A Policy Examination of Covid-19 Impact on the Radiology Department Standard Operating Procedures (SOPs): The Malaysian Experience
DOI:
https://doi.org/10.33102/mjosht.v10i1.386Keywords:
medical imaging, radiology workforce, standard operating procedure, Covid-19 policyAbstract
The purpose of this paper is to review the new management policy in medical imaging of the Covid-19 post-pandemic transition. This paper discussed the Standard Operating Procedure (SOP) introduced by the Ministry of Health (MoH) Malaysia to prevent and control intrahospital transmissions of Covid-19. A conceptual framework is proposed to highlight the key areas in the national SOP for preventing Covid-19 intrahospital transmissions in the radiology department. The key areas were classified into four categories: planned requests (patient appointments), (ii) open-access management (walk-in patient workflow and the triage system), (iii) direct contact (during radiology procedures), and (iv) exit policy and disinfection (post imaging conduct). The paper ends with a summary of diagnostic imaging classifications based on chest radiographs (CXR) and Computed Tomography (CT) images of suspected and confirmed Covid-19 patients. The Covid-19 SOP for the radiology department by the MoH was found to retain most of the patient quarantine and isolation guidelines by the Centre for Disease Control and Prevention (CDC) and incorporated several international policies on patient triage and disinfection of radiological equipment. The majority of the SOP is also sustained, like the SOP during the pandemic, except for the SOP that has been proven to be insignificant by recent research. The Covid-19 SOP for the radiology department plays an important role in reducing the intrahospital spread of Covid-19, with some areas needing improvement. Health workers in the radiology department should continue implementing the Covid-19 SOP and increase their knowledge in identifying Covid-19 signs on radiographic images to help safeguard themselves and the patients from intrahospital transmissions.
Downloads
References
Ullah, S., Mohd Nor, N. H., Daud, H., Zainuddin, N., Gandapur, M. S. J., Ali, I., and Khalil, A. “Spatial cluster analysis of COVID-19 in Malaysia”. Geospatial Health 16, no. 1 (2021). doi: https://doi:10.4081/gh.2021.961.
Hashim, J.H., Adman, M.A., Hashim, Z., Mohd Radi, M.F., Kwan, S.C. “COVID-19 Epidemic in Malaysia: Epidemic Progression, Challenges, and Response”. Frontiers in Public Health 9, no. 560592 (2021). doi: https://doi:10.3389/fpubh.2021.560592.
World Health Organization. “COVID-19 in Malaysia Situation Report 86”. Last accessed January 11, 2023. https://www.who.int/malaysia/internal-publications-detail/covid-19-in-malaysia-situation-report-86.
Elshami, W., Akudjedu, T.N., Abuzaid, M., David, L.R., Tekin, H.O., Cavli, B., and Issa, B. “The radiology workforce’s response to the COVID-19 pandemic in the Middle East, North Africa and India”. Radiography 27, no. 2 (2021): 360-368. doi: https://doi:10.1016/j.radi.2020.09.016.
Ooi, J.W., Er, A.T., Chong, C.M., Tsai, K.T., and Chong, M.C. “Knowledge, attitudes and perceptions of radiology healthcare workers during the COVID-19 pandemic”. Proceedings of Singapore Healthcare 31, (2021). doi: https://doi:10.1177/20101058211015801.
Ashari, M.A., Zainal, I.A., and Zaki, F.M. “Strategies for radiology departments in handling the COVID-19 pandemic”. Diagnostic and Interventional Radiology 26, no. 4 (2020): 296-300. doi: https://doi:10.5152/dir.2020.20232.
Syafiqah Salim. “Malaysia to transition to endemic phase of covid-19 on April 1, says PM”. The Edge Markets. Last accessed January 11, 2023. https://www.theedgemarkets.com/article/malaysia-enter-endemic-phase-april-1-says-pm.
Ministry of Health Malaysia. “Radiology Services Guidelines In The Management Of Suspected, Probable And Confirmed Covid-19 Patients”. Last accessed January 11, 2023. https://covid-19.moh.gov.my/garis-panduan/garis-panduan-kkm/ANNEX_24_RADIOLOGY_SERVICES_GUIDELINE_IN_THE_MANAGEMENT_OF_COVID-19_17062021.pdf.
Mossa-Basha, M., Meltzer, C.C., Kim, D.C., Tuite, M.J., Kolli, K.P., and Tan, B.S. “Radiology department preparedness for covid-19: radiology scientific expert review panel”. Radiology 296, no. 2 (2020). doi: https://doi:10.1148/radiol.2020200988.
