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array:23 [ "pii" => "S2173510720301087" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2020.10.001" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1242" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2020;62:503-14" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S0033833820301429" "issn" => "00338338" "doi" => "10.1016/j.rx.2020.10.004" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1242" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2020;62:503-14" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Serie: Radiología y COVID-19</span>" "titulo" => "Gestión de la pandemia. 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El cuadro resume los diferentes fenómenos que se producen en los tejidos una vez desencadenada la infección. Los mecanismos de la infección son complejos y no se conocen totalmente. Los efectos en los tejidos son el resultado de la acción directa del virus y de la respuesta del huésped, tanto de la inflamación directa como de la respuesta inmunitaria. La llamada “respuesta disfuncional” determina la conocida como “tormenta de citoquinas”, y esta respuesta anómala es una de las principales causas de la patología grave en los casos con mala evolución clínica. A este efecto se suma la acción de las alteraciones tromboembólicas (el virus induce una respuesta anómala trombótica) y los efectos que produce la alteración del circuito metabólico de la angiotensina 2.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Valdés, A. Rovira, J. Guerrero, Á. Morales, M. Rovira, C. Martínez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Valdés" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Rovira" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Guerrero" ] 3 => array:2 [ "nombre" => "Á." "apellidos" => "Morales" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Rovira" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Martínez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173510720301087" "doi" => "10.1016/j.rxeng.2020.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510720301087?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833820301429?idApp=UINPBA00004N" "url" => "/00338338/0000006200000006/v4_202012240812/S0033833820301429/v4_202012240812/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173510720300458" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2020.04.002" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1195" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2020;62:515-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Series: Ultrasound of the gastrointestinal tract</span>" "titulo" => "Presentation of the serie «Ultrasound of the Gastrointestional Tract»" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "515" "paginaFinal" => "516" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presentación de la serie «Ecografía del tracto digestivo»" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "T. Ripollés González" "autores" => array:1 [ 0 => array:2 [ "nombre" => "T." "apellidos" => "Ripollés González" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833820300552" "doi" => "10.1016/j.rx.2020.04.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833820300552?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510720300458?idApp=UINPBA00004N" "url" => "/21735107/0000006200000006/v1_202012210613/S2173510720300458/v1_202012210613/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173510720300951" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2020.09.002" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1229" "copyright" => "SERAM" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Radiologia. 2020;62:502" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">SERIES: RADIOLOGY AND COVID-19</span>" "titulo" => "Presentation of the Serie «Radiology and COVID-19» Lessons learned from COVID-19: the radiologist's point of view" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "502" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presentación de la serie «Radiología y COVID-19»: Lecciones de la COVID-19: el punto de vista del radiólogo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.J. Arenas-Jiménez, L. Gorospe Sarasúa, M. Martí de Gracia" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J.J." "apellidos" => "Arenas-Jiménez" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Gorospe Sarasúa" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Martí de Gracia" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833820301259" "doi" => "10.1016/j.rx.2020.09.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833820301259?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510720300951?idApp=UINPBA00004N" "url" => "/21735107/0000006200000006/v1_202012210613/S2173510720300951/v1_202012210613/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Series: Radiology and COVID-19</span>" "titulo" => "Managing the pandemic from the radiology department’s point of view" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "503" "paginaFinal" => "514" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Valdés, A. Rovira, J. Guerrero, Á. Morales, M. Rovira, C. Martínez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Valdés" "email" => array:1 [ 0 => "pabvalsol@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Rovira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Guerrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Á." "apellidos" => "Morales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Rovira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "C." "apellidos" => "Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Vall d’Hebron, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Universitari Sagrat Cor, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital Son LLàtzer, Palma de Mallorca, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Gestión de la pandemia. Visión del radiólogo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 4336 "Ancho" => 3167 "Tamanyo" => 1016353 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The main measures that should be taken in a radiology department to guarantee a safe working environment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The Covid-19 infection began as a pneumonia of unknown origin, the first cases being reported in the People's Republic of China in December 2019.