Russia (bbabo.net), - Moscow is returning to the provision of routine care in clinics, which the city temporarily suspended due to the massive distribution of "omicron". Almost from the first day of the pandemic, radiologists have also been fighting for the life and health of Muscovites who have fallen ill with a new infection. Never before has there been such a demand for computed tomography as in the past two years. And what is happening in CT centers now? Sergey Morozov, Chief Specialist in Radiation and Instrumental Diagnostics of the Department of Health of Moscow and the Ministry of Health of Russia for the Central Federal District of the Russian Federation, told the correspondent about this.

Sergei Pavlovich! With the help of testing, Moscow laboratories not only identify those infected with the coronavirus, but also determine exactly which strain a person has picked up. And what does the omicron look like on a CT scan, which, as you know, now accounts for the majority of those infected with COVID-19 in Moscow?

Sergey Morozov: Let me remind you: computed tomography is a method for detecting damage to the lung tissue. Over the past two years, about 1 million studies have been conducted in outpatient CT centers, which showed that approximately 600,000 patients with COVID-19 had lungs affected. But now the nature of the defeat has fundamentally changed. In the first waves, when the Wuhan strain first came to the city, and then the Delta strain, only 20-25 percent of the infected lungs remained unaffected. In the rest, the degree of damage was from minimal CT-1, when the radiologist saw only individual small foci in the area of ​​the lung less than 25 percent, to CT-2 with damage up to 50 percent, CT-3 - from 50 to 75 percent, and finally CT-4 - a severe form of pneumonia with a lesion of more than 75 percent.

Today's wave of the pandemic is actually not associated with lung tissue damage at all. In fact, although the pandemic continues, it is a disease of a completely different severity. Most of the patients have CT-0, that is, the lungs are clean. Neither the network of alveoli nor the network of capillaries through which blood flows, where thrombosis and other complications, such as bacterial pneumonia, have previously occurred, is not affected. The conclusion is unequivocal: at the first sign of a cold, the sick person now does not need to run to do a CT scan.

Nevertheless, some patients with a positive result of the PCR test are referred by doctors for CT, while others are not. The question arises: to whom is computed tomography still indicated?

Sergey Morozov: For those who have a disease with complications and suspected pneumonia. Usually this applies to patients who are weakened, with immunodeficiency, who move little. That is, patients at risk: those suffering from diabetes, obesity, arterial hypertension, chronic heart failure. The virus itself, as you know, most often does not require specific treatment. Its danger lies in the fact that a bacterial infection can join. Therefore, examination is required if, despite the use of drugs, a high temperature persists, there is shortness of breath, there is pain in the chest.

Although the pandemic continues, it is already a completely different disease in terms of severity, in fact, not associated with lung tissue damage at all

But let's be honest and admit that there is also a group of patients who are simply scared. They are used to being afraid of covid, and the very word "omicron" sounds somehow suspicious. It is these patients who most often rush to CT. So to speak, just in case.

But despite the fact that the number of hospitalizations continues to decrease, about 1000 patients are still admitted to hospitals every day. Surely not just because of their excessive anxiety...

Sergey Morozov: People are usually hospitalized with complications from the course of the coronavirus disease, arising from the reasons that I have already mentioned. In addition, there are remnants of the "delta" strain in the city, which is more difficult to tolerate. But in general, the number of severe hospitalizations is decreasing every day. This can be seen both in the decrease in the number of patients in hospitals on artificial lung ventilation, and according to the data of outpatient CT centers, which literally every day record a decrease in the degree of damage to the lungs of patients.

How do CT centers work in the city now?

Sergey Morozov: In 2020, 48 centers worked, and 120-140 patients passed through each daily, now this number is not required, and some CT centers have returned to scheduled appointments. At the peak of the incidence in the centers, there was a completely different nature of work. They acted more as sorting points, helping doctors determine which of the sick should be immediately hospitalized, and who should be allowed home for treatment under the supervision of a telemedicine center. Now, without leaving coronavirus patients in need without diagnostics, CT centers are increasingly switching to a planned mode of operation.Do clinics have enough equipment for this?

Sergey Morozov: Yes, but it's time to change it. The life cycle contracts, under which the capital acquired most of it in 2012, provide for the replacement of all radiation equipment of polyclinics with more modern ones in ten years. All new MRI scanners will now be wide aperture, which dramatically reduces claustrophobia, and CT scans will be low-dose modes. Mammographs will have a tomosynthesis function for more accurate diagnostics.

Updating already?

