There’s been a deluge of information in recent months about how radiologists should approach gathering chest images from patients with coronavirus. Now, an international group of experts in thoracic radiology and pulmonology are attempting to sort through the noise and distill best practices into one easy-to-read document.
The Fleischner Society on Tuesday released its consensus statement on the role of both chest x-ray and CT in the management and diagnosis of COVID-19. The document—published April 7 in Radiology—includes five main recommendations, which are adaptable to different clinical scenarios.
“We need to understand that conditions across the globe vary greatly. Our goal in developing this statement was to offer guidance that is sensitive to these differences and applicable broadly,” lead author Geoffrey Rubin, MD, a professor in radiology and bioengineering at Duke University School, said in a statement.
To reach a consensus, the society convened a group of 15 thoracic radiologists, 10 pulmonologists and one pathologist, along with further experts in several more disciplines. Panelists represented some of the hardest hit countries in the world, including China, Italy, the United States and France.
They evaluated the use of chest imaging in three scenarios—mild respiratory features consistent with COVID-19 infection; moderate to severe features; and moderate to severe features in a resource-constrained environment. The Fleischner Society boiled down their work to five main recommendations:
- Imaging is not routinely indicated as a screening test for COVID-19 in asymptomatic individuals.
- Imaging is also not indicated for patients with mild features, unless they are at risk for disease progression.
- Imaging is, however, indicated for those with moderate to severe features, regardless of their COVID-19 test results.
- Imaging is also indicated for patients with the virus and evidence of worsening respiratory status.
- In resource-constrained environments with limited access to CT, chest x-ray may be preferred for individuals with COVID-19, unless worsening respiratory warrant the use of computed tomography.
The expert panel cautioned that the statement is only opinion, and its recommendations could change in a heartbeat, given the fluid nature of the pandemic.
“Currently, no therapy has been confirmed to alter the course of COVID-19; there is no known cure, and there is no vaccine for prevention,” Rubin added. “As effective treatments are developed, thoracic imaging may find new roles by establishing treatment response or characterizing patients as likely responders to novel therapies.”
Read more in Radiology.
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.