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Following these first reports, the disease's origin was investigated, the infected population was isolated and other preventive measures were taken. By 7 January 2020, the virus causing the infection had already been isolated<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>: a coronavirus named 2019-nCoV (“<span class="elsevierStyleBold">new coronavirus detected in 2019</span>”). A few days later, the virus's genome was available<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and work began on developing tests to detect and diagnose it. The infection spread to 24 countries in under a month. On 11 February 2020, the World Health Organisation called this new infection Covid-19,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and just one month later, on 11 March, declared it a worldwide pandemic. Since then, the number of cases has continued to grow at differing rates all over the world, and by the beginning of July 2020, more than 11 million cases and over half a million deaths due to Covid-19 infection had been reported.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first study on cases of Covid-19-induced pneumonia was published in January 2020, involving 41 patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Since then, the number of publications has grown almost exponentially<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and, in the field of radiology, not only on cases with pulmonary pathology but also with Covid-19 infection symptoms in different organs and systems.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Covid-19 infection continues to pose numerous question marks with regard to epidemiology, virology, response to treatment and the development of an eventual vaccine. The percentage of the population that is immune is also unclear, as is the infection's prevalence outside the highest spikes in incidence. All these data render it very complex to establish recommendations for adapting healthcare processes in radiology departments.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Different studies have been carried out on the analysis of the possible impact of Covid-19 infection in the coming months and even years.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In view of the difficulty involved in obtaining robust data and the scientific novelty of this infection, analyses are normally based on extrapolating the results of infections produced by similar viruses (other coronaviruses) and on the study of mathematical models based on the different variables available. In this context, conclusions can change as new data are obtained, although certain points do appear to be clear:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall">The current crisis, with a worldwide pandemic and areas with a very high prevalence, will not disappear in a matter of months. Social distancing and lockdown measures have made it possible to attenuate the number of deaths and infections, although this has also results in a low percentage of immunised people. This means that any approach to phasing out distancing measures (if indeed they are eliminated) must be staggered and slow.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0030" class="elsevierStylePara elsevierViewall">It is not clear how the virus will behave as the seasons change, or if it will mutate in the future. Coronaviruses usually present frequent mutations,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> although it is not clear that these mutations are taking place faster than expected or that they may impact the disease or its transmission.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">There are clinical trials underway to test the efficacy of medical treatments to prevent infection. There are already projects for obtaining vaccines that could be available in the first quarter of 2021. All of these variables have a big influence on the management of the infection and on protection measures. Therefore, the risk of infection continues, which is why a set of safety measures must be maintained in radiology departments. The intensity of these measures should be bolstered when the prevalence of the disease increases, which is to be expected given the possibility of new periodic crises of different intensity. Therefore, all radiologists should be familiar with Covid-19 infection, the SARS-CoV-19 virus and how to prevent infection. This will make it possible to design safe and efficient healthcare pathways.</p></li></ul></p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">The Covid-19 infection. What the radiologist should know SARS-CoV-2 virus</span><p id="par0040" class="elsevierStylePara elsevierViewall">The SARS-CoV-2 virus is a ß genus coronavirus (one of the four genera of coronavirus), with a structure and a genome very similar to other known coronaviruses, such as SARS-CoV and MERS-CoV.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> It is a virus with a single capsid-enveloped RNA chain of variable morphology (normally rounded and ovoid) with a size of between 60 and 140 nm.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The nucleocapsid is protected by a phospholipid envelope into which the surface glycoproteins are inserted (S, HE, M and E).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Of the these, the S protein is particularly relevant, as it binds to the cell receptor to allow the virus to enter the cell.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The S protein is divided functionally into two domains: S1 (responsible for binding with the cell receptor) and S2 (which permits fusion with the cell membrane).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Pathophysiology of Covid-19 infection. The basics</span><p id="par0045" class="elsevierStylePara elsevierViewall">When the virus makes contact with the mucosa cells (nasopharynegeal or respiratory), it binds to the ACE2 (angiotensin-converting enzyme 2) receptor.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The ACE2 receptor is fundamental in the renin-angiotensin-aldosterone system, and in normal conditions is very important in the regulation of homeostasis and the balance of fluids and electrolytes. In this way, besides playing a fundamental role in cell infection, the fact that the virus blocks this receptor could be another of the virus's pathogenesis factors.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Once inside the cell, the virus releases its RNA gene into the cellular cytoplasm and replication begins. Once the new viral particles have been formed, they are released in order to re-initiate the cycle. This cycle has been studied, and different therapeutic strategies have been proposed that seek to block the different phases. The ACE2 receptors are involved in many cell tissues, particularly the lungs (type II pneumocytes), heart, blood vessels, kidneys, liver and gastrointestinal tract.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Although certain tissues present a greater density of ACE2 receptors than the lungs, Covid-19 infection usually begins in the lungs,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and certain tissues with a greater density of ACE2 receptors than the lungs present less or little involvement in Covid-19 infection, as occurs in the gallbladder, the kidneys, seminal glands or testicles.