The Breast Journal ( IF 1.9 ) Pub Date : 2020-05-25 , DOI: 10.1111/tbj.13891 Afnan Fahd Al-Muhanna 1
A Series of pneumonia cases of unknown cause were reported in Wuhan, China in December 2019, later found to be related to the novel coronavirus (2019‐nCoV).1 On 11 February 2020, the WHO named the virus as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) and the disease were given the name of Coronavirus Disease 2019 (COVID‐19). Since then, COVID‐19 epidemic is spreading all over the world,2 with a significant impact on the health care system and were announced to be pandemic by WHO 30 January 2020,3 By 24 April 2020, the WHO reported 2,626,321 confirmed cases globally with 181,938 deaths.4 The first two reported cases from Saudi Arabia were on 2 March 2020.5 Saudi government takes many actions in a way to keep numbers as low as possible to flatten the curve and give a chance for the health care system to be ready.
On 16 March 2020, a set of policies and procedures were designed internationally by a team of leaders in radiology, and it was published online at the Radiology (RSNA journal) to improve Radiology Department preparedness in the setting of the COVID 19 epidemic. Their main goals were to achieve sufficient capacity to continued operation during a health care emergency, to support the care of patients with COVID‐19, and to maintain radiologic diagnostic and interventional support for the hospital and health system.6 However, they did not come out with specific recommendations for breast imaging unit.
Breast imaging is a high demand specialty, mainly if you work at tertiary care academic institute, which makes us enthusiastic about setting a list of policies and procedures to overcome the challenges we face with the COVID‐19 pandemic. We aim to ensure our staff and patient safety at the same time, maintaining a consistent workflow.
Our breast imaging unit at King Fahd Hospital of the University (KFHU) is on the ground floor allocated just behind the isolation room and emergency department; this pushes us to change our workflow.7 The hospital is providing world‐class medical care in addition to its integral role as a training center. Since the announcement of COVID‐19 Epidemic by WHO, our hospital infection control department was conducting different meetings to ensure Preparedness and readiness of all clinical departments, additionally, they provide an up to date educational materials for healthcare workers at our hospital intranet web page as per recommendation from Saudi CDC and the national committee for COVID‐19 shared by ministry of health MOH 8, 9
- All Patients should be screened for COVID‐19. As per hospital policy, all patients, visitors, and staff are screened at the entrance. Patient screening is now undertaken at the time of scheduling following a specific Case Definition sheet posted at the radiology front desk (Figure 1). Any patients who screen positive for possible COVID‐19 illness are redirected to designated isolation clinic.
- All screening mammography and screening MRI cases were cancelled including high risk patients.
- Reschedule all BI‐RADS 3 (probably benign) cases.
- Reschedule procedures for BI‐RADS 3(probably benign) and BI‐RADS 4A (low suspicion for malignancy).
- Only cases with high clinical concern are accepted for diagnostic studies.
- Sampling For BI‐RADS 4(suspicious) and BI‐RADS 5 (highly suggestive of malignancy) is performed at the same visit.
- All patients should be masked during the examination and at the time of the procedure.
- Preoperative localization is done just prior to surgery using wires to reduce the number of hospital visits.
- All breast imaging studied should be delayed for known or suspected COVID‐19 patients as per our hospital infection control policy.
- Implementation of “social distancing” strategies as recommended by our infection control department for our patients, staff, trainees, and faculty. Such as limiting the number of chairs in waiting rooms and scheduling appointments 45 minutes apart, ensuring 1‐meter distance between patients at radiology front desk.
- 11. We encourage remote consultation to decrease the number of people in radiology reading rooms via smart call or video call and for Multidisciplinary meetings, our plan to move it to video conferencing. Currently, we are exploring strategies to allow diagnostic radiologists to work from home and developing guidance for when this is appropriate.
- 12. Close coordination with our hospital infection control team to ensure that all department employees are aware of recommended infection control protocols.
- 13. Availability of Personal protective equipment (PPE) in addition to the education of appropriate donning and doffing techniques for PPE.
- 14. Our Technologists are being reassigned to areas of anticipated greater need, such as X‐ray and CT.
- 15. Our breast imaging radiologist is participating in X‐ray readings and covering on‐calls.
- 16. All under and post‐graduate teaching is conducted through blackboard and zoom video communication.
- 17. Provided an up to date information about COVID‐19 for Post graduate students, trainee and radiology staff through e‐mails, WhatsApp group, and messages.
- 18. Home quarantine was recommended for staff who arrive from countries with COVID‐19 epidemic.
- 19. Use of door signage to limit access to reading rooms.
- 20. Continue sharing information with all departments.
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