Sergey Morozov: The city is actively engaged in the reconstruction of outdated clinics. More than 30 of the 200 that should be updated in the coming years have already opened to patients. In each of them, not only the building was rebuilt to meet modern requirements, but also the latest equipment was installed. For example, smart CT scanners have appeared that automatically read coronary calcium using artificial intelligence, when determining osteoporosis, the density of vertebral bodies is assessed, abnormalities in the lungs and many other pathologies are detected. Instead of obsolete fluorography devices, U-arms are installed, low-dose digital X-ray diagnostic devices that allow you to examine not only the lungs, but also other parts of the body. A large plan has also been developed to equip polyclinics with densitometers for assessing bone tissue and detecting osteoporosis.

As the chief specialist in radiation and instrumental diagnostics not only of the Moscow Department of Health, but also in the Central Federal District of the Russian Ministry of Health, tell me: does such ultra-modern equipment currently appear only in the capital or is it also supplied to other regions of the country?

Sergey Morozov: In the territories and regions of Russia, there is also a large-scale re-equipment of medical institutions. In oncology, specialized hospitals in many of them, you can see the most super-advanced machines, even dual-energy and spectral machines with a wide range of capabilities. But so far, not many regions can boast of having CT and MRI in the primary network. And in the capital, when ten years ago we installed them, one could often hear the question, why such expensive equipment in the district clinic? But then came the pandemic with mass pneumonia, and it became clear that without CT it is simply impossible there. Otherwise, where would all the patients go? In hospitals? Then they would have turned into a bottleneck, and health care would not have coped with such a flow of patients.

It's the same with MRI. Where else to put them, if not in clinics? After all, people with diseases of the spine, brain, chronic diseases of the joints go there. But the regions have not yet come to this - they have come to understand that such diagnostic methods are needed not only for already sick patients, but first of all for those who have only the first signs of the disease and its development can be influenced. Therefore, many outdated diagnostic methods are still used in the regions. For example, they continue to prescribe linear tomography for x-ray studies. It looks like a CT scan, but nothing is visible there.

In addition, some regions continue to receive analog equipment, which is simply installed and not connected anywhere. But modern radiology is primarily a network. Each device must be digital and must be connected to a single information system to ensure the availability of this equipment.

We did this in Moscow - we have all digital devices in a single network, headed by an expert reference center, which Moscow Mayor Sergei Sobyanin opened at the very beginning of the pandemic, on April 29, 2020. During this time, he remotely described 1 million 800 thousand studies made by polyclinics, regardless of whether there is a radiologist there or not. It is now enough for a polyclinic in Moscow to have an X-ray laboratory assistant with a different level of education, and doctors will promptly receive a qualitative description of the study from our center. The presence of such a reference center as ours allows us to reduce the duration of the description of the studies carried out by five times. This is important not only during a pandemic. This will enable any region to provide the population with screening programs for detecting lung cancer, tuberculosis using CT, covering the female half of the population with mammography and other diseases. The studies described by the reference center automatically immediately fall into the Muscovite's electronic medical record, to which both the patient and his attending physician have access.

Do hospital doctors also have access to electronic cards of Muscovites?Sergey Morozov: All polyclinics and all hospitals are connected to the Unified Radiological Information System in Moscow. When, say, a serious patient is brought to Kommunarka, doctors do not need to rush to do a CT scan, it is enough to open his electronic medical record and look at the study that has already been done. Or, say, when the chief obstetrician-gynecologist of Moscow, Anton Olenev, conducts a consultation on the condition of some patient in a clinic, all its participants also have before their eyes all the studies in the form of pictures. This is a tool that ensures the interaction of all parts of healthcare and maximum expert support.

What is your imaging reference center?

Sergey Morozov: This is a team of 150 radiologists who work around the clock. They issue about 35,000 study descriptions per week, but the studies are not carried out by them, but by medical organizations, which then receive descriptions from us in electronic form. The use of artificial intelligence algorithms helps us make more accurate diagnoses. A tired doctor may miss something, pay no attention to something, and artificial intelligence will notice everything and draw the appropriate conclusion.

Thanks to this, our doctors work with a very high load, but without tension. This is facilitated by the ideally organized workplace in the reference centerms of speed of work, IT support, availability of electronic reference books, and communication through different channels. In fact, we have a new medical specialty - specialists working with a patient's digital twin. Such a center in Moscow, created in the state healthcare system, is so far the only one in the world. And the URIS system in which it works, in terms of the number of connected equipment, is the largest in Europe. With the help of artificial intelligence, we have processed the data of millions of patients. No one else has had this experience yet.

Is this capital experience accessible to the country?

Sergey Morozov: Of course. Moscow willingly shares its innovations with everyone who is interested in them. We publish a huge amount of methodological materials, with the help of which the regions can simply copy them. We have a connection hub where we consult colleagues using artificial intelligence technologies. There is an accredited training center, which online programs simultaneously connect up to 12,000 doctors from different regions. And, I think, the day is not far off when in a regular clinic, for example, with sinusitis, they will tell you: "Let's do a CT scan of the maxillary sinuses for you."

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