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> What happens once the infection begins depends on many factors. The pathophysiology of Covid-19 infection is complex and not fully understood, involving several different mechanisms:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Alveolar inflammatory reaction.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall">Involvement of the capillaries adjacent to the alveoli, which may lead to thrombotic microangiopathy phenomena.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">ACE2 receptor blockade.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">Coagulation alteration, with hypercoagulability state.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">Triggering of an important immune response, in the so-called "cytokine storm”.</p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">The basic pathophysiology of Covid-19 infection is presented in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>. These figures are adaptations of the series published in references.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,16,18,19–26</span></a> These references should be reviewed in order to further explore the pathophysiology. In summary, the main points that must be considered in order to understand the pathogenesis, radiological manifestations and treatment possibilities are the following:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">•</span><p id="par0080" class="elsevierStylePara elsevierViewall">The virus activates inflammatory and immune response in the lungs, with the production of cytokines and interferon and activation of lymphocytes.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">•</span><p id="par0085" class="elsevierStylePara elsevierViewall">This response may be insufficient, so the organism reacts, by amplifying it. This gives rise to the so-called "cytokine storm" and may trigger lymphocyte depletion.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">•</span><p id="par0090" class="elsevierStylePara elsevierViewall">At the same time, a coagulopathy is produced, in which local factors (endothelial aggression), venous stasis and a state of hypercoagulability play a part.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">•</span><p id="par0095" class="elsevierStylePara elsevierViewall">In severe cases, the sum of all these factors gives rise to symptoms that have been called diffuse pulmonary intravascular coagulopathy which, unlike the classic symptoms of disseminated intravascular coagulopathy, does not present thrombocytopenia.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Although the virus can affect other organs directly, many of the changes that occur outside the lungs are related more to systemic, thrombotic and microangiopathic involvement than to the direct action of the virus on the specific organ,<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,27</span></a> although in some cases, such as kidney disease, the mechanisms can be more complex.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Covid-19: transmission and prevention</span><p id="par0105" class="elsevierStylePara elsevierViewall">The main form of transmission of the SARS-CoV-2 virus from one human being to another is via the secretions of infected persons, mainly through direct contact with respiratory droplets of more than 5 microns (and which can be transmitted at distances of up to 2 metres).<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Contact between the hands or contaminated fomites with the mucosa of the mouth, nose or eyes can constitute an a route of infection. The virus has also been detected in the saliva of infected patients,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> which opens up the door to diagnosis via saliva samples.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The virus is known to be able to persist for up to 9 days<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> on certain surfaces (metal, plastic or glass), although it can be neutralised by means of the usual disinfection measures. The virus has been isolated in smaller droplets, and while the possibility of airborne transmission is still being debated,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> some cases of this type of transmission have been demonstrated in closed and poorly-ventilated environments.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> For these reasons, and while not all recommendations include measures for preventing airborne transmission, it is important to maintain good hygiene and suitable ventilation of all rooms.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> The frequency of bowel involvement means that faecal transmission is a possibility. One recent review<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> shows that this has yet to be clarified, and that although there is no evidence of transmission, strict hygiene measures must be taken to prevent it. Vertical (mother-to-child) transmission seems somewhat unlikely, although some isolated cases have been published.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> The presence of the virus in the semen of a small group of patients has been demonstrated, albeit only in the initial days of convalescence.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Nevertheless, sexual transmission seems somewhat unlikely.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">One important problem in the prevention of this disease is the possible transmission by asymptomatic individuals. The median incubation period is 5-6 days, with a range of 1-14 days, although 97.5% of symptomatic cases develop within 11.5 days following exposure.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> It has been shown that asymptomatic individuals can transmit the infection,<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> which makes it necessary to be very strict with the preventive measures and requires the development of detection policies for these potentially contagious individuals.</p><p id="par0115" class="elsevierStylePara elsevierViewall">With regard to the transmission capacity of symptomatic patients, it has been seen that most of those infected have a high viral load before and during the first few days after the onset of symptoms.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> In patients with mild clinical symptoms, viral load is low as of the second week following the appearance of the symptoms, there being little likelihood of their transmitting the infection at that point, even although the virus can be detected with microbiology techniques (PCR).<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> In this way, transmission would mainly occur in the first week after the onset of symptoms (between days 2 and 3 and days 7 and 8) in mild cases. In more severe cases, transmission would be more intense and longer lasting.