The Banner for COVID-19
RANZCR has developed a position statement on steroid injections and the COVID-19 Vaccine to inform clinical decision making. Currently there is no evidence to suggest that a steroid injection to a joint or soft tissue will reduce the effectiveness of a COVID vaccine. Each patient’s situation is unique. Referring clinicians and radiologists should exercise clinical judgement in weighing the severity of the patient’s symptoms, the urgency of treatment, alternatives to corticosteroid injection, and the patient’s overall clinical situation against the small, theoretical, but unproven, risks of corticosteroid injection.
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RANZCR has developed imaging recommendation for patients suspected of vaccine-induced immune thrombotic thrombocytopenia (VITT) to supplement the VITT Multidisciplinary Guideline for Doctors developed by The Thrombosis and Haemostasis society of Australia and New Zealand (THANZ).
Recent literature from the United States has indicated that some individuals own immune response post COVID vaccination (Pfizer and Moderna) may manifest as unilateral axillary lymphadenopathy related to the vaccinated arm. Such responses have not been reported with the Astra-Zeneca vaccine thus far. The Royal Australian and New Zealand College of Radiologists notes that the rare occurrence of axillary lymphadenopathy following COVID vaccinations may cause diagnostic confusion. However, balanced with the risk of increased screening intervals, RANZCR does not recommend delaying screening, particularly for higher risk groups, and rural and remote populations where access to screening is not always available.
A RANZCR Faculty of Radiation Oncology position on appropriate scheduling of virtual appointments (as opposed to face-to-face) with patients under the care of radiation oncologists in Australia and New Zealand in the context of COVID 19 pandemic.
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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.
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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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.
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.
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.
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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Updated 20 April 2020Published 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.
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.