key: cord-1010970-sig2vaee authors: Zanardo, Moreno; Schiaffino, Simone; Sardanelli, Francesco title: Bringing radiology to patient's home using mobile equipment: A weapon to fight COVID-19 pandemic date: 2020-06-18 journal: Clin Imaging DOI: 10.1016/j.clinimag.2020.06.031 sha: 10e911da410293ad08a411014b45074cf8c6523e doc_id: 1010970 cord_uid: sig2vaee Because of coronavirus disease 2019 (COVID-19) high contagiousness, it is crucial to identify and promptly isolate COVID-19 patients. In this context, chest imaging examinations, in particular chest x-ray (CXR), can play a pivotal role in different settings, to triage in case of unavailability, delay of or first negative result of reverse transcriptase-polymerase chain reaction (RT-PCR), and to stratify disease severity. Considering the need to reduce, as much as possible, hospital admission of patients with suspected or confirmed infection, the use of mobile x-ray equipment could represent a safe approach. We picture a potential sequence of events, involving a team composed by a radiographer and a nurse, going to patient's home to perform CXR, nasopharyngeal swab (and, if needed, also a blood sample), with fast radiologist tele-reporting, and resulting patient management approach (home isolation or emergency room admission, when needed). This approach brings healthcare to patient's home, reducing the risk of infected subjects referring to family doctors' office or emergency departments, and strengthening community medicine while maintaining a strong connection with radiology departments. Since the novel coronavirus disease, named COVID-19, was recognized by the World Health Organization as pandemic on March 11 th , 2020, measures have been taken to try flattening the epidemic curve and to allow healthcare systems to deal with the emergency. Because of COVID-19 high contagiousness and spreading through respiratory droplets [1] , it is crucial to identify and promptly isolate COVID-19 patients. In Italy, more than 22.000 health care providers resulted positive to COVID-19, and 154 physicians have dead due to the disease (https://portale.fnomceo.it/elenco-dei-medici-caduti-nel-corso-dellepidemia-di-covid-19/), most of them being family doctors. To deal with pandemic, most countries organized constricted security measures, including lockdown, social distancing, and usage of personal protective equipment, partially continued also after the pandemic peak. In this context, chest imaging examinations, in particular chest x-ray (CXR) [2] and computed tomography (CT) [3] can play a pivotal role in different settings, to triage in case of unavailability, delay of or first negative result of reverse transcriptase-polymerase chain reaction (RT-PCR) [4] , and to stratify disease severity. We must consider the need to reduce, as much as possible, hospital admission of patients with suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection when they could receive care at home, as well as the access to emergency department of patients without SARS-CoV-2 infection. Indeed, the former may increase the infection outbreak, the latter may be unnecessarily exposed to risk of infection. The weakness of an effective community medicine practice, including home healthcare, has been judged as a strategic issue in the discussion on the pandemic outbreak in Italy, in particular in Lombardy. The use of mobile x-ray equipment could represent a safe approach, enabling imaging of suspected or confirmed COVID-19 patients, performing examinations in their house or nursing home, reducing social contacts [5] . Of note, it has been already shown that x-ray examinations performed at home (or in the nursing home) using modern mobile equipment provide an image quality at least comparable to those obtained at hospital [6, 7] . We picture the following sequence of events ( Figure 1 ): 1) a case of suspected COVID-19 patient is detected by any telephone service or doctor requested of a visit in the presence of symptoms or contact with a confirmed COVID-19 case; 2) a team composed by a radiographer and a nurse go to patient's home to perform CXR using a mobile equipment, nasopharyngeal swab (and, if needed, also a blood sample); 3) clinical information and CXR images are sent to a radiology department through a protected web-based tool; 4) a radiologist immediately reports the examination; 5) the report is sent to the general practitioner or any other clinician for the best decision-making; 6) the team, being still at patient's home, can explain to patients and her/his family what to do and, if necessary, to start applying home isolation. The RT-PCR result will be considered as soon as it is available and a diagnostic pathway including history of contacts with COVID-19 patients, symptoms, CXR and RT-PCR result may guide the clinical decision-making. To reduce health care workers potential exposure to COVID-19, general precautions should be adopted while performing CXR and pharyngeal swab. The worker should wear a N95 mask or higher, disposable fluid-resistant gown, a pair of disposable gloves, goggles or visor for eyeprotection. CXR machine should be covered with plastic sheeting to facilitate disinfection. After acquisition, CXR machine must be disinfected with low-or intermediate-level disinfectant, disposables properly disposed, and workers washed their hands [8] . This approach brings healthcare to patient's home, reducing the risk of infected subjects referring to family doctors' office or emergency departments. Further advantages include the following: a) cleaning and disinfecting of all imaging equipment, including mobile x-ray machine and detectors can be performed quietly and carefully during the wait of the radiological report; b) COVID-19): A Perspective from China Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle Domiciliary radiography: an important service? Comparison of image quality in chest, hip and pelvis examinations between mobile equipment in nursing homes and static indirect radiography equipment in the hospital. Radiography (Lond) COVID-19) Outbreak: What the Department of Radiology Should Know This work was partially supported by Ricerca Corrente funding from Italian Ministry of Health to IRCCS Policlinico San Donato.