British Society Of Thoracic Imaging Research Articles

Evaluation of the Progress of Coronavirus Disease-19 Pneumonia using the British Society of Thoracic Imaging Reporting Model: A Validation Study

Abstract: Background: SARS-COV-2 (also known as severe acute respiratory syndrome corona virus-2), emerged as a pandemic and became an overwhelming global concern, causing substantial morbidity and mortality worldwide. Reverse transcription polymerase chain reaction (RT-PCR) is considered a gold standard in detecting clinically symptomatic patients but can have false negative and false positive results. As chest X-Ray (CXR) is considered as a baseline investigation in many hospitals, BSTI reporting model during COVID-19 pandemic has been a useful tool in diagnosis of COVID-19 pneumonia. Objective: To validate the British Society Thoracic Imaging (BSTI) coding system in the evaluation of the progress of the disease severity in patients with coronavirus disease-2019 (COVID-19) pneumonia. Materials and Methods: This is a cross sectional observational study. Total 450 CXRs (which included both the baseline and serial CXRs) of 225 COVID positive patients (RT-PCR positive for COVID-19 on nasal swabs) were included. These were retrospectively reviewed and reported by two Radiologists (having experience of at least 5 years in Radiology Reporting) in Corona Ward in Dr. Ruth K M Pfau Civil Hospital Karachi, Pakistan, for the duration of 10 months from 1st March 2020 till 31st December 2020. BSTI coding system was used to classify and interpret the CXR imaging findings as normal, definitive, indeterminate and non-COVID for baseline (CXR on 1st day of admission) and follow up CXRs (done in between 3rd and 7th day of admission). Data was analyzed using SPSS version 25. Numeric data was assessed for distribution using Shapiro-Wilks test. Median and interquartile range (IQR) were reported for numeric variables. Frequencies and percentages were reported for categorical data. Kappa statistics was applied to assess the agreement between BSTI scoring at baseline and follow-up CXRs. A p-value ≤0.05 was considered as statistically significant. Result: CXRs (including 225 baseline and 225 follow up CXRs) of 225 RT-PCR COVID-19 positive patients were analyzed. Interval change in BSTI coding system was noted, increase in frequency of probable/definitive COVID-19 findings were diagnosed on serial CXRs. The BSTI scoring at baseline and follow-up showed moderate agreement with kappa statistics as 60.3% (p=0.001). Conclusion: BSTI coding system can be helpful to classify the COVID-19 disease on CXR and filter for the prognosis of disease severity in the serial radiographs. Utilization of BSTI reporting model for reporting CXRs, even before RT-PCR, in future COVID pandemic can be considered as a useful tool.

Reporting of coronary artery calcification on chest CT studies in patients with interstitial lung disease

To evaluate the prevalence of coronary artery calcification (CAC) on non-contrast computed tomography (CT) of the thorax in patients with interstitial lung disease (ILD), assess consistency of CAC reporting and assess incidence of subsequent cardiac events. Patients with known interstitial lung disease who underwent a CT thorax over a 2-year period were retrospectively reviewed. Presence of CAC was assessed using a visual scale for CAC reporting and graded as mild, moderate, or severe by two cardiothoracic radiologists. CT reports were reviewed to determine if presence of CAC had been described. Electronic medical records were reviewed for any subsequent cardiothoracic events from the date of the CT thorax to present. 254 patients were included in the analysis (54.7% men; mean age 59.9 yo). 43.7% had CAC on their CT thorax; however, in 87.3% of those, reports did not comment on its presence. 8 patients had cardiac events; 7 of them had CAC on CT although only in 1 case this was reported. Global CAC and LAD CAC Patients with cardiac events had a significantly higher global CAC (p=0.016) and LAD CAC (p=0.048) when compared to patients without. We demonstrated a high prevalence of CAC in ILD patients and its significant association with adverse cardiac events. Unfortunately, CAC on CT thorax is still largely unreported. As per recent BSCI/BSCCT and BSTI guidelines, reporting of CAC should become part of routine practice, as may prompt prevention and impact on patients outcome.

