The COVID-19 pandemic has had a broad impact on patients, providers, payors, and healthcare organizations. A little more than a year after the world declared a public health emergency, we are only beginning to understand the full consequences of this pandemic. I had the pleasure of collaborating with a handful of colleagues, including the ACR’s consultant Tom Fruscello, MBA; Mythreyi B. Chatfield, PhD, executive vice president of quality and safety at the ACR; Stefanie Weinstein, MD, professor of radiology in the department of radiology and biomedical imaging at the University of California, San Francisco; William F. Sensakovic, PhD, chair of the ACR Dose Index Registry Committee and chair of the division of medical physics and associate professor at Mayo Clinic (Arizona); and David B. Larson, MD, MBA, chair of the ACR Commission on Quality and Safety and professor of pediatric radiology in the department of radiology at Stanford University, on a recent study highlighting the impact of COVID-19 on CT volumes across the U.S. using data from the ACR Dose Index Registry. While you can read the full article in the JACR® at bit.ly/CTVolumes, I’d like to share top takeaways and speculate about how they may relate to our future.1
In the spring of 2020, the CDC released guidance that advised medical facilities to reschedule non-urgent outpatient visits, which included non-urgent imaging examinations and image-guided procedures. Soon thereafter — due to a combination of this guidance and various other factors — there was an abrupt and rapid decline in radiology volume.
At its nadir in the spring of 2020, there were approximately 50% fewer CT examinations being performed per day compared to historical predictions. Since that time, as we improved our safety protocols and better learned how to safely care for patients with known or unknown COVID-19 in the healthcare environment, those lost imaging examinations have slowly recovered. However, as of April 2021, we still haven’t reached expected levels. In the U.S., there are approximately 10–15% less CT examinations being performed per day compared to historical predictions. You can track this ongoing disparity by visiting the National Radiology Data Registry publications highlights on the ACR website at acr.org/NRDR-Publication-Highlights.
Already underserved populations have seen the gap widen between care needed and care provided during the pandemic.
Though the partial recovery has been encouraging, it remains unclear to what extent these continued lost diagnostic tests are having a detrimental effect on patient care. For example, decreased patient engagement with healthcare during the pandemic likely resulted in delayed diagnosis and delayed care of other diseases. This trend was most substantial in urban communities, communities with a greater population density, communities with greater unemployment, and communities with a greater proportion of people of color.
COVID-19 exacerbated preexisting disparities in healthcare that are prevalent in the U.S. (see sidebar). Already underserved populations have seen the gap widen between care needed and care provided during the pandemic. We must take action to ensure that all of our patients can access quality healthcare.