Dennie, C., Hague, C., Lim, R.S., Manos, D., Memauri, B. F., Nguyen, E. T., and Taylor, J. “Canadian Society of Thoracic Radiology/Canadian Association of Radiologists consensus statement regarding chest imaging in suspected and confirmed covid-19”. Canadian Association of Radiologists Journal 71, no. 4 (2020): 470-481. doi: https://10.1177/0846537120924606.
Rubin, G. D., Ryerson, C. J., Haramati, L. B., Sverzellati, N., Kanne, J. P., Raoof, S., Schluger, N. W., Volpi, A., Yim, J. J., Martin, I. B. K., Anderson, D. J., Kong, C., Altes, T., Bush, A., Desai, S. R., Goldin, J., Goo, J. M., Humbert, M., Inoue, Y., Kauczor, H. U., and Leung, A. N. “The role of chest imaging in patient management during the COVID-19 pandemic”. Chest 158, no. 1 (2020): 106-116. doi: https://doi:10.1016/j.chest.2020.04.003.
Shahrin Aizat Noorshahrizam. “No more mandatory temperature scans, logbook check-ins from Friday, says defence minister. Malaymail”. Last accessed January 11, 2023. https://www.malaymail.com/news/malaysia/2022/02/08/no-more-mandatory-temperature-scans-logbook-check-ins-from-friday-says-defe/2040244.
Facente, S.N., Hunter, L.A., Packel, L.J., Li, Y., Harte A., Nicolette, G., McDevitt, S., Peterson, M., and Reingold, A.L. “Feasibility and effectiveness of daily temperature screening to detect COVID-19 in a prospective cohort at a large public university”. BMC Public Health 21, no. 1 (2021). doi: https://doi:10.1186/s12889-021-11697-6.
Dhesegaan Bala Krishnan. “New policies for caregivers and visitors at government hospitals to take effect this Saturday”. NEW STRAITS TIMES. Last accessed January 11, 2023. https://www.nst.com.my/news/nation/2022/04/790745/new-policies-caregivers-and-visitors-government-hospitals-take-effect.
Ministry of Health Malaysia. “SOP Sektor kesihatan”. Last accessed January 11, 2023. https://covid-19.moh.gov.my/faqsop/sop-pkp-pemulihan/SOP-Perubatan_-Dikemaskini-pada-3-September-2020.pdf.
Rossi, A., Prochowski Iamurri, A., Cerchione, C., Gentili, N., Danesi, V., Altini, M., Paganelli, G., and Barone, D. “Radiology Imaging Management in an italian cancer center (IRST IRCCS) during the COVID-19 pandemic”. Insights into Imaging 11, no. 1 (2020). doi: https://doi:10.1186/s13244-020-00935-x.
Peros, G., Gronki, F., Molitor, N., Streit, M., Sugimoto, K., Karrer, U., Lunger, F., Adamina, M., Breitenstein, S., and Lamdark, T. “Organizing a COVID-19 triage unit: A Swiss perspective”. Emerging Microbes & Infections 9, no. 1 (2020): 1506-1513. doi: https://doi:10.1080/22221751.2020.1787107.
Pan, L., Zeng, J., Pu, H., and Peng, S. “How to optimize the Radiology Protocol during the global covid-19 epidemic: Keypoints from Sichuan Provincial People’s Hospital”. Clinical Imaging 69, (2020): 324-327. doi: https://doi:10.1016/j.clinimag.2020.07.008.
Shen, Y., Cui, Y., Li, N., Tian, C., Chen, M., Zhang, Y.W., Huang, Y.Z., Chen, H., Kong, Q.F., Zhang, Q., and Teng, G.J. “Emergency responses to covid-19 outbreak: Experiences and lessons from a General Hospital in Nanjing, China”. CardioVascular and Interventional Radiology 43, no. 6 (2020): 810-819. doi: https://doi:10.1007/s00270-020-02474-w.
Nakajima, K., Kato, H., Yamashiro, T., Izumi, T., Takeuchi, I., Nakajima, H., and Utsunomiya, D. “Covid-19 pneumonia: Infection control protocol inside computed tomography suites”. Japanese Journal of Radiology 36, no. 5 (2020): 391-293. doi: https://doi:10.1007/s11604-020-00948-y.
Nik Mazian, A., Kamiso, N., and Ab Rahman, S.S. “Adaptation of workflow during COVID-19 pandemic: A Malaysian Radiology Department’s experience”. Ulum Islamiyyah 2, (2021): 70-76. doi: https://doi:10.33102/uij.vol33no3.321.