Chest radiograph classification and severity of suspected COVID-19 by different radiologist groups and attending clinicians: multi-reader, multi-case study

ObjectivesTo quantify reader agreement for the British Society of Thoracic Imaging (BSTI) diagnostic and severity classification for COVID-19 on chest radiographs (CXR), in particular agreement for an indeterminate CXR that could instigate CT imaging, from single and paired images.MethodsTwenty readers (four groups of five individuals)—consultant chest (CCR), general consultant (GCR), and specialist registrar (RSR) radiologists, and infectious diseases clinicians (IDR)—assigned BSTI categories and severity in addition to modified Covid-Radiographic Assessment of Lung Edema Score (Covid-RALES), to 305 CXRs (129 paired; 2 time points) from 176 guideline-defined COVID-19 patients. Percentage agreement with a consensus of two chest radiologists was calculated for (1) categorisation to those needing CT (indeterminate) versus those that did not (classic/probable, non-COVID-19); (2) severity; and (3) severity change on paired CXRs using the two scoring systems.ResultsAgreement with consensus for the indeterminate category was low across all groups (28–37%). Agreement for other BSTI categories was highest for classic/probable for the other three reader groups (66–76%) compared to GCR (49%). Agreement for normal was similar across all radiologists (54–61%) but lower for IDR (31%). Agreement for a severe CXR was lower for GCR (65%), compared to the other three reader groups (84–95%). For all groups, agreement for changes across paired CXRs was modest.ConclusionAgreement for the indeterminate BSTI COVID-19 CXR category is low, and generally moderate for the other BSTI categories and for severity change, suggesting that the test, rather than readers, is limited in utility for both deciding disposition and serial monitoring.Key Points• Across different reader groups, agreement for COVID-19 diagnostic categorisation on CXR varies widely.• Agreement varies to a degree that may render CXR alone ineffective for triage, especially for indeterminate cases.• Agreement for serial CXR change is moderate, limiting utility in guiding management.

RELEVANCE OF CHEST X-RAY IN COVID-19 DIAGNOSIS

Background: Radiological imaging also plays an important role in diagnosing and severity assessment of the disease. British Society of Thoracic Imaging released guidance for reporting computed tomography as well as chest radiographs. We conducted this study to assess the sensitivity and specicity of chest radiograph for COVID-19 patients attending a COVID Hospital in India. Material And Methods: This was a retrospective study in which suspected COVID-19 patients attending HNB Base Hospital, Srinagar, Uttarakhand from April 2021 to June 2021 who underwent RTPCR and chest radiographs were taken. Chest X-rays were classied according to the BSTI chest X-ray report Performa. This Performa was then compared with the RTPCR reports of the patients to calculate the sensitivity and specicity. Results: Comparison of the four chest X-ray groups according to the BSTI guidance with RT-PCR status was done. It revealed that almost 85.48% of the normal chest X-ray group were RT-PCR positive and 30.68% of the chest X-rays that had classic or probable COVID-19 features came out to be RT-PCR negative. 75% of patients who were grouped in Non-COVID-19 in accordance with their chest x-ray features were RT-PCR positive. Discussion And Conclusion: The specicity (40.66%) and sensitivity (50.62%) of the BSTI guidance for chest x-ray are low as shown in our study. The main drawback of this study is that we have kept RT-PCR as the gold standard.

Chest radiography findings of COVID-19 pneumonia: a specific pattern for a confident differential diagnosis.