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Prevention (basic measures)</span><p id="par0120" class="elsevierStylePara elsevierViewall">In view of the above, the preventive measures with regard to staff are based on:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">•</span><p id="par0125" class="elsevierStylePara elsevierViewall">Establishing barriers (distance or physical barriers) between people. The basic measures would be the safety distance (2 metres) and the use of face masks. When dealing with infected or possibly infected patients, the use of personal protective equipment (PPE).</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">•</span><p id="par0130" class="elsevierStylePara elsevierViewall">Hygiene. Hand sanitisation is the simplest and most effective way of preventing the transmission of microorganisms, including SARS-CoV-2.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> Washing the hands with soap and water will suffice (there is no need to use antibacterial soaps), rubbing the hands for at least 40-60 seconds. Hydroalcoholic hand sanitisers are an alternative for quick disinfection although they should only be used once the hands are clean.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">•</span><p id="par0135" class="elsevierStylePara elsevierViewall">Identifying infected patients and possible carriers. In the case of symptomatic patients, it is easier to comply with the measure.: However, it is important to maintain a detection policy for asymptomatic carriers and to avoid any possible exposure. The policies put in place may vary from one site to another, although, generally speaking, carrying out tests on all workers is recommended,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> as is enforcing certain measures that will make it possible to identify potentially infected persons when they come to the radiology department.</p></li></ul></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Diagnosis of Covid-19 infection</span><p id="par0140" class="elsevierStylePara elsevierViewall">Diagnosis of Covid-19 infection is based on the direct or indirect detection of the virus.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> Microbiological and laboratory tests have improved in terms of sensitivity and specificity, although results must be interpreted with caution in view of the possibility of false negatives and false positives. Imaging tests are of great value in the management of patients with Covid-19 infection, as will be seen in forthcoming articles in <span class="elsevierStyleSmallCaps">Radiología</span>, although their usefulness in the initial diagnosis is limited to specific cases (mainly patients with a high suspicion and negative laboratory tests, or cases in which a quick diagnosis is required and no laboratory tests are available).<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">47,48</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Safe management of the Radiology department in the Covid era</span><p id="par0145" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Sociedad Española de Radiología Médica</span> [Spanish Society of Medical Radiology] (SERAM) has drafted a document focusing on the management of radiology departments during the Covid-19 pandemic<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> which reviews the existing literature and issues a set of recommendations. A Delphi questionnaire on these recommendations was used to ascertain the consensus among different radiologists in Spain. This questionnaire yielded 34 recommendations, which can be consulted in the cited reference.</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Measures and recommendations</span><p id="par0150" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> is an infographic that summarises the main measures that should be taken in a radiology department to guarantee a safe working environment. It is a general document that can be applied both to a pandemic situation and to situations with a low prevalance of the disease, but in which safety measures must still be taken.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Some of the measures that must be addressed are listed below.</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Basic protection measures</span><p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Personal Protective Equipment (PPE):</span> these are barrier systems that should be used by staff to minimise the risk when studying a patient with conformed or suspected Covid-19 infection. Certain basic measures (specific clothes, surgical face masks, caps and gloves – if deemed necessary) are used to establish three levels of protection according to the risk<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a>:<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">1</span><p id="par0165" class="elsevierStylePara elsevierViewall">First level (areas with possible contact with patients).</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">2</span><p id="par0170" class="elsevierStylePara elsevierViewall">Second level (when there is going to be contact with patients).</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">3</span><p id="par0175" class="elsevierStylePara elsevierViewall">Third level (when aerosols may be produced).</p></li></ul></p><p id="par0180" class="elsevierStylePara elsevierViewall">It is important to remember that both the recommendations and the material used may change, so the latest guidelines of the Spanish Ministry of Health or the local Ministries of Health should be checked. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> includes the recommended measures at the time this document was drafted.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Face masks:</span> the use of face masks has become widespread as the Covid-19 pandemic has advanced. At the time of writing this document, face coverings are obligatory for patients and health staff alike.</p><p id="par0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Structural measures:</span> in coordination with the corresponding organic and functional manager, and consisting basically of:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">•</span><p id="par0195" class="elsevierStylePara elsevierViewall">Adapting waiting rooms to make sure that the minimum distance is guaranteed (2 metres, or 1.5 metres if patients are wearing face masks).</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">•</span><p id="par0200" class="elsevierStylePara elsevierViewall">Mark out corridors and safe zones.</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">•</span><p id="par0205" class="elsevierStylePara elsevierViewall">Adequate signage.