Survey finds widespread variation in imaging modalities used to assess COVID-19 across the globe

There is widespread variation in the imaging modalities used to assess COVID-19 across the globe, though most are avoiding radiology care in asymptomatic patients, experts reported Thursday.

Since the start of the pandemic, many have debated the merits of using imaging as a first-line test to diagnose COVID-19. Scientists in China, for instance, previously touted CT’s usefulness in pinpointing the disease, while major societies in the U.S. and U.K. have urged against this practice.

A new survey shared in European Radiology attempts to quantify some of this divergence. All told, experts surveyed 50 radiology departments, representing 33 countries across all continents. They hope the findings will inform radiology departments with how to organize and develop imaging protocols during this and future pandemics.

“It is obvious that the practice of imaging in COVID-19 differs throughout the world, especially regarding the utilization of conventional chest x-ray and computed tomography,” Ivana Blažić, with the Radiology Department at the Clinical Center of Serbia, and colleagues wrote Sept. 17. “We believe that the results of this survey will help to understand current practice heterogeneities and to identify needs and gaps in the organization and function of radiology departments worldwide in relation to the COVID-19 pandemic.”

The majority of respondents said they typically do not perform imaging in asymptomatic patients (69%), while 60% used it at the end of confinement.  And the vast majority of radiology departments deployed chest imaging in patients suspected or confirmed to have the disease (89% and 94%, respectively).

About 98% of institutions adhered to established guidelines and recommendations in their country, but only 58% used structured reporting. Another 83% of respondents said the pandemic has resulted in a significant impact to their department’s typical business activities.

The report also goes into greater detail about some of the modality variation from one country to the next. CXR, mobile x-ray, and chest CT are the most commonly used systems amid the pandemic. Chest x-ray is mostly utilized in intensive care units at the bedside along with follow-up for treatment, Blažić et al. reported. Ultrasound is also typically used at the point of care, often by intensivists, while CT deployment “varies considerably.”

Most local societies did not recommend routine computed tomography to identify the disease. But CT is often performed on patients who are under investigation for COVID-19, and most radiology departments use contrast-enhanced chest CT to rule out pulmonary embolism or evaluate lung volume.

“The utilization of CT depends a lot on local circumstances in a specific area since inequality in healthcare access is huge around the world. European and Chinese professional societies advocate for the use of CT more than others, but most societies worldwide do not recommend routine use of CT for the identification of COVID-19 pneumonia…” the research team advised.

There’s lots more to digest. Read the entire analysis in European Radiology here.