Chest radiography (CR) patterns for the diagnosis of COVID-19 have been established. However, they were not ideated comparing CR features with those of other pulmonary diseases. To create the most accurate COVID-19 pneumonia pattern comparing CR findings of COVID-19 and non-COVID-19 pulmonary diseases and to test the model against the British Society of Thoracic Imaging (BSTI) criteria. CR of COVID-19 and non-COVID-19 pulmonary diseases, admitted to the emergency department, were evaluated. Assessed features were interstitial opacities, ground glass opacities, and/or consolidations and the predominant lung alteration. We also assessed uni-/bilaterality, location (upper/middle/lower), and distribution (peripheral/perihilar), as well as pleural effusion and perihilar vessels blurring. A binary logistic regression was adopted to obtain the most accurate CR COVID-19 pattern, and sensitivity and specificity were computed. The newly defined pattern was compared to BSTI criteria. CR of 274 patients were evaluated (146 COVID-19, 128 non-COVID-19). The most accurate COVID-19 pneumonia pattern consisted of four features: bilateral alterations (Expß=2.8, P=0.002), peripheral distribution of the predominant (Expß=2.3, P=0.013), no pleural effusion (Expß=0.4, P=0.009), and perihilar vessels' contour not blurred (Expß=0.3, P=0.002). The pattern showed 49% sensitivity, 81% specificity, and 64% accuracy, while BSTI criteria showed 51%, 77%, and 63%, respectively. Bilaterality, peripheral distribution of the predominant lung alteration, no pleural effusion, and perihilar vessels contour not blurred determine the most accurate COVID-19 pneumonia pattern. Lower field involvement, proposed by BSTI criteria, was not a distinctive finding. The BSTI criteria has lower specificity.

Value of Including CT Chest in the Management of Acute Abdominal Emergencies: Experience During First Wave of COVID-19 Pandemic at a UK District General Hospital.

AimsCOVID-19 can present with abdominal pain and affects the management of emergency surgical patients. The aim of this retrospective study was to assess the incidence of positive findings on CT chest in patients presenting with acute abdomen, who underwent CT thorax as part of the Intercollegiate General Surgical Guidance on COVID-19 during the first wave. To correlate CT chest findings with confirmed cases on reverse transcription polymerase chain reaction (RT-PCR), and to determine its influence on surgical management of abdominal emergencies.MethodsA retrospective observational study of adult emergency surgical referrals (excluding trauma) for acute abdomen over a 10-week period was performed. COVID-19 changes on CT chest were categorized as per the British Society of Thoracic Imaging (BSTI) CT reporting criteria. Patient demographics, COVID-19 RT-PCR, management and outcome were recorded. Statistical analysis was performed using Microsoft Excel (Microsoft Corporation, Redmond, USA) with p-value significant at ≤0.05.ResultsOf the 160 patients included, 111 (69.38%) had COVID-19 RT-PCR. Twenty-four patients had CT chest findings suggestive of COVID-19. Amongst these, 45.83% demonstrated classic/probable CT features of COVID-19, of which 36.36% had positive RT-PCR. Most patients who had acute abdominal findings had a normal CT chest (p=0.03). Twenty-five (15.63%) patients presenting with abdominal pain had normal CT abdomen and seven (28%) of these had CT features of COVID-19. Only 43 (34.4%) patients needed a surgical intervention, of which 18.6% had COVID-19 changes on CT, confirmed by positive RT-PCR in 12.5%.ConclusionCT chest is an important investigation during the COVID-19 pandemic in suspected cases to help assess the severity of lung involvement. CT chest as an additional investigation modality in acute abdomen had clinically helped in triaging of patients to appropriate specialties but did not influence emergency surgical management.

RSNA and BSTI grading systems of COVID-19 pneumonia: comparison of the diagnostic performance and interobserver agreement

