The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic

By G. Rubin, C. Ryerson, L. Haramati, N. Sverzellati, J. Kanne, S. Raoof, N. Schluger, A. Volpi, J. Yim, Ian B. K. Martin and 19 more. Radiology, 2020

1,593 citations recorded by the source corpus.

With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and health care workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management of COVID-19.

Subfields: Critical Care and Intensive Care Medicine, Oncology, Radiology, Nuclear Medicine and Imaging

View Paper: https://www.semanticscholar.org/paper/894b4809a91fcfff44d82949d3f08971d342ac02

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Oncology

1. Deng-Ping Fan
2. Huan Fu
3. Radu Marculescu
4. Md Mostafijur Rahman

In Radiology, Nuclear Medicine and Imaging

1. B. van Ginneken
2. Huan Fu
3. Mathias Prokop
4. Ling Shao
5. Jianbing Shen
6. Tao Zhou
7. Deng-Ping Fan
8. Ge-Peng Ji

Citations in the corpus

• COVID-19 identification in chest X-ray images on flat and hierarchical classification scenarios (2020, background): “Nevertheless, the CXR is still useful because it is cheaper, faster, expose the patient to less radiation and is more widespread than CT scan [6, 7].”
• Radiologist-Level COVID-19 Detection Using CT Scans with Detail-Oriented Capsule Networks (2020, background): “These advantages potentially make radiographic imaging techniques a great complementary tool to rRT-PCR testing with which to fight the COVID-19 pandemic [7, 8] .”
• Predictors of COVID-19 severity: A literature review (2020, background): “The panel recommended that chest imaging is indicated for patients with poor or worsening respiratory function, or if they are determined to be at risk for disease progression.(44)”
• CO-RADS – A categorical CT assessment scheme for patients with suspected COVID-19: definition and evaluation (2020, background): “The Fleischner Society, in their recent statement, however, sees a role for imaging in various scenarios, with imaging, and in particular, CT scanning, as a major tool if symptoms worsen or in an environment that is resource-constrained for RT-PCR (11).”
• Inf-Net: Automatic COVID-19 Lung Infection Segmentation From CT Images (2020, background): “As an important complement to ( RT-PCR tests, the radiological imaging techniques, e.g., Xrays and computed tomography (CT), have also demonstrated effectiveness in both current diagnosis, including follow-up assessment and evaluation of disease evolution [5] , [6] .”
• Iteratively Pruned Deep Learning Ensembles for COVID-19 Detection in Chest X-rays (2020, background): “While not currently recommended as primary diagnostic tools, chest X-rays (CXRs) and computed tomography (CT) scans have been used to screen for COVID-19 infection and evaluate disease progression in hospital admitted cases [3], [4].”