1. McGraw, Mark

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New research finds that the coronavirus pandemic altered the composition of pediatric radiology exams and had a negative effect on the likelihood of completion of radiologic exams for this patient population.

Pediatric Imaging Ex... - Click to enlarge in new windowPediatric Imaging Exams. Pediatric Imaging Exams

Pointing to the "unprecedented changes in radiology practice worldwide," and a need for "a framework of pediatric radiology resource allocation for future acute resource-limited settings," a team including researchers from Massachusetts General Hospital sought to quantify and analyze changes in pediatric radiology practice throughout the pandemic, considering demographic and clinical characteristics. The study was published in Academic Radiology (2021;


As the study illustrates, containment and mitigation approaches have been intensified in the midst of the pandemic, but the "exponential and progressive increase in the number of cases has overwhelmed health systems globally."


The authors note that several studies have assessed the impact of COVID-19 on radiology practice in terms of overall changes in exam volume, but wrote that "there is limited information regarding the pandemic's specific impact on pediatric radiology," and specified the purpose of their study as being "to characterize the changes in pediatric imaging exams during the COVID-19 pandemic and identify those factors most affecting the likelihood of exams taking place during the pandemic."


To achieve this end, the researchers retrospectively searched Massachusetts General's electronic health record for pediatric imaging exams performed between Sept. 15, 2019, and May 1, 2020, with March 15, 2020, serving as the dividing date between baseline and pandemic periods. Age, modality, exam indication, need for anesthesia/sedation, and exam completion or cancellation were recorded, and all examinations were compared between baseline and pandemic periods using a chi-square test and a logistic regression multivariate analysis.


The authors evaluated the aforementioned factors (age, modality, exam indication, need for anesthesia/sedation, and exam completion or cancellation) from more than 15,000 imaging exams. Among these examinations, more than 13,000 were taken during the baseline period, with more than 1,000 performed during the pandemic period.


Overall, the team found that the composition and completion of pediatric radiology exams "changed substantially" during the pandemic period, with a subset of exams resilient to cancellation identified.


For example, the researchers found the percentage of imaging exams for adolescents decreasing from 53.5 percent pre-pandemic to 45.5 percent during the pandemic period. Meanwhile, exams for non-traumatic pain dropped from 46.3 percent to 39.1 percent. Neonatal, infant, and early childhood imaging increased, while the use of computed tomography went from 5.9 percent to 7.4 percent. The use of ultrasound increased from 13.5 percent to 18.3 percent. Oncologic imaging rose from 6.5 percent to 8.8 percent, and imaging performed under anesthesia increased from 1.3 percent to 2.7 percent.


With regard to exam completion rates, neonatal and MRI imaging showed higher likelihood of completion during the pandemic period, while fluoroscopy was linked to lower odds of completion.


The investigators cited multiple factors that account for the decreased volume of imaging studies they observed. For example, pediatrician daily clinical practices changed, "including increased virtual care and accompanying alterations in threshold for ordering imaging."


In addition, deferrals and cancellations of non-urgent surgeries and other procedures had an indirect effect on requests for procedure-related imaging, according to the authors, who noted that "characterizing the impact of COVID on pediatric radiology practice "is of particular interest because, even though the number of cases of severe COVID-19 in this population has been relatively low compared with adults, the disruptions caused by the pandemic have substantially changed the daily practices of pediatricians and pediatric patients."


Focusing on the initial 3 months of the coronavirus pandemic, the researchers found that, "compared with the pre-pandemic period, pediatric radiology exams were more likely to be performed on younger patients-a higher proportion of neonatal and infant studies, a lower proportion of adolescent exams-with a higher proportion of ultrasound exams and a lower proportion of X-ray and fluoroscopy exams," noted Michael S. Gee, MD, PhD, Deputy Chair and Chief of Pediatric Radiology at Massachusetts General and a co-author of the study.


These findings will likely impact the pediatric radiology team's approach to imaging pediatric patients going forward, he noted.


"In future coronavirus or other pandemics associated with limited resources, we must continue to provide pediatric radiology services for patients who need them, including children with known or suspected cancer or congenital/developmental conditions," Gee emphasized. "Also, magnetic resonance imaging of infants and young children requiring sedation will still need to be prioritized because of their critical role in guiding patient care."


Mark McGraw is a contributing writer.