BackgroundThis study aimed to compare the performance and interobservers agreement of cases with findings on chest CT based on the British Society of Thoracic Imaging (BSTI) guideline statement of COVID-19 and the Radiological Society of North America (RSNA) expert consensus statement.MethodsIn this study, 903 patients who had admitted to the emergency department with a pre-diagnosis of COVID-19 between 1 and 18 July 2020 and had chest CT. Two radiologists classified the chest CT findings according to the RSNA and BSTI consensus statements. The performance, sensitivity and specificity values of the two classification systems were calculated and the agreement between the observers was compared by using kappa analysis.ResultsConsidering RT-PCR test result as a gold standard, the sensitivity, specificity and positive predictive values were significantly higher for the two observers according to the BSTI guidance statement and the RSNA expert consensus statement (83.3%, 89.7%, 89.0%; % 81.2,% 89.7,% 88.7, respectively). There was a good agreement in the PCR positive group (κ: 0.707; p < 0.001 for BSTI and κ: 0.716; p < 0.001 for RSNA), a good agreement in the PCR negative group (κ: 0.645; p < 0.001 for BSTI and κ: 0.743; p < 0.001 for RSNA) according to the BSTI and RSNA classification between the two radiologists.ConclusionAs a result, RSNA and BSTI statement provided reasonable performance and interobservers agreement in reporting CT findings of COVID-19. However, the number of patients defined as false negative and indeterminate in both classification systems is at a level that cannot be neglected.

Association of echocardiographic parameters with chest computed tomography score in patients with COVID-19 disease

PurposeAlthough coronavirus disease 2019 (COVID-19) primarily affects the pulmonary system, the involvement of the heart has become a well-known issue. Pulmonary CT plays an additive role in the diagnosis and prognosis of the disease. We aimed to investigate the association of echocardiographic indices with pulmonary CT scores and mortality in COVID-19 patients. Materials and methodsA total of 123 patients diagnosed with COVID-19 were included in this study. The British Society of Thoracic Imaging (BSTI) score and echocardiographic parameters were calculated, and echocardiographic indices were compared between BSTI score grades. ResultsDuring in-hospital follow-up, 36 of 123 patients (29.3%) had died. BSTI score, IVS, LVPWd, RV mid-diameter, RV basal diameter, RV longitudinal diameter, sPAP, and RVMPI were higher, and RVFAC, TAPSE, and RVS were lower in the non-survivor group than in the survivor group. There were statistically significant changes between BSTI scores in terms of LVPWd, RV mid diameter, RV basal diameter, RV longitudinal diameter, sPAP, RVFAC, RVMPI, and TAPSE. BSTI score was positively correlated with sPAP and RV basal diameter and negatively correlated with TAPSE and RVFAC. Multivariate logistic regression analysis demonstrated that sPAP (OR ​= ​1.071, p ​= ​0.002) and RV basal diameter (OR ​= ​1.184, p ​= ​0.005) were independent predictors of high BSTI scores (grade 4 and 5). Furthermore, age, sPAP, and a high BSTI score (grade 5) were independent predictors of in-hospital mortality in COVID-19 patients. ConclusionEchocardiographic indices were correlated with BSTI scores, and patients with higher BSTI scores had more cardiac involvement in COVID-19.

Interobserver Agreement in the Analysis of the Different Radiological Classification of COVID-19 on Computed Tomography

Introduction: Computed tomography (CT) has approximately 98% sensitivity for Coronavirus disease-2019 (COVID-19). Various algorithms were designed using CT images. However, the interobserver agreement of different radiological classifications of COVID-19 is not yet known. Thus, this study aimed to investigate the interobserver agreement of different radiological classifications of COVID-19. Materials and Methods: This study included 212 patients who were positive on the polymerase chain reaction test and eligible for CT. Four radiologists examined all CT images simultaneously. They reached a consensus that CT images can provide definite findings of COVID-19. The Radiological Society of North America (RSNA) consensus statement, the British Society of Thoracic Imaging (BSTI) structured reporting statement, and COVID-19 Reporting and Data System (CO-RADS) were used. Fleiss' Kappa was used to detect interobserver agreement. Kappa values of 0.00-0.20 were considered as slight, 0.21-0.40 as fair, 0.41-0.60 as moderate, 0.61-0.80 as substantial, and 0.81-1.00 as near-perfect agreement, and p<0.05 was accepted as significant.

