Diagnostic and Interventional Radiology Case Volume and Education in the Age of Pandemics: Impact Analysis and Potential Future Directions

Abstract

Rationale and objectives: To assess the immediate impact of the COVID-19 pandemic on Diagnostic and Interventional Radiology education, and to propose measures to preserve and augment trainee education during future crises.

Materials and methods: Diagnostic Radiology (DR) studies and Interventional Radiology (IR) procedures at a single tertiary-care teaching institution between 2015 and 2020 were reviewed. DR was divided by section: body, cardiothoracic, musculoskeletal (MSK), neuroradiology, nuclear medicine, pediatrics, and women's imaging. IR was divided by procedural types: arterial, venous, lymphatic, core, neuro, pediatrics, dialysis, cancer embolization or ablation, noncancer embolization, portal hypertension, and miscellaneous. Impact on didactic education was also assessed. ANOVA, t test, and multiple comparison correction were used for analysis.

Results: DR and IR caseloads decreased significantly in April 2020 compared to April of the prior 5 years (both p < 0.0001). Case volumes were reduced in body (49.2%, p < 0.01), MSK (54.2%, p < 0.05), neuro (39.3%, p < 0.05), and women's imaging (75.5%, p < 0.05) in DR, and in arterial (62.6%, p < 0.01), neuro IR (57.6%, p < 0.01) and core IR (42.6%, p < 0.05) in IR. IR trainee average caseload in April 2020 decreased 51.9% compared to April of the prior 5 years (p < 0.01). Utilization of online learning increased in April. Trainees saw significant increases in overall DR didactics (31.3%, p = 0.02) and no reduction in IR didactics, all online. Twelve major national and international DR and IR meetings were canceled or postponed between March and July.

Conclusion: Decreases in caseload and widespread cancellation of conferences have had significant impact on DR/IR training during COVID-19 restrictions. Remote learning technologies with annotated case recording, boards-style case reviews, procedural simulation and narrated live cases as well as online lectures and virtual journal clubs increased during this time. Whether remote learning can mitigate lost opportunities from in-person interactions remains uncertain. Optimizing these strategies will be important for potential future restricted learning paradigms and can also be extrapolated to augment trainee education during unrestricted times.

Keywords: COVID; Education; IR/DR Residency; Quality Improvement; Virtual training.

Figure 1

Stacked bar graph of Diagnostic Radiology (DR) caseload and varieties of January to April of 2020 in comparison with the previous 5 years (2015–2019). MSK, musculoskeletal.

Figure 2

Stacked bar graph of Interventional Radiology (IR) caseload and varieties of January to April of 2020 in comparison with the previous 5 years (2015–2019). Misc, miscellaneous; PHTN, portal hypertension; Peds, pediatrics. Core IR included the following procedures: central venous catheter placement, drainage procedures, enteral tube placement, and biopsies.

Figure 3

Interventional Radiology (IR) case volume in 2020 by week. Dashed lines represented the upper and lower 90% confidence intervals of a fitted fourth-order polynomial curve (R² = 0.7767). Week number denotes the chronological week-by-week divide in 2020; i.e. week 1 represents Jan 5th, 2020 to Jan 11th, 2020.