</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">•</span><p id="par0210" class="elsevierStylePara elsevierViewall">Partitions and isolation measures for administrative staff.</p></li></ul></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Measures to guarantee distancing</span><p id="par0215" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">•</span><p id="par0220" class="elsevierStylePara elsevierViewall">Among the staff: ensure suitable distribution of workstations; facilitate non-attendance-based radiology, with appropriate shifts; define a policy for the use of common rooms; avoid visits from staff from other departments (telephone inquiries, virtual meetings, etc.).</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">•</span><p id="par0225" class="elsevierStylePara elsevierViewall">Reduce the number of people having to go to the department (staggered appointments, one-off tests, ask patients not to come accompanied but, if they do, never by more than one person, etc.).</p></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Measures for preventing the transmission of infection at workstations</span><p id="par0230" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">•</span><p id="par0235" class="elsevierStylePara elsevierViewall">Facilitate hand hygiene, with informative signage, bottles of hand sanitiser, etc.</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">•</span><p id="par0240" class="elsevierStylePara elsevierViewall">Personalise workstations, making sure that staff do not share material. Clean all workstations thoroughly at the beginning and the end of shifts.</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">•</span><p id="par0245" class="elsevierStylePara elsevierViewall">Use disposable gloves when shared equipment is to be handled (such as workstations).</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">•</span><p id="par0250" class="elsevierStylePara elsevierViewall">Prohibit food or eating at workstations. Use only disposable containers for drinks.</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">•</span><p id="par0255" class="elsevierStylePara elsevierViewall">Wear clean uniforms for each shift. Do not take used clothes home to wash.</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ascertain the risk of exposure</span><p id="par0260" class="elsevierStylePara elsevierViewall">By reviewing the patient's medical record, performing diagnostic tests or specific questionnaires,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> depending on the situation or the level of infection in the community. Some protocols include the performance of analytical tests (PCR) prior to surgical procedures or interventions, although these protocols are variable. In any event, these procedures should never replace personal protective measures, in view of the possibility of false negatives in laboratory tests.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> Generally speaking, performing radiological tests (CT scan or chest X-ray) is not recommended as a screening method of asymptomatic patients,<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> particularly in low-prevalence situations. In a high prevalence environment, the CT scan could be justified on account of its high negative predictive value in situations in which a quick decision needs to be taken and no accessible laboratory tests are available. There are no analyses that demonstrate this measure is cost-effective.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ascertain immune status of staff</span><p id="par0265" class="elsevierStylePara elsevierViewall">All radiology department staff should be tested to ascertain their immune status. A substantial percentage of workers are known not to be infected by patients but rather by colleagues.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> The most susceptible staff should be relocated to suitable and low-risk work areas.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a></p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Redesign of the imaging process</span><p id="par0270" class="elsevierStylePara elsevierViewall">All the above measures and recommendations will call for a redesign of the imaging process. Some recommendations about this adaptation are provided by way of a summary in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Impact on other processes</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Impact on budget control</span><p id="par0275" class="elsevierStylePara elsevierViewall">The economic crisis produced by Covid-19 infection is so important that some specialists regard it as the most important one since the World War II, although the reduction in gross domestic product per capita is the most widespread since 1870, due to the number of countries affected.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a> Hospitals and radiology departments have been affected by this crisis, facing increased costs (safety measures), reduced production and, at private centres, reduced billing. Profitability will be impacted in all cases due to the costs of producing studies not ultimately conducted. An analysis performed in the USA<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a> pointed to a reduction in billable activity of between 50% and 70%, with a simultaneous increase in expenditure. In the initial stages of the crisis, it was estimated that this unfavourable situation could last for up to 9 months. This all means that it is important to monitor expenditure, coupled with good accounting management.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Impact on training and research</span><p id="par0280" class="elsevierStylePara elsevierViewall">The safety measures affect all the activities of the radiology department, including training, both training sessions and on-the-job training of students (medical students or higher-level diagnostic imaging technicians) and doctors in training (in radiology or other specialties).<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">59–62</span></a> In view of the economic impact of the crisis and its potential duration, it is important that all training programmes are maintained and that all departments establish, using the new technologies, measures to overcome the difficulties posed by the current situation.</p><p id="par0285" class="elsevierStylePara elsevierViewall">Hospital training activities (courses and congresses) have also been impacted<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a> through the suspension of attendance-based activities and the development of online training activities. There is no consensus as to the possible medium- and long-term impact of the crisis on these activities, as this will depend on factors such as the development of a vaccine or the safety regulations that are applied.