HIGH-RESOLUTION CT (HRCT) CHEST FINDINGS IN PCR POSITIVE PATIENTS OF COVID19 AT COMBINED MILITARY HOSPITAL RAWALPINDI

Objective: To study High resolution computed tomography chest findings in polymerase chain reaction (PCR) positive patients of COVID-19.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Combined Military Hospital Rawalpindi, from May to Jun 2020.&#x0D; Methodology: Study included high resolution computed tomography chest of 200 patients admitted to COVID ward who were polymerase chain reaction positive. Patients having previously diagnosed Interstitial lung disease were excluded. Informed consent from patients were taken. Different findings on High resolution computed tomography chest were summarized as percent of total cases. British society of thoracic imaging (BSTI) classification was used to classify high resolution computed tomography chest patterns of COVID-19 pneumonia.&#x0D; Results: Out of 200 patients included in study, 7 had previous changes on their chest imaging and were excluded. 193 patients (145 males and 48 females) enrolled had a median age of 52 years. One hundred and two patients (52.9%) showed classical pattern for COVID-19, 81 patients (41.9%) had indeterminate changes, 3 patients (1.6%) had atypical changes while 7 (3.6%) had normal high resolution computed tomography chest. Four had pleural effusions while 5 had mediastinal lymphadenopathy. One hundred and eight nine (97.9%) patients had bilateral lung involvement, 145 (75.1%) had central and peripheral while 48 (24.9%) had peripheral invol-vement only. One hundred and forteen (59%) patients had ground glass opacities while 70 (36.3%) had ground glass opacities with consolidation. Nine (4.7%) patients presented with consolidation only.&#x0D; Conclusion: High resolution computed tomography chest and COVID polymerase chain reaction done at the same time.........

Chest X-Rays Findings in Patients Positive for COVID 19 at Sheikh Zayed Hospital Lahore

Aim: To assess the results of chest x ray radiographs of patients positive for Covid-19, presented at the tertiary care hospital according to the classification by the British Society of Thoracic Imaging (BSTI. Place and Duration: In COVID-19 Ward (Department of Medicine) Sheikh Zayed Hospital, Lahore for three months duration from January 2021 to March 2021. Methods: A total of 96 patients were selected. In this observational study, positive COVID-19 patient determined by the reverse transcriptase polymerase chain reaction (RT-PCR) were enrolled for this study above the age of 14 years. CXR results were classified conferring to BSTI documentation and classification in terms of percentage and frequency. Results: Chest rays of 96 patients who tested positive for Covid-19 by RT-PCR over the age of 14 years were examined. Chest X-rays are classified according to the BSTI Covid-19 X-ray classification. Out of 96 patients, 10 patients (10.41%) had normal chest x-rays, 19 (19.80%) patients had classic bilateral, peripheral and basal consolidation / ground glass opacity (GMO), 60 (62.5%) had unspecified group,7(7.29%) patients have poor quality X-ray film. The unilateral involvement was noticed in 15 and bilateral in 49 patients, 12 of the patients had diffuse involvement on chest radiograph and peripheral involvement in 39 patients. According to regional dominance, 41 of the unspecified (42.70%) had middle and lower lung involvement, 7 (7.29%) had only the middle zone, and 8 (8.33%) had involvement of lower zone. Conclusions: In this study, Covid-19 chest X-rays are usually presented as ground glass opacity, mixed consolidation with GGOs in the middle and lower peripheral areas of the bilateral lung. Chest X-ray BSTI classification is used to classify Covid-19 severity in our patients, thus differentiating in the classic Covid-19 of the middle zone versus low zone involvement. Keywords: Consolidation, Covid, Ground Glass Opacity, Chest Image.

