unsuitable for the screening and diagnosis of COVID-19. Internationally, CT has predominantly been used when other forms of testing, such as RT – PCR are unavailable, insensitive, or both. This is not the case in Australia or New Zealand at present.

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Advice on appropriate use of CT throughout the COVID-19 pandemic 

Updated 20 April 2020
Published 9 April 2020

RANZCR has released a position statement on the appropriate use of CT during the COVID-19 pandemic, particularly in relation to patients undergoing emergency surgery. RANZCR recognises the need for our surgical colleagues to have the utmost protection against the risk of becoming infected during the course of their daily work and strongly support policies, procedures and PPE that facilitate this. However, RANZCR strongly advises against conducting routine chest CT scans for all individuals undergoing emergency surgery in Australia and New Zealand. We believe the misuse of chest CT and misapplication of results in this situation brings unnecessary and clinically important risks to the surgical team and the patient, given the current status of the COVID-19 pandemic in Australia and New Zealand. 

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Joint Position Statements

COVID-19 Essential Role of Clinical Radiology Services

A coalition of leading imaging bodies in Australia and New Zealand are concerned with reports that radiology departments and practices are experiencing difficulties accessing personal protective equipment (PPE). RANZCR have urged the Australian and New Zealand governments to ensure all private and public clinical radiology departments and practices have access to PPE throughout the COVID-19 pandemic.

RANZCR joined with Australian Diagnostic Imaging Association (ADIA), Australian Society of Medical Imaging and Radiation Therapy (ASMIRT), Australasian Sonography Association (ASA), Medical Imaging Nursing Association (MINA), Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM), and the New Zealand Institute of Medical Radiation Technology (NZIMRT) to release the COVID-19 Essential role of clinical radiology services position statement.

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Other Position Statements

The Role of Imaging in COVID-19 Disease