^{Published June 28, 2021}

For valiant service selflessly rendered on the frontlines of the fight against COVID-19, the American Roentgen Ray Society symbolically awarded each and every one of our members the 2021 ARRS Gold Medal. The ARRS Gold Medal Story Series shares perspectives of imaging professionals who conquered the day-to-day challenges of battling COVID-19.

The declaration by the World Health Organization of the coronavirus disease (COVID-19) pandemic in December 2019 led to an avalanche of information which did not manifest clearly, especially here in Nigeria. The signs, symptoms, presentation, and management of patients with COVID-19 slowly evolved for us.

The breast imaging sections of our hospitals went into an almost complete lull, as radiologists were exceedingly careful about exposing themselves to patients whose infection status was unknown. Testing patients for COVID-19 was not easy, due to lack of resources and consumables. More so, there was a dearth of personnel protective equipment (PPE), which was in extremely short supply from hospital management. Initially, breast clinics were shut down, and all activities were suspended. We had to set up an Infection, Prevention, and Control (IPC) Committee, which I chaired, while developing core guidelines for operations in the department.

All of the underlisted were considered crucial standard operating procedures:

• Undergo IPC training and tutorials
• Audit staff for protection
• Inventory, maintain, and decontaminate equipment
• Aerate all facilities
• Identify isolation opportunities for at-risk patients

Contamination Prevention

With temperature checks and masks mandatory for entry, our front desk served as patient registration only, not for triaging, so that foot traffic did not build up. To maintain social distancing of at least 2 meters apart in all waiting areas, the floors were marked in red to depict this distance. All persons entering the triage zone had to wash their hands with soap and running water. Posters showing proper modes of mask-wearing and hand-washing—as well as for gloves, goggles, and faces shields—were posted around the hospital. Only one relative was allowed to accompany a patient who could not stand on their own. To further reduce foot traffic, payment areas were augmented and fast-tracked.

Examination Rooms

Only one patient at a time was allowed in the examination room, and the radiographer/radiologist was well-kitted, depending upon that patient’s risk assessment. For COVID-19-postive patients, we had a dedicated mobile radiography unit, though all rooms were decontaminated after every procedure.

Decontamination

With hand sanitizers at each interactive point and zone, hands were properly washed before and after every procedure. All surfaces were decontaminated after each procedure, including cleaning and decontamination of reusable PPE and proper disposal of disposable ones. Our hospital’s standardized protocols for decontaminating an imaging room and equipment—especially CT after attending to a patient with COVID-19—featured downtime of about one hour in between procedures. Result retrieval points were set up in a cubicle outside the facility, and to reduce human occupancy, results were dispatched by e-mail. Remote reporting was encouraged, too.

Communication

Bold signage was displayed all over the hospital, including clear instructions and visible explanation notices posted on our doors. Relevant phone numbers (e.g., Central Preparedness Team, Hospital Infection Control Committee, Departmental IPC, National Center for Disease Control, etc.) were displayed on the front desk, triage zone, and notice boards.

Capacity Building

In addition to restricting their local and international travel, our entire staff received regular training (and retraining) in IPC protocols, especially how to don and doff PPE.

Some of our radiologists also contracted COVID-19. It got to a stage where all the staff in the pathology department tested positive, so ultrasound-guided biopsies were not possible. Even patients had restricted themselves from showing up for treatment in the hospitals, for fear of the unknown and restriction of movement. Breast cancer patients preferred to receive treatment through phone calls, since there were no teleradiology options.

However, musculoskeletal services were made available for patients who needed to be seen as emergency cases.

With the gradual improvement of the knowledge of the disease, availability of testing facilities, PPE, and now, vaccines, there has been much easing of restrictions. A gradual return to normal is envisaged. In our hospitals, there has been a return of influx for breast imaging patients in the last two months, especially for ultrasound and mammography, since these are the readily available investigations.