key: cord-0796469-duelzihy
authors: Mossa-Basha, Mahmud; Krupinski, Elizabeth A.; Filippi, Christopher G.; Sharpe, Richard E.; Giger, Maryellen
title: Report from the RSNA COVID-19 Task Force: COVID-19 Impact on Academic Radiology Research- A Survey of Vice Chairs of Research
date: 2021-12-03
journal: J Am Coll Radiol
DOI: 10.1016/j.jacr.2021.10.017
sha: 91008bbc69c16bb2dc6b3ab53c3fcb5aa9bc24ae
doc_id: 796469
cord_uid: duelzihy

Objective Survey Vice Chairs of Research from academic radiology departments on the impact of COVID-19 on research activities. Methods The survey asked respondents to quantify changes in research performed during the shutdown and ramp-up, relative to pre-COVID levels. Respondents estimated research activity changes by overall research type (wet/instrumentation/core facilities, prospective non-COVID clinical research and computational labs) and then by the research activity type (data analysis, grant or manuscript writing, clinician involvement, summer student participation and international research fellow appointments). Chi-square test was used for comparison between shutdown and ramp-up, with Yates correction when necessary. Results 46/105 (43.8%) Vice Chairs responded. For 95.5%, wet/instrumentation/core facilities research decreased to ≤50% during shutdown, and for 83.3% during ramp-up (p<0.0001). 89.2% and 46.5% indicated reduction to ≤25% of non-COVID clinical research during shutdown and ramp-up, respectively (p<0.0001). Only computational research increased to 120% during shutdown (39.5%) or ramp-up (50%) (p=0.8984). For data analysis from closed labs, 75% and 86% showed decreased activity during shutdown and ramp-up, respectively (p=0.28). 45.5% and 23.3% indicated increased grant writing during shutdown and ramp-up (p=0.093). For 52.3% and 23.3%, manuscript writing/submission increased during shutdown and ramp-up, respectively (p<0.02). Clinician research involvement trended towards relative decreases during shutdown (84.1% vs. 60.5%, p=0.05). There was similar drop in summer student participation (shutdown-86.4%, ramp-up-83.7%, p=0.95) and international researcher appointment (shutdown-85.7%, ramp-up-86.1%; p=0.96). Conclusion Many radiology research activities diminished during the COVID-19 shutdown, and to a lesser extent during the ramp-up. Activities that could be done remotely such as computational analysis, grant and manuscript writing/submission, increased.

The COVID-19 pandemic has significantly impacted hospital and healthcare systems in many ways, with significant impact on clinical radiology departments (1, 2) , including impacts on finances (3) and operational efficiencies (4) . Academic radiology departments, similar to other clinical departments, were also forced to suspend many research activities (5) . Researchers and their staff were forced to stay home, as hospitals and universities only allowed essential healthcare workers on premises, in order to limit potential COVID-19 spread. Prospective non-COVID clinical research was generally suspended, including patient recruitment, scanning on clinical or research imaging modalities, and on-site data analysis. In addition, many clinical scientists were diverted to focus on clinical work within the radiology department or to care for patients on the front lines. There were slowdowns in institutional review board reviews and approvals, as well as marked delays in journal manuscript reviews (6) . At many institutions, intramural funding opportunities were suspended, in order to divert funds to clinical care (6) . There was also an impact on NIH-funded studies, as many labs continued to pay salaries for lab staff, without the ability to continue prospective non-COVID clinical research activities (6).

These challenges resulted in a greater than 20% decline in research time for researchers in clinical sciences, and a 24% decline in research time across all disciplines (7) . Some areas of research, however, were not as greatly affected including computational sciences (7) . In fact, research in radiology Artificial Intelligence (AI) labs often experienced increases in productivity. Approaches to lessen the impact on research varied between institutions and academic radiology departments. The current study is a survey of academic radiology Vice Chairs of Research to determine the impact of COVID-19 on research activities within radiology departments.

The Radiological Society of North America (RSNA) COVID Task Force developed an anonymous survey in Qualtrics (Qualtrics, Provo, UT). An initial draft was prepared and then iteratively refined by group consensus. A link to the survey was emailed to the RSNA list serve of radiology department Vice Chairs of Research, consisting of 105 Vice Chairs on July 15, 2020. One reminder email was subsequently sent to the group. The survey was closed on August 3, 2020.

The survey asked respondents to quantify changes in research performed during the height of the pandemic shutdown, and then during the subsequent ramp-up period, relative to pre-COVID levels. The survey did not explicitly define the shutdown or ramp-up periods for respondents, as each institution may have had a different duration and period for the shutdown. Specifically, respondents estimated the change in research activities by overall type of research being performed and then by the specific type of research activities performed. Categories for overall type of research included wet/instrumentation lab and core facilities research, prospective non-COVID clinical research and computation labs (image analysis, AI, etc.). Categories for specific type of research activities performed included data analysis, grant writing activity, manuscript writing/submissions, clinical involvement in research, summer student participation in research and appointment of international research fellows.