Ding, J., Fu, H., Liu, Y., Gao, J., Li, Z., Zhao, X., Zheng, J., Sun, W., Ni, H., Ma, X., Feng, J., Wu, A., Liu, J., Wang, Y., Geng, P., and Chen, Y. “Prevention and control measures in Radiology Department for covid-19”. European Radiology 30, no. 7 (2020): 3603-3608. doi: https://doi:10.1007/s00330-020-06850-5.
Kwee, T.C., and Kwee, R.M. “Chest CT in covid-19: What the radiologist needs to know”. RadioGraphics 40, no. 7 (2020):1848-1865. doi: https://doi:10.1148/rg.2020200159.
Wan, Y.L., Schoepf, U.J., Wu, C.C., Giovagnoli, D.P., Wu, M.T., Hsu, H. H., Chang, Y.C., Yang, C.T., and Cherng, W.J. “Preparedness and best practice in radiology department for covid-19 and other future pandemics of severe acute respiratory infection”. Journal of Thoracic Imaging 35, no. 4 (2020): 239-245. doi: https://doi:10.1097/rti.0000000000000529.
Mossa-Basha, M., Medverd, J., Linnau, K.F., Lynch, J.B., Wener, M.H., Kicska, G., Staiger, T., and Sahani, D.V. “Policies and guidelines for covid-19 preparedness: Experiences from the University of Washington”. Radiology 296, no. 2 (2020). doi: https://doi:10.1148/radiol.2020201326.
Gange, C.P., Pahade, J.K., Cortopassi, I., Bader, A.S., Bokhari, J., Hoerner, M., Thomas, K.M., and Rubinowitz, A.N. “Social distancing with portable chest radiographs during the COVID-19 pandemic: Assessment of radiograph technique and image quality obtained at 6 feet and through glass”. Radiology: Cardiothoracic Imaging 2, no. 6 (2020). doi: https://doi:10.1148/ryct.2020200420.
Chen, Q., Zu, Z.Y., Jiang, M.D., Lu, L., Lu, G.M., and Zhang, L.J. “Infection control and management strategy for covid-19 in the Radiology Department: Focusing on experiences from China”. Korean Journal of Radiology 21, no. 7 (2020): 851. doi: https://doi:10.3348/kjr.2020.0342.
European Centre for Disease Prevention and Control (ECDC). “European Centre for Disease Prevention and Control: COVID-19”. Last accessed December 30, 2021. https://www.ecdc.europa.eu/en/novel-coronavirus-china.
ACR. “ACR COVID-19 clinical resources for radiologists,”. Last accessed December 30, 2021. www.acr.org/Clinical-Resources/COVID-19-Radiology-Resources.
Kooraki, S., Hosseiny, M., Myers, L., and Gholamrezanezhad, A. “Coronavirus (COVID-19) outbreak: What the Department of Radiology should know”. Journal of the American College of Radiology 17, no. 4 (2020): 447-451. doi: https://doi:10.1016/j.jacr.2020.02.008.
Center for Disease Control and Prevention, “Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC,” Last accessed Dec. 30, 2021. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.
Cellina, M., Orsi, M., and Oliva, G. “How to reorganize the radiology departments to face the 2019 coronavirus disease outbreak”. Disaster Medicine and Public Health Preparedness 14, no. 6 (2020):789-791. doi: https://doi:10.1017/dmp.2020.159.
Department of Imaging Sciences & Interventional Radiology, “Covid Standard Operating Procedure For Radiological Procedures” Sree Chitra Tirunal Institute for Medical Sciences and Technology. Last accessed January 11, 2023. https://www.sctimst.ac.in/COVID-19/RESOURCES/Covid%2019%20Standard%20Operating%20Procedure%20Imaging%20&%20Interventional%20Radiology.pdf.
Malizia, A., Filograna, L., Sbordone, F.P., Ciccarese, G., Carbone, A., Carrer, B., Ryan, C.P., Ludovici, G.M., Chierici, A., and Manenti, G. “Response of a radiology department to the SARS-COV-2 pandemic: The experience of the hospital “Policlinico Tor Vergata” in Rome”. International Journal of Environmental Research and Public Health 18, no.10 (2021): 5255. doi: https://doi:10.3390/ijerph18105255.
Qu, J., Yang, W., Yang, Y., Qin, L., and Yan, F. “Infection control for CT equipment and radiographers’ personal protection during the coronavirus disease (covid-19) outbreak in China”. American Journal of Roentgenology 215, no.4 (2020): 940-944. doi: https://doi:10.2214/ajr.20.23112.
