Radiologists are raising concerns about the possibility of overcalling coronavirus in radiology reports and triggering costly infection control protocols when a patient does not have the virus. But swinging the pendulum too far the other way could mean missing diagnosis and letting patients loose to spread the virus further.
Two radiology professors with the University of Pennsylvania are offering advice to physicians navigating these uncertainties. Imaging societies have recently raised concerns about computed tomography’s lack of specificity in pinpointing the virus, and its overlap with other common chest conditions. This places physicians at the risk of misattribution, falsely diagnosing COVID-19 in ill patients with other respiratory problems, the experts wrote Friday in a Medscape commentary.
“Radiologists thus face a familiar dilemma, choosing between overcalling or undercalling, and both errors are costly,” wrote Saurabh Jha, MD, and Scott Simpson, DO, both with the Philadelphia-based school’s Department of Radiology. “Furthermore, with constrained resources, attention on patients who don't have coronavirus will divert attention from those who do.”
A physician’s first instinct may be to “throw responsibility back” to other providers, using disclaimers such as "clinically correlate" or "pneumonia can't be excluded,” the authors wrote. However, they believe a team-based, joint effort helps. They offered five steps radiologists can take to help move toward this approach when attempting to pinpoint COVID-19 using imaging:
- Radiologists should familiarize themselves with the “spectrum of findings” for the virus from chest CT, including the most common characteristics, such as peripheral ground-glass opacities.
- Imaging physicians should only mention COVID-19 after they speak with other members of the care team and “all agree that coronavirus infection is possible.”
- If No. 2 is the case, radiologists should grade their level of confidence on a scale from low to intermediate or high.
- Clinicians should also express the pretest probability of a COVID-19 infection.
- Radiologists should combine their own information together with findings from other clinicians, which will “improve CT’s accuracy.”
“A joint effort prevents the burden of diagnosis falling on one side,” Jha and Simpson added. “The diagnosis of coronavirus should be confirmed with [reverse transcription polymerase chain reaction], though precautions should commence, including disinfecting the CT.”
Read more of their advice in Medscape.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.