</p><p id="par0290" class="elsevierStylePara elsevierViewall">The Covid-19 crisis has also had an impact on research, particularly in processes not related to this infection.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> Moreover, the crisis has generated scientific output at an unprecedented speed. This, which on the one hand has permitted key breakthroughs in a very short time, has also meant that in some cases editorial control has not been applied with the usual rigour,<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> sometimes having a big impact worldwide.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Risk management</span><p id="par0295" class="elsevierStylePara elsevierViewall">Covid-19 infection is a threat to staff and patients and a core item in the way that a radiology department approaches its activity consists of good risk management, both prospectively and retrospectively. It is no different to other risk analyses, meaning that risk assessment studies will follow the same methodology.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Impact on structure</span><p id="par0300" class="elsevierStylePara elsevierViewall">The latest report published by the <span class="elsevierStyleItalic">Federación Española de Empresas de Tecnología Sanitaria</span> [Spanish Federation of Medical Technology Companies] (FENIN) on medical technology<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a> highlights the precarious situation of research into high-tech hospital equipment, which has accumulated a deficit since the crisis of 2008. The Covid-19 crisis has heightened this situation. Although many devices or equipment have been used less, in other cases they have been overused, and intensive cleaning and disinfection have affected some of them. For several months, the normal rhythm of machine maintenance has been altered. In this scenario, it is important that radiology departments have an updated plan addressing the situation of the equipment and renewal needs, supported by a clear rationale. Moreover, the first Covid-19 infection crisis has demonstrated the advantages of having direct portable conventional radiology equipment and portable ultrasound equipment. Radiology will play a key role in the management of the crisis, and for this it is essential that managers and politicians must comprehend the importance of maintaining reliable and safe technology.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Impact on radiology professionals</span><p id="par0305" class="elsevierStylePara elsevierViewall">The organisation of radiology departments has been greatly impacted by the Covid-19 crisis. During the pandemic, many departments have had to change their focus and dedicate their activities almost exclusively to the diagnosis of Covid-19. To this end, workforces have been restructured, both technicians and radiologists, with unequal working days and positions with different degrees of healthcare pressure. As the pressure of the Covid-19 infection decreases, organisations are returning to normal, but the need to maintain certain safety measures renders it necessary to reinforce certain aspects of healthcare that were not envisaged in initial staffing plans. Some examples include the need to bolster technical personnel for jobs with greatest risk (operating portable devices for infected patients, radiology in "dirty" zones), or the need to adapt radiologists' workstations so they can continue to perform simple X-rays, which is considered essential. It is important to clearly define all the department's activities in each one of the Covid-19 infection stages (prevalence), in order to be able to adjust the resources available. Sometimes, these measures involve redesigning workstations and the functions of each position, adapting them to specific conditions.</p></span></span></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors</span><p id="par0310" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">1</span><p id="par0315" class="elsevierStylePara elsevierViewall">Responsible for study integrity: PVS, ARC, JGB, ÁMS, MRC, CMS.</p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">2</span><p id="par0320" class="elsevierStylePara elsevierViewall">Study concept: PVS, ARC, JGB, ÁMS, MRC, CMS.</p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">3</span><p id="par0325" class="elsevierStylePara elsevierViewall">Study design: PVS, ARC, JGB, ÁMS, MRC, CMS.</p></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">4</span><p id="par0330" class="elsevierStylePara elsevierViewall">Data acquisition: PVS, ARC, JGB, ÁMS, MRC, CMS.</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">5</span><p id="par0335" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: PVS, ARC, JGB, ÁMS, MRC, CMS.</p></li><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">6</span><p id="par0340" class="elsevierStylePara elsevierViewall">Statistical processing: N/A.</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">7</span><p id="par0345" class="elsevierStylePara elsevierViewall">Literature search: PVS, ARC, JGB, ÁMS, MRC, CMS.</p></li><li class="elsevierStyleListItem" id="lsti0185"><span class="elsevierStyleLabel">8</span><p id="par0350" class="elsevierStylePara elsevierViewall">Drafting of the manuscript: PVS, ARC, JGB, ÁMS, MRC, CMS.</p></li><li class="elsevierStyleListItem" id="lsti0190"><span class="elsevierStyleLabel">9</span><p id="par0355" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually significant contributions: PVS, ARC, JGB, ÁMS, MRC, CMS.</p></li><li class="elsevierStyleListItem" id="lsti0195"><span class="elsevierStyleLabel">10</span><p id="par0360" class="elsevierStylePara elsevierViewall">Approval of the final version: PVS, ARC, JGB, ÁMS, MRC, CMS.</p></li></ul></p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0365" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1438348" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1312964" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1438347" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1312965" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "The Covid-19 infection. What the radiologist should know SARS-CoV-2 virus" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Pathophysiology of Covid-19 infection. The basics" ] ] ] 5 => array:3 [ "identificador" => "sec0020" "titulo" => "Covid-19: transmission and prevention" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Prevention (basic measures)" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Diagnosis of Covid-19 infection" ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "Safe management of the Radiology department in the Covid era" "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0040" "titulo" => "Measures and recommendations" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Basic protection