Long, X., Zhang, L., Alwalid, O., Lei, Z., Liang, B., Shi, H., Zheng, C.H., and Yang, F. “Radiology Department Preventive and control measures and work plan during covid-19 epidemic-experience from Wuhan”. Chinese Journal of Academic Radiology 4, no.1 (2021): 1-8. doi: https://doi:10.1007/s42058-021-00055-5.
Goh, Y., Chua, W., Lee, J.K.T., Ang, B.W.L., Liang, C.R., Tan, C.A., Choong, S.A.W., Hoon, H.X., Ong, M.K.L, and Quesk, S.T. “Operational strategies to prevent coronavirus disease 2019 (COVID-19) spread in radiology: Experience from a Singapore radiology department after severe acute respiratory syndrome”. Journal of the American College of Radiology 17, no. 6 (2020):717-723. doi: https://doi:10.1016/j.jacr.2020.03.027.
Elengoe, A. “Covid-19 outbreak in Malaysia. Osong Public Health and Research Perspectives 11, no. 3 (2020):93-100. doi: https://doi:10.24171/j.phrp.2020.11.3.08.
Bikdeli, B., Madhavan, M. V., Jimenez, D., Chuich, T., Dreyfus, I., Driggin, E., Nigoghossian, C., Ageno, W., Madjid, M., Guo, Y., Tang, L. V., Hu, Y., Giri, J., Cushman, M., Quéré, I., Dimakakos, E. P., Gibson, C. M., Lippi, G., Favaloro, E. J., Fareed, J., et.al. “Covid-19 and thrombotic or thromboembolic disease: Implications for prevention, antithrombotic therapy, and follow-up”. Journal of the American College of Cardiology 75, no. 23 (2020): 2950-2973. doi: https://doi:10.1016/j.jacc.2020.04.031.
Kanne, J.P., Bai, H., Bernheim, A., Chung, M., Haramati, L.B., Kallmes, D.F., Little, B.P., Rubin, G., and Sverzellati, N. “Covid-19 imaging: What we know now and what remains unknown”. Radiology 299, no.3 (2021). doi: https://doi:10.1148/radiol.2021204522.
Stogiannos, N., Fotopoulos, D., Woznitza, N., and Malamateniou, C. “Covid-19 in the radiology department: What radiographers need to know”. Radiography 26, no. 3 (2020): 254-263. doi: https://doi:10.1016/j.radi.2020.05.012.
Li, X., Zeng, W., Li, X., Chen, H., Shi, L., Xiang, H., Cao, Y., Chen, H., and Wang, J. “CT imaging changes of Corona virus disease 2019(COVID-19): A multi-center study in Southwest China”. Journal of Translational Medicine 18, no. 1 (2020). doi: https://doi:10.1186/s12967-020-02324-w.
Pan, F., Ye, T., Sun, P., Gui, S., Li, L., Zheng, D., Wang, J., Hesketh, R.L., Yang, L. and Zheng, C. “Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (covid-19)”. Radiology 295, no. 3 (2020): 715-721. doi: https://doi:10.1148/radiol.2020200370.
Duan, Y. N., Zhu, Y.Q., Tang, L.L., and Qin, J. “CT features of novel coronavirus pneumonia (COVID-19) in children”. European Radiology 30, no. 8 (2020): 4427-4433. doi: https://doi:10.1007/s00330-020-06860-3.
Chen, A., Huang, J. X., Liao, Y., Liu, Z., Chen, D., Yang, C., Yang, R. M., and Wei, X. “Differences in clinical and imaging presentation of pediatric patients with COVID-19 in comparison with adults”. Radiology: Cardiothoracic Imaging 2, no. 2 (2020). doi: https://doi:10.1148/ryct.2020200117.
Jacobi, A., Chung, M., Bernheim, A., and Eber, C. “Portable chest X-ray in coronavirus disease-19 (covid-19): A Pictorial Review”. Clinical Imaging 64, (2020): 35-42. doi: https://doi:10.1016/j.clinimag.2020.04.001.
Wong, H. Y. F., Lam, H. Y. S., Fong, A. H., Leung, S. T., Chin, T. W., Lo, C. S. Y., Lui, M. M., Lee, J. C. Y., Chiu, K. W., Chung, T. W., Lee, E. Y. P., Wan, E. Y. F., Hung, I. F. N., Lam, T. P. W., Kuo, M. D., and Ng, M. Y. “Frequency and distribution of chest radiographic findings in patients positive for covid-19”. Radiology 296, no.2 (2020). doi: https://doi:10.1148/radiol.2020201160.