For each data element, respondents were asked to indicate the level of research activity relative to pre-COVID baseline, using a 6-point scale (complete stoppage, 25%, 50%, 75%, no change, 120%). The complete survey is available in Supplemental Table 1 . Data were analyzed using Chi-Square tests with Yates corrections when necessary. Table 1 (or Figure 1 ) shows overall changes in volume of type of research performed during shutdown and ramp-up periods relative to the pre-pandemic baseline.

Regarding wet/instrumentation lab and core facilities research, 95.5% of respondents indicated a reduction to 50% or less in activity from pre-COVID levels during shutdown, and 83.3% during ramp-up. The level of wet/instrumentation lab and core facilities research activities were significantly increased during the ramp-up compared to shut down (+12.5%, X 2 = 27.42, p < 0.0001). 65.9% of wet/instrumentation lab and core facilities research activity was completely stopped during shutdown and 9.5% during the ramp-up.

Regarding prospective non-COVID clinical research activity, 89.2% of respondents indicated a reduction to 25% or less of pre-COVID levels during shutdown, and 46.5% during ramp-up. The level of prospective non-COVID clinical research activity was significantly increased during ramp-up compared to shut down (+42.7%, X 2 = 22.03, p < 0.0001). 52.2% of prospective non-COVID clinical research activity was completely stopped during shutdown and 9.3% during ramp-up.

The only overall type of research that any respondents indicated had increased to 120% during shutdown or ramp-up periods occurred in computational labs. During shutdown, 30.2% of computational labs experienced no change and 9.3% experienced an increase to 120% of baseline. During ramp-up, 42.9% experienced no change from baseline and 7.1% experienced an increase to 120%. The differences between shut down and ramp-up were not statistically significant (X 2 = 1.62, p = 0.8984). Figure 2 shows the specific type of research activities performed during shut-down and the subsequent ramp-up period. There was no significant difference in data analysis from closed labs, with 75% and 86% showing baseline or decreased activity during shutdown and ramp-up, respectively (X 2 = 2.58, p = 0.28). Grant writing activity showed a trend towards increasing, with 45.5% of respondents indicating increased grant writing activity during shutdown (45.5%) compared to 23.3% indicating an increase during the ramp-up, though this difference was not significant (X 2 = 4.74, p = 0.093). Manuscript writing and submission increased during shutdown according to 52.3% of respondents, compared to only 23.3% indicating an increase in writing/submission during the ramp-up (X 2 = 7.9, p < 0.02). There was a trend towards decreased clinical involvement in research during shutdown (84.1% indicated a decrease) as compared to during the ramp-up (60.5% indicated a decrease) (X 2 = 5.85, p = 0.05). During both periods there was a near equivalent drop in summer student participation in research (shutdown-86.4%, rampup-83.7%; X 2 = 0.108, p = 0.95) and appointment of new international research fellows (shutdown-85.7%, ramp-up-86.1%; X 2 = 0.002, p = 0.96).

During the COVID-19 pandemic, research activities were markedly impacted at academic institutions, in line with reduction of elective radiological imaging and procedures upon which many studies depend.

During stay-at-home periods, many institutions shut down prospective non-COVID clinical research and research that would not directly impact patient care and outcomes. There has since been a ramp-up period, mirroring clinical ramp-ups (8) in some respects, that is still ongoing. We found that, according to Vice Chairs of Research across radiology departments, wet/instrumentation lab and core facilities research and prospective non-COVID clinical research were most dramatically affected, with a significant increase in activity during the ramp-up. Computational lab research was not dramatically affected during the shutdown or ramp-up.

There was no significant difference in the level of data analysis performed during the shutdown vs. during the ramp-up, with pre-COVID levels as a reference, with a slight skew towards reduced research efforts during both periods. Similarly, there was no significant difference in grant writing activities, which were increased for both groups relative to pre-COVID baseline. There was marked reduction in international research fellow and summer student research activity during both periods that were not significantly different. There was an increase in manuscript writing during the shutdown, which was significantly different from the ramp-up period, and there was a shutdown related reduction in clinical involvement in research, which was significantly different from the ramp-up.

The survey results indicating increased computational research activities in radiology departments has some similarities to a survey study by Myers et al. (7) conducted of principal investigators across many disciplines, which found computer science had the smallest decline in research activity across all disciplines. Similar to our results, Myers et al. (7) showed that laboratory-based research activities were most impacted, with 30-40% reductions. Computational radiology research during the shutdown showed increased activity, in contradistinction to wet/instrumentation lab and core facilities research, likely due to data and computational access from home. And while clinician involvement in research during the pandemic shutdown decreased, this likely differed between specialties. Anecdotally, for some institutions, increased radiologist involvement increased due to reduced imaging interpretation responsibilities during the elective imaging shutdown.

