Should Chest X-ray Be Used in Diagnosing COVID-19?

Abstract

While chest x-ray is readily available and may precede RT-PCR test, chest x-ray has low sensitivity early in the COVID-19 disease and shows non-specific lung abnormalities in COVID-19 patients. 
 
 Chest x-ray is part of the initial diagnostic tool used on COVID-19 patients in some hospitals as it yields fast results compared with reverse transcription-polymerase chain reaction (RT-PCR).
 
 
 Chest Computed Tomography (CT) has been reported to be more sensitive than chest x-ray in determining the presence of COVID-19.
 
 
 Chest x-ray findings in confirmed COVID-19 patients show:
 
  Normal lung findings early in the illness and in mildly symptomatic patients
 Typical ground-glass opacities and consolidation in the lung periphery
 Lung abnormalities are non-specific and may likewise be present in other infections and coronavirus-types of pneumonia
 
 The American College of Radiology (ACR), Center for Disease Control and Prevention (CDC), Canadian Association of Radiologists (CAR), Canadian Society of Thoracic Radiology (CSTR), and British Society of Thoracic Imaging do not recommend the use of chest x-ray to diagnose COVID-19. The Fleisher Society, composed of radiologists and pulmonologists in ten countries, does not recommend a chest x-ray for patients suspected of mild COVID-19. A chest x-ray is recommended for patients with moderate to severe COVID-19 needing immediate triage and patients at high risk for disease progression. Despite presence of chest x-ray findings suggesting COVID-19, RT-PCR test remains the standard diagnostic procedure.