Letchumanan, M., Md Anour, A.A., Ganapathy, S.S., Harry, S., Nik Lah, N.S.H., Arsad, N., and Ahmad Fisol, N.F. “Chest radiographs in coronavirus disease 2019 (Covid-19)”. Medical Journal of Malaysia 76, no. 2 (2021):131-137. https://www.e-mjm.org/2021/v76n2/COVID-19-chest-radiograph.pdf.
Hansebout, R.R., Cornacchi, S.D., Haines, T., and Goldsmith, C.H. “How to use an article about prognosis”. Canadian Journal of Surgery 52, no. 4 (2009): 328-336. https://www.canjsurg.ca/content/cjs/52/4/328.full.pdf.
Sjoding, M. W., Admon, A. J., Saha, A. K., Kay, S. G., Brown, C. A., Co, I., Claar, D., McSparron, J. I., and Dickson, R. P. “Comparing clinical features and outcomes in mechanically ventilated patients with COVID-19 and acute respiratory distress syndrome”. Annals of the American Thoracic Society 18, no. 11 (2021): 1876-1885. doi: https://doi:10.1513/annalsats.202008-1076oc.
Ioannidis, J.P.A., Axfors, C., and Contopoulos-Ioannidis, D.G. “Population-level covid-19 mortality risk for non-elderly individuals overall and for non-elderly individuals without underlying diseases in pandemic epicenters”. Environmental Research 188, (2020). doi: https://doi:10.1016/j.envres.2020.109890.
Gupta, S., Hayek, S. S., Wang, W., Chan, L., Mathews, K. S., Melamed, M. L., Brenner, S. K., Leonberg-Yoo, A., Schenck, E. J., Radbel, J., Reiser, J., Bansal, A., Srivastava, A., Zhou, Y., Sutherland, A., Green, A., Shehata, A. M., Goyal, N., Vijayan, A., Velez, J. C. Q., et al. “Factors associated with death in critically ill patients with coronavirus disease 2019 in the US”. JAMA Internal Medicine 180, no.11 (2020):1436. doi: https://doi:10.1001/jamainternmed.2020.3596.
Kompaniyets, L., Pennington, A. F., Goodman, A. B., Rosenblum, H. G., Belay, B., Ko, J. Y., Chevinsky, J. R., Schieber, L. Z., Summers, A. D., Lavery, A. M., Preston, L. E., Danielson, M. L., Cui, Z., Namulanda, G., Yusuf, H., Mac Kenzie, W. R., Wong, K. K., Baggs, J., Boehmer, T. K., and Gundlapalli, A. V. “Underlying medical conditions and severe illness among 540,667 adults hospitalized with covid-19, March 2020–March 2021”. Preventing Chronic Disease 18, (2021). doi: https://doi:10.5888/pcd18.210123.
Petrilli, C. M., Jones, S. A., Yang, J., Rajagopalan, H., O’Donnell, L., Chernyak, Y., Tobin, K. A., Cerfolio, R. J., Francois, F., and Horwitz, L. I. “Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: Prospective cohort study”. BMJ (2020). doi: https://doi:10.1136/bmj.m1966.
Du, R. H., Liang, L. R., Yang, C. Q., Wang, W., Cao, T. Z., Li, M., Guo, G. Y., Du, J., Zheng, C. L., Zhu, Q., Hu, M., Li, X. Y., Peng, P., & Shi, H. Z. “Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-COV-2: A prospective cohort study”. European Respiratory Journal 55, no. 5 (2020). doi: https://doi:10.1183/13993003.00524-2020.
Schmidt, M., Hajage, D., Demoule, A., Pham, T., Combes, A., Dres, M., Lebbah, S., Kimmoun, A., Mercat, A. Beduneau, G., et.al. “Clinical characteristics and day-90 outcomes of 4244 critically ill adults with covid-19: A prospective cohort study”. Intensive Care Medicine 47, no.1 (2020): 60-73. doi: https://doi:10.1007/s00134-020-06294-x.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Ahmad LuqmanulHakim Ahmad Sunawari, Aisyah Rahimi, Aminatul Saadiah Abdul Jamil, Shahrina Ismail, Azira Khalil
This work is licensed under a Creative Commons Attribution 4.0 International License.
The copyright of this article will be vested to author(s) and granted the journal right of first publication with the work simultaneously licensed under the Creative Commons Attribution 4.0 International (CC BY 4.0) license, unless otherwise stated.