key: cord-314174-7axpgwva
authors: Lang, Min; Yeung, Tristan; Shepard, Joanne O.; Sharma, Amita; Petranovic, Milena; Flores, Efren J.; McLoud, Theresa C.; Som, Avik; Saini, Sanjay; Prabhakar, Anand M.; Succi, Marc; Little, Brent P.
title: Operational challenges of a low-dose CT lung cancer screening program during the COVID-19 pandemic
date: 2020-10-26
journal: Chest
DOI: 10.1016/j.chest.2020.10.045
sha: 
doc_id: 314174
cord_uid: 7axpgwva

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Dr. Little is a textbook author and editor for Elsevier and receives royalties for his prior work. Dr. Succi reports personal fees and non-financial support from 2 Minute Medicine, Inc., and royalties from Frequency Therapeutics for work not related to this manuscript. Dr. Flores reports grant funding from the American College of Radiology Innovation Fund and the National Cancer Institute Research Diversity Supplement for work not related to this manuscript.

The coronavirus disease 2019 (COVID-19) pandemic has had tremendous impact on healthcare 5 systems, requiring diversion of resources to focus on the immediate needs of critically ill patients 6 while postponing "non-essential" services, including lung cancer screening (LCS) low dose CT 7 (LDCT). 1,2 Although annual LCS is recommended for high-risk individuals, 3 the risk of COVID-8 19 exposure for both patients and healthcare workers may outweigh the benefits amidst the 9 pandemic. 1 As a result, multiple organizations recommended delaying LCS. 1,4-6 Postponement of 10 baseline and follow up examinations, especially for high risk patients with Lung-RADS (LR) 11 categories 3 (1-2% probability of malignancy) and 4 (5-15% probability of malignancy), may 12 result in delayed diagnosis and treatment of lung cancer. 7 The purpose of our study was to assess 13 how LCS LDCT volume was impacted by the COVID-19 pandemic. Three time periods were analyzed: "pre-COVID peak" -January 1 st through February 29 th , 2020 6 (weeks 1 through 8), prior to LCS scheduling changes in March; "COVID peak" -March 1 st 7 through May 2 st , 2020 (weeks 9 through 17), during which annual and initial LCS examinations 8 were postponed due to COVID-19 surge in Massachusetts; and "post-COVID peak" -May 3 rd 9 through July 25 th , 2020 (weeks 10 through 29), after resumption of normal LCS scheduling. 

Average weekly non-LCS chest CT volume decreased by 29% from the pre-COVID peak period 13 to the COVID peak period and recovered to 92% of pre-COVID peak levels during the post-14 COVID peak period (Figure 2A) . The average weekly LCS LDCT volume decreased by 74% 15 from the pre-COVID peak period to the COVID peak period, followed by gradual recovery, 16 reaching 68% of average pre-COVID peak LCS weekly volume by the end of July (week 29; 17 Figure 2A ). An average 10.8% of the weekly overall chest CT volume were LCS studies during 18 the pre-COVID-peak period compared to 3.6% during the COVID peak period, which recovered 19 to 8.1% by the end of July (week 29; Figure 2B ).

During the COVID peak period, annual LCS LDCT volume and baseline LCS LDCT 21 study volume decreased by approximately 72% and 78%, respectively, from the pre-COVID preceding "pre-COVID peak" period and following "post-COVID peak" period. 

Management of Lung Nodules and Lung Cancer 14 Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

Imaging Volume Trends and Recovery During the COVID-19 16 Pandemic: A Comparative Analysis Between a Large Urban Academic Hospital and Its Affiliated Imaging 17 Centers

Information for Healthcare Professionals about Coronavirus (COVID-19). Centers for Disease 21 Control and Prevention

Cancer Screening During the COVID-19 Pandemic

The Economic Impact of the COVID-19 Pandemic on Radiology Practices

Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study

COVID-19 exacerbating inequalities in the US

We would like to thank Ms. MaryAnn Tateosian for her efforts as our LCS program manager and navigator that contributed to the recovery of our LCS LDCT volume.