measures" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Measures to guarantee distancing" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Measures for preventing the transmission of infection at workstations" ] 3 => array:2 [ "identificador" => "sec0060" "titulo" => "Ascertain the risk of exposure" ] 4 => array:2 [ "identificador" => "sec0065" "titulo" => "Ascertain immune status of staff" ] ] ] 1 => array:3 [ "identificador" => "sec0070" "titulo" => "Redesign of the imaging process" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0075" "titulo" => "Impact on other processes" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Impact on budget control" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "Impact on training and research" ] 2 => array:2 [ "identificador" => "sec0090" "titulo" => "Risk management" ] 3 => array:2 [ "identificador" => "sec0095" "titulo" => "Impact on structure" ] 4 => array:2 [ "identificador" => "sec0100" "titulo" => "Impact on radiology professionals" ] ] ] ] ] ] ] 8 => array:2 [ "identificador" => "sec0105" "titulo" => "Authors" ] 9 => array:2 [ "identificador" => "sec0110" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-08-16" "fechaAceptado" => "2020-10-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1312964" "palabras" => array:3 [ 0 => "Coronavirus infection" 1 => "Patient safety" 2 => "Practice management" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1312965" "palabras" => array:3 [ 0 => "Infección por coronavirus" 1 => "Seguridad del paciente" 2 => "Gestión" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The COVID-19 pandemic is forcing our entire society to adopt numerous changes, at least until an effective treatment and/or vaccine becomes widely available. Because COVID-19 is a new disease that has required us to make complex decisions based on scant evidence, the pandemic is having an enormous impact on our health system.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Radiology departments play a fundamental role in the management of COVID-19, both in the diagnosis of the disease and in the posterior management of patients. To ensure the safety of patients and healthcare professionals, it is essential to understand the infection so that safe circuits can be implemented.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">This article summarizes the pathophysiology of COVID-19 infection and explains the measures that radiology departments need to adopt during the pandemic.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La infección COVID-19 está obligando a toda la sociedad a adoptar numerosos cambios, al menos hasta que exista un tratamiento o vacuna eficaces. El impacto que está produciendo en nuestro sistema sanitario tiene pocos precedentes similares, al tratarse de una patología nueva y que ha obligado a tomar decisiones complejas a partir de una evidencia escasa.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Los servicios de radiología tienen un papel fundamental en el manejo de esta patología, tanto en el diagnóstico como en el manejo posterior de los pacientes. Pero, para ello, se debe entender la infección, de forma que se puedan poner en marcha circuitos seguros para pacientes y trabajadores.</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">En este artículo se resume la fisiopatología de la infección COVID-19 y se presentan las medidas que se deben adoptar en el servicio de radiología.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Valdés P, Rovira A, Guerrero J, Morales Á, Rovira M, Martínez C. Gestión de la pandemia. Visión del radiólogo. Radiología. 2020;62:503–514.</p>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 884 "Ancho" => 3175 "Tamanyo" => 143561 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">General pathophysiology of the Covid-19 infection. The SARS-CoV-2 virus binds to the ACE2 receptor which is located on the surface of certain cells. Once bound to the membrane, it enters the cell and replicates, while also blocking the receptor. The phenomena produced by the virus can be divided into three major groups: those caused by inflammatory response and the immune system, those due to alteration of the angiotensin II system through receptor blockade, and those that are secondary to the coagulopathy and thrombotic phenomena produced by the virus.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2543 "Ancho" => 3175 "Tamanyo" => 356523 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">General pathophysiology of Covid-19 infection. The chart summarises the different phenomena occurring in the tissues once the infection has been triggered. The mechanisms of infection are complex and are not fully understood. The effects on tissues are the result of the direct action of the virus and the host's response, both the indirect inflammation and immune response. The so-called "dysfunctional response" determines what is known as the "cytokine storm”, and this abnormal response is one of the main causes of severe pathology in cases with a poor clinical evolution. This effect is compounded by the action of thromboembolic alterations (virus induces an abnormal thrombotic response) and the effects produced by the alteration of the angiotensin 2 metabolic circuit.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 4128 "Ancho" => 2516 "Tamanyo" => 635022 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Basic diagram of the published theories about the pathophysiology of Covid-19 infection in different organs. In all of them, the main agent is the ACE2 receptor, which allows the virus to bind to the cell. However, the phenomena related to immune response and coagulopathy sometimes play a more important role.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 4336 "Ancho" => 3167 "Tamanyo" => 1016353 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The main measures that should be taken in a radiology department to guarantee a safe working environment.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Observations:</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">• If certain items of equipment are not available, the preceding one on the scale should be used.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">• If surgical masks are not available, a face shield may be used, which offers sufficient protection against droplet transmission.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">• A disposable gown may be used over the waterproof gown so that the waterproof gown can be reused.