King's College Hospital NHS Foundation Trust Radiology's response to COVID-19

Prof Paul Sidhu, Professor of Imaging Sciences and Acting Corporate Medical Director (Operations) [pictured below, right] working in the Department of Radiology at King’s College Hospital NHS Foundation Trust, shares how his department has responded to the COVID-19 pandemic.

Paul SidhuImaging technologies – for example x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) - have played a crucial role in the diagnosis of COVID-19-related lung disease. Chest X-rays and CT scans have been primarily used for accurate and early diagnosis of the disease.

Prof Paul Sidhu outlined his radiology department’s response to COVID-19 in a recent report published in the British Journal of Radiology. Paul spoke with us about some of his experiences.

Can you describe your experiences during the COVID-19 pandemic?

The radiology department at King’s College Hospital NHS Foundation Trust has dealt with a number of major incidents over the years, but nothing prepared us for this period of time.

The COVID-19 pandemic has affected every aspect of life so far, and the medical response has been extremely challenging.

The experiences of the radiology department at King’s College Hospital NHS Foundation Trust, from the time immediately before the lockdown in March, to the easing of restrictions and the hospital recovery in late June, have been summarised and published in the British Journal of Radiology.

How have demands for radiology been affected by the pandemic?

There was little knowledge of the imaging requirements that would be needed to deal with the consequences of the large number of patients that were admitted in a very short space of time, with little information gleaned from the experience of other nations ahead of us on the “curve”.

We had to prepare for being in high demand. We rapidly set up a command structure, designated imaging pathways, made available staff and equipment in the areas needed the most. We had to evolve our response on a daily basis, move quickly to make the changes, keep frontline staff informed and deal with illness within the frontline workforce.

What are some of the areas you cover in more detail in the publication on how the department responded to the pandemic?

In our British Journal of Radiology publication, we share a two-step process of King’s College Hospital NHS Foundation Trust’s escalation and de-escalation response to COVID-19. The article focuses on the role of radiologists and allied healthcare staff and reshaping of our department to provide efficient imaging services, facilitate patient flow and maintain infection control.

Once the Trust declared COVID-19 as a major incident, it initiated a three-tier command and control structure with Gold (strategic level), Silver (tactical) and Bronze (operational). The radiology department also followed its own “Bronze” and “Silver” command structure to streamline decision-making and ensure our 400 staff in the department were deployed appropriately. We identified the minimum support needed for safe acute imaging services to allow the more junior radiology trainees to be redeployed elsewhere in the hospital, while maintaining more experienced radiology trainees within our team of radiologists who continued to provide a 24 hour service.

We shared guidelines on how to identify and report COVID-19 on chest radiography and CT, which helped radiology colleagues report on the disease in a consistent manner.

Another key principle of ours was to use portable imaging – where equipment is brought to the patient – to reduce the risk of contamination and cross-infection in the radiology department.

In the publication there’s also more detail on the wider hospital’s response to COVID-19 on patient pathways, wellness and psychological support and personal protective equipment.

How did you adapt to provide services for non-COVID-19 patients?

The shutting down of normal healthcare services affected radiology, but we endeavoured to make available safe imaging pathways for those non-COVID-19 patients, whilst maintaining the emergency non-COVID imaging. Many different imaging specialties managed the service in unique ways to sustain the department, change working practice and enabled rapid imaging triage of patients and interpretation of images.

Moving into an emergency situation proved less difficult than the return of normal imaging practice, as detailed in our review. The backlog of imaging procedures had to be managed and in particular cancer waiting had to be dealt with quickly.

We had a very unique experience during the early months of the pandemic, and we have shared our overall management strategy from March – June which we believe has worked, and hopefully will be seen as a useful document for other departments to use and modify for local needs in a second “curve” of cases.

The Imaging and Biomedical Engineering Clinical Academic Group (CAG) provides comprehensive imaging facilities across one of the largest set ups of its kind in Europe.