Chest X-ray findings in COVID-19 patients: a descriptive study

Background: Early suspicion and diagnosis remains the cornerstone for the better outcome of patients and to decrease cross infection in cases of COVID-19 pneumonia. In a country like Nepal X-ray facilities are readily available radiological tool in most of the centers and can be important screening tool. There is a lack of studies detailing the chest XR (C-XR) findings in these patients when compared to that dedicated to the CT features. Study aims to describe the patterns of the lung opacities in CXR in these patients.Methods: This is retrospective descriptive study conducted at NMCTH in COVID-19 patients from 12 September to 17 October 2020. Demographic characteristics, symptoms, co-morbidities and C-XR findings were studied. CXR findings were categorized according to BSTI classification.Results: Among 111 COVID-19 RT-PCR positive cases admitted 102 (91.9%) belonged to age group 18-65 years, 89 (80.2%) were males. Cough and fever were the commonest symptoms present in 109 (98.2%) patients. Ischemic heart disease and hypertension in 32 (28.8%) patients were the commonest co morbidities. According to British society of thoracic imaging (BSTI) COVID-19 CXR classification, six patients (5.4%) had normal chest X-rays. Classic/probable COVID-19 picture was present in 79 (71.17%) patients while (7.2%) had intermediate for COVID-19 X-ray findings. Among 79 patients with classic/probable COVID-19 CXR findings 71 (89.8%) had bilateral consolidation/ground glass haze, 72 (91.1%) had peripheral lung involvement while 66 (83.5%) had middle and lower zone involvement.Conclusions: Ground glass opacities/consolidations with bilateral location, peripheral distribution and middle- lower zone predominance were the commonest X-ray findings in our study.

COVID-19 and Adenovirus Multi-Lobar Pneumonia on CT Scan in a Patient with Repeatedly Normal Chest X-Rays Despite Severe Hypoxia and the Need for Non-Invasive Ventilation

The British Society of Thoracic Imaging (BSTI) has published clear guidance on the classification of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) patients, which are summarised in four main categories: COVID-classical, COVID-indeterminate, COVID-normal, or non-COVID. We report the case of a 34-year-old lady who is otherwise fit and well. She presented with typical COVID-19 symptoms requiring supplemental oxygen, with normal CXR and COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) swab on admission. Her condition deteriorated after 24 hours with severe hypoxia requiring up to 60% oxygen. Repeat CXR was normal, which was followed by computed tomography pulmonary angiogram (CTPA) that ruled out pulmonary embolism; however, CTPA confirmed multi-lobar pneumonia consistent with COVID-19. The patient was admitted to the intensive care unit for non-invasive ventilation (NIV) and ongoing care. Extended respiratory screening confirmed positive COVID-19 antibodies and positive adenovirus swabs. The patient also developed COVID-19 related hepatocellular injury and myocarditis in the absence of other causes. These were treated by a multidisciplinary team, and the patient achieved full recovery after three weeks. This case highlights the fact that normal CXR does not rule out COVID-19 pneumonia even in the severely hypoxic patient requiring NIV. Also, it is important to investigate for other potential causes of hypoxia in a deteriorating patient, such as pulmonary embolism and non-COVID causes of pneumonia.

Towards nationally curated data archives for clinical radiology image analysis at scale: Learnings from national data collection in response to a pandemic.

The prevalence of the coronavirus SARS-CoV-2 disease has resulted in the unprecedented collection of health data to support research. Historically, coordinating the collation of such datasets on a national scale has been challenging to execute for several reasons, including issues with data privacy, the lack of data reporting standards, interoperable technologies, and distribution methods. The coronavirus SARS-CoV-2 disease pandemic has highlighted the importance of collaboration between government bodies, healthcare institutions, academic researchers and commercial companies in overcoming these issues during times of urgency. The National COVID-19 Chest Imaging Database, led by NHSX, British Society of Thoracic Imaging, Royal Surrey NHS Foundation Trust and Faculty, is an example of such a national initiative. Here, we summarise the experiences and challenges of setting up the National COVID-19 Chest Imaging Database, and the implications for future ambitions of national data curation in medical imaging to advance the safe adoption of artificial intelligence in healthcare.

Portable Chest X – Ray in COVID -19 Positive Cases in a Tertiary Care Centre in Central India. (A Retrospective Analysis of 739 Cases)

–PCR. Portable chest radiography is the first imaging modality that can be used to detect lung abnormalities and get follow up when required. Radiological findings observed in various CXR are ground-glass opacity/haziness, Consolidations, Peripheral air space opacities, diffuse air space involvement, and uncommon findings – pleural effusion, cavitation, pneumothorