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4 Things You Need to Know About How to Run a Breast Imaging Practice During the COVID-19 Crisis

The COVID-19 pandemic has strained healthcare organizations worldwide, requiring massive adaption and reprioritization. Yet while the world is focused on novel coronavirus, patients continue to need care for other health conditions, including breast cancer. Breast imaging remains an essential service for many. Here’s what you need to know about running a breast imaging practice during the COVID-19 crisis.

Breast imaging should be made available to patients who need it

On April 13, 2020, the American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers), the National Comprehensive Cancer Network (NCCN), the Commission on Cancer (CoC) of the American College of Surgeons, and the American College of Radiology ACR) released joint recommendations for prioritization of care.1

Priority A patients have life-threatening or urgent symptomatic conditions that require urgent treatment. A patient with a severe breast abscess may be classified as Priority A; breast imaging should be available and accessible.2

Priority B patients do not need immediate treatment but have conditions that will likely require treatment before the COVID-19 pandemic is over. These patients include women undergoing diagnostic imaging for suspicious symptoms or after an abnormal mammogram, women who need MRIs to evaluate disease and plan treatment, and women who require imaging to undergo essential biopsies.3

Screening exams are considered Priority C and should be delayed until after the pandemic. However, screening mammograms and MRIs may be considered for BRCA mutation carriers under the age of 40 if screening delays are expected to persist longer than six months.4

Some flexibility exists for meeting MQSA requirements

The U.S. Food and Drug Administration (FDA) has postponed inspections of mammography facilities and the Division of Mammography Quality Standards (DMQS) is granting automatic two-month extensions for facilities that were scheduled to undergo their annual medical physicist survey between January 2020 and June 2020. You do not need to file a request for this extension.5

Facilities that cannot meet certain requirements – such as staff continuing education – due to coronavirus-related circumstances should be prepared to provide detailed documentation.6

The FDA and CMQS may issue additional guidance as the situation evolves. You can contact the MQSA Hotline with questions: MQSAhotline@mersatechinc.com or 1-800-838-7715.

Staff protection is essential

The Centers for Disease Control and Prevention (CDC) recommend that staff wear an N95 mask, disposable isolation gown and gloves, and eye protection with goggles when working closely with patients who have or are under investigation for COVID-197-8. The National Institute for Occupational Safety and Health (NIOSH) recommends storing them in a “clean, breathable container such as a paper bag.” N95 masks should not be shared.9

Facility managers should also screen staff and prospective patients for fever and symptoms of COVID-19 before they enter the facility. Symptomatic patients should wear a mask and should not be allowed in general waiting rooms.10

Schedule ample time for disinfection

Because SARS-CoV-2, the virus that causes COVID-19, can linger on plastic and metal surfaces for days, imaging equipment and surfaces must the thoroughly disinfected in between patients, so consider spacing out appointments. The CDC, FDA and World Health Organization (WHO) recommends cleaning soiled areas with soap and water and then applying a disinfectant such as sodium hypochlorite, iodophor germicidal detergent solution, ethyl alcohol or isopropyl alcohol.11-12

Check with equipment manufacturers before using soap and water or other cleaning agents on sensitive imaging equipment. The U.S. Environmental Protection Agency (EPA) has released a list of agents claimed to be effective against SARS-CoV-2; some equipment manufacturers have cross-referenced that list with agents known to be compatible with their materials.13 You can find a cross-referenced list for GE Healthcare products at https://cleaning.gehealthcare.com/

RESOURCES

  1. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic. The COVID-19 Pandemic Breast Cancer Consortium: Representatives from the American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers (NAPBC), the National Comprehensive Care Network (NCCN), the Commission on Cancer (CoC), and American College of Radiology. https://www.facs.org/-/media/files/quality-programs/napbc/asbrs_napbc_coc_nccn_acr_bc_covid_consortium_recommendations.ashx Accessed April 15, 2020.
  2. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic. The COVID-19 Pandemic Breast Cancer Consortium: Representatives from the American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers (NAPBC), the National Comprehensive Care Network (NCCN), the Commission on Cancer (CoC), and American College of Radiology. https://www.facs.org/-/media/files/quality-programs/napbc/asbrs_napbc_coc_nccn_acr_bc_covid_consortium_recommendations.ashx Accessed April 15, 2020.
  3. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic. The COVID-19 Pandemic Breast Cancer Consortium: Representatives from the American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers (NAPBC), the National Comprehensive Care Network (NCCN), the Commission on Cancer (CoC), and American College of Radiology. https://www.facs.org/-/media/files/quality-programs/napbc/asbrs_napbc_coc_nccn_acr_bc_covid_consortium_recommendations.ashx Accessed April 15, 2020.
  4. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic. The COVID-19 Pandemic Breast Cancer Consortium: Representatives from the American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers (NAPBC), the National Comprehensive Care Network (NCCN), the Commission on Cancer (CoC), and American College of Radiology. https://www.facs.org/-/media/files/quality-programs/napbc/asbrs_napbc_coc_nccn_acr_bc_covid_consortium_recommendations.ashx Accessed April 15, 2020.
  5. MQSA Inspection Information Related to COVID-19. U.S. Food and Drug Administration. https://www.fda.gov/radiation-emitting-products/mammography-quality-standards-act-and-program/mqsa-inspection-information-related-covid-19 Accessed April 15, 2020.
  6. MQSA Inspection Information Related to COVID-19. U.S. Food and Drug Administration. https://www.fda.gov/radiation-emitting-products/mammography-quality-standards-act-and-program/mqsa-inspection-information-related-covid-19 Accessed April 15, 2020.
  7. Coronavirus (COVID-19) Outbreak: What the Department of Radiology Should Know. Journal of the American College of Radiology. https://www.jacr.org/article/S1546-1440(20)30150-2/fulltext#sec4 Accessed April 15, 2020.
  8. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html Accessed April 15, 2020.
  9. Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings. The National Institute for Occupational Safety and Health. https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html Accessed April 15, 2020.
  10. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html Accessed April 15, 2020.
  11. Coronavirus (COVID-19) Outbreak: What the Department of Radiology Should Know. Journal of the American College of Radiology. https://www.jacr.org/article/S1546-1440(20)30150-2/fulltext#sec4 Accessed April 15, 2020.
  12. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html Accessed April 15, 2020.
  13. List N: Disinfectants for Use Against SARS-CoV-2. United States Environmental Protection Agency. https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 Accessed April 15, 2020.