Vagal et al. (5) summarized steps taken by 6 academic radiology departments in research during the pandemic. The common theme was cessation of on-site in-person research and recruitment, with a few exceptions: 1) COVID-19 research and 2) research that if paused would result in significant detriment to patient health. Some institutions also permitted continuation of long-standing research projects where a pause would result in significant detriment to the project. Researchers worked from home and some institutions had researchers focus on other research activities, including grant and manuscript writing and data analysis. Student and trainee activities were also halted or significantly diminished. This is similar to what the current survey found, in which the respondents indicated most non-COVID research activities and wet/instrumentation lab and core facilities research activities were paused during the shutdown, while grant and manuscript submissions and computational analysis work increased. In our survey, however, data analysis from closed labs did not increase, which may be a result of researchers unable to access data remotely and/or reduced access to students or post-doctoral research fellows. Many of the respondents to our survey also indicated cessation of summer student and international fellow research activity that could impact research in a variety of ways.

This study depicts the research experiences of academic institutions across the country during the COVID shutdowns and subsequent ramp-ups and can help inform radiology department leadership teams of research activities that can be maintained with limited intervention, those areas that will require more support to ramp back up after a shutdown, and potentially areas of research that were impacted during the shutdown that could have been maintained with limited risk during future pandemics or related crises. This data can also help radiology leadership better understand the discontinuity of faculty and lab research productivity that could inform promotion considerations. The current survey indicated a reduction in data analysis from closed labs and limited research activities from students and international research fellows. In future research shutdowns, these are potential activities that can be promoted by radiology departments, encouraging and facilitating remote research activities through increased virtual research infrastructure. In addition, with the capabilities of performing computational analysis from home, an increased focus from departments to support artificial intelligence research could help maintain research activities during future shutdowns. Creation of virtual research educational materials and interactive workshops on grant writing, research methodology and manuscript writing can help radiologists conduct virtual research activities with appropriate guidance through periods of reduced clinical responsibilities and remote work. These resources could also help introduce trainees and students to research, facilitating their research activities with virtual education and mentorship.

There are a few limitations to the current survey study. First, the study was performed during the initial ramp-up period of a dynamic pandemic, with most institutions only considering full return for Fall 2021. Institutional research activities have likely evolved over time and continue to do so as institutional, state and federal restrictions ease. Second, the scope of the survey was narrow, addressing only certain research activities. For example, we did not address the impact of the shutdown and ramp-up on COVID-19 focused research. This approach was chosen to increase engagement and response rates. Approaches developed to maintain animal and equipment facilities, address equity in research, and researcher wellness were not addressed. While we would have preferred to receive responses from every respondent, we feel the results are likely generalizable given the 44% response rate. The RSNA Vice Chairs for Research is a diverse group representing institutions that are diverse with respect to geography, size (both clinical and research), research funding levels, research support and infrastructure, and faculty. Although the survey was anonymous, we believe the respondents represented the overall diversity of academic radiology research. Third, a number of areas of research addressed in this study have multifactorial influences, affected by state and national laws and immigration agency policy changes, and not strictly under the control of the academic institutions. These details, however, are beyond the scope of this article.

 During the COVID-19 shutdown, many research activities were diminished, and this persisted for many activities during the ramp-up.  Activities that could be conducted from home such as computational analysis, as well as grant and manuscript writing and submission, however remained the same or increased.  Having knowledge of the types of activities particularly impacted by an event such as the COVID pandemic can help us prepare for future events should they occur, as well as help leaders such as Vice Chairs for Research innovate around new ways to conduct research in the future.

J o u r n a l P r e -p r o o f

During the COVID-19 pandemic, research activities were markedly impacted at academic institutions, in line with reduction of elective radiological imaging and procedures upon which many studies depend. 

Radiology Department Preparedness for COVID-19: Radiology Scientific Expert Review Panel

Special Report of the RSNA COVID-19 Task Force: The Short-and Long-term Financial Impact of the COVID-19 Pandemic on Private Radiology Practices

Coronavirus Disease 2019 (COVID-19): Radiology Department Financial Impact and Planning for Post-COVID Recovery

Policies and Guidelines for COVID-19 Preparedness: Experiences from the University of Washington

The Impact of the COVID-19

Academic careers and the COVID-19 pandemic: Reversing the tide

Unequal effects of the COVID-19 pandemic on scientists

Radiology Department Preparedness in the Coronavirus Disease 2019 (COVID-19) Postshutdown Environment