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of patient care \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Examples \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Respiratory protection equipment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gown and eye protection \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gloves \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hand hygiene \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">More than 2 metres away \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Walking in corridors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory protection not required \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Usual uniform \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">According to standard precautions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Always \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Between 1 and 2 metres \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performing tasks in the room more than 1 m away from the patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgical mask (and/or face shield) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disposable gown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">According to standard precautions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Always \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Less than 1 m away/physical contact \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performing imaging tests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgical mask (and/or face shield) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Waterproof gown (and eye protection if face shield is not used) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Whenever there is contact with the patient and their environment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Always \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Procedures that generate aerosols \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory tract procedures (such as bronchoscopy or intubation) or which may cause coughing (such as chest interventions) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FFP (FFP2 or FFP3), depending on availability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Waterproof gown and watertight eye protection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Always \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Always \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2474261.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Use of personal protective equipment. Recommendations may change from week to week, depending on the new discoveries about the aetiopathogenesis of Covid-19 infection.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Subprocess \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Action \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Observations \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Appointments: agenda design \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Redesign of each room's agenda to adapt to contaminated and clean zones \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Appointments: agenda design \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Take into account the times required for cleaning, disinfection and the use of protective equipment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The extra time needed will vary depending on the room and the circuit, although it may lead to a delay of between 15 minutes and 2 hours in certain situations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Appointments: agenda design \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adapt the number of appointments to waiting room capacity at all times \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The number of patients given an appointment at the same time must not surpass the waiting room's capacity once all the safety measures (distancing) have been taken into account \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Appointments: agenda design \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adjust the number of the staff required \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adapt the type and number of professionals in order to take the safety measures into account \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Request validation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The radiologist must validate all imaging test requests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Besides evaluating suitability, the zone in which the test will be included must be taken into account \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient appointments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prioritise one-off tests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Try to ensure the patient comes to the radiology department the fewest possible number of times and spends the least possible time there \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient appointments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Give the patient safety instructions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Short questionnaire about the possibility of infection; ask the patient not to come accompanied \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Receiving the patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Detect possible infected patients or transmitters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">With a questionnaire on receiving the patient \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performance of the test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Define specific procedures for each room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Insist on safety procedures, particularly regarding cleaning and disinfection of rooms and equipment, and staff hygiene \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Test report \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Report chest X-rays \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The chest X-ray report can be useful for detecting unsuspected cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Test report \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use preconfigured reports \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The use of template reports for X-rays and chest CT scans is recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Test report \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Design teleradiology stations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Teleradiology stations should be available to guarantee continued activity in the event of a high-prevalence situation \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2474262.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Some recommendations regarding the adaptation of the imaging process.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:68 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A Novel Coronavirus from Patients with Pneumonia in China, 2019" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. 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