 Hello friends, welcome to Indian Radiologist. On today's video, we will be speaking on a basic guideline that we require to prepare a radiology department so that we are prepared for COVID-19. As we know, COVID-19 is the recently discovered virus that has been labeled as a pandemic by WHO. Although most of the patients come with common cold, many patients progress to a severe acute respiratory syndrome which has led to very high infection rates and deaths in China as well as Italy and Iran. As of 21st March 2020, India has 283 confirmed cases but the cases are expected to rise as more and more testing is being conducted on citizens across the country. COVID-19 is a much more infectious disease compared to influenza as we can see from this chart and from a clinical perspective the symptoms occur about two to 14 days after exposure which may start with a sore throat but can progress to fever, cough and shortness of breath. Now the problem with coronavirus from a clinical perspective is that especially people who are in close contact with one another within about six feet through respiratory droplets produced when an infected person coughs or sneezes. It is also possible that the person can get COVID-19 by touching a surface or object that has a virus on it and then touching their own mouth, nose or possibly their eyes. This virus also has the ability to stay on surfaces for a long period. For example, on plastic and stainless steel it can stay for almost up to two to three days and while working there are certain guidelines we need to follow especially in the department of radiology. Although CT scan was touted as one of the main imaging criteria to diagnose COVID-19, we now know that they are no longer part of the diagnostic criteria for COVID-19. The initial CT findings of course start with peripheral brown grass infiltrates and one can also get crazy paving and organizing nemonias. Lab tests are the test of choice to diagnose COVID-19 and CT is being used only in certain circumstances. So how do we protect ourselves and our staff from COVID-19? So the checks have to start at various levels starting with entering the hospital at the hospital entrance itself. Patients coming in have to be asked about travel history. A fever check has to be done with infrared. People entering the hospital have to wear a mask. Strictly no visitors have to be allowed when coming into the hospital. An accompanying person has to be allowed in only if necessary. Once they pass this first check post and move towards the radiology department we are looking at protocols for the patient, for the radiology personnel and for the radiologists. Patients we have to understand that the elderly should come first because as you know from recent data which is available right from China to Italy to the US. Most of the deaths that have been occurring have occurred in the higher age group above 60 onwards. The US chart is of course of the intensive care admissions. So the elderly should be taken up first should not be made to wait. All people coming in contact with each other should be wearing a mask at all times. It's a good idea when the people enter the radiology department at the door itself there's a hand wash which is available. The hand wash should be made compulsory for all those entering the radiology department. A dedicated history has to be asked from the patients. This of course might go once we move from stage 2 to stage 3 and it becomes a community transmission but even then people who are coming in contact with those who have traveled abroad stand a higher chance of having the COVID-19. So even history of contact with people who have traveled abroad should be asked from these patients. Another important thing is that try to push away unnecessary testing. So those tests which are not considered urgent by the department should be deferred by at least one to two weeks until this phase passes. At the front desk again the personnel have to be very vigilant. So you'd rather keep the sharper and the smarter technical staff on the front desk. They need to ask for travel history. They need to request the patients to wear a mask. Strictly no visitors should be allowed in the department or accompanying persons only if necessary. The staff will need to wear an N95 mask. They will need to be encouraged to wash their hands frequently. The timings of the staff need to be staggered. So ideally all staff who are working on an 8-hour shift needn't be at the counter at one time. They could be split into four or five-hour duties because if by chance one does come in contact with a positive patient then that staff will have to be quarantined. So if many are working together then the entire group may have to be quarantined. So that is something we need to bear in mind when we are making the duty list for the radiology personnel and technicians. If they do need to work together in one room you will have to delineate spaces so there is less mingling of staff. A similar plan has to be made for radiologists. You need to stagger their timings so that they don't come into contact with each other. You need to work solo on workstations. As we reach for our shift or duty we need to wipe down our keyboard or mouse before starting work. CT and MR radiologists can work from home for the next couple of weeks and do tele-reporting or report on the packs. We need to make a WhatsApp team of the department and discuss online daily if there are any suspected cases that have come about. All schedule meetings which we have with paraclinical or clinical staff need to be cancelled so you will not be coming in contact with those people and if possible you can conduct online meetings on Zoom or on WhatsApp or Google Duo. As radiologists we know we expect to see the changes that many papers have spoken about but we must realize that CT is not the imaging test for choice as of today. In a letter published on March 12 in intensive care medicine ultrasound scans have been used to help monitor patients with COVID-19 and they've used lung ultrasound to monitor more than a dozen patients in China with COVID-19 infections and the findings they have pointed out are five characteristic findings actually which include pleural line thickening and irregularity, a variety of B lines which are focal or multifocal, a few consolidation patterns and visible A lines during the recovery phase. Rare occurrence of pleural effusions has also been documented on ultrasound. So these findings would be useful in monitoring patients in the ICU itself on a portable setting rather than getting the patient down each time to the radiology department for either ultrasound or for CT scanning. Of course these findings will be predominantly found on ultrasound only if the lesions of the lung are close to the pleura. CT imaging is reserved only for those patients in whom patient management may be affected those with COVID-19 or in whom an alternative diagnosis must be ruled out. So whenever a call comes from the ICU for a portable x-ray or due precautions and due diligence must be performed the healthcare personnel entering the patient's room should be wearing an N95 mask ideally eye protection as well and a gown and gloves. On taking the x-ray thin sheet can be used to cover the x-ray to prevent it from contact with the patient. Once the x-ray is done the sheet can be discarded. If a suspected patient or a positive patient does need to come down for a CT scan the idea would be to conduct this examination towards the end of the day as the last patient. Once the scan is done a deep cleaning should be initiated and there should be a one hour downtime for passive air exchange reports can be sent to all staff members and to the ICU by electronic means like via email or by a text message. So in summary the radiology workflow would work something like this. If there is a clinical suspicion for COVID-19 present the RT-PCR test is the screening modality of choice and there is no need for imaging for screening or evaluation of COVID-19. If an alternative diagnosis is being considered that would affect management a portable imaging if possible should be done and that would start with a chest x-ray. This chest x-ray should be performed with due diligence and precautions. If imaging is required in the radiology department it would be a first CT again using due precautions taking care of droplet infection with the technicians and all staff in the room wearing N95 mask and protective gear. The test should be at the end of the day the last scan preferably if possible so that a deep cleaning can be initiated of the CT scan room. If it is done in the middle of the day when the department is still going to continue after this patient at least a one hour time interval needs to be taken before you conduct the next scan. We need to try the most to limit the imaging on a portable basis in the form of x-rays and ultrasound can be used as a supplement once a CT diagnosis is established and monitor these patients based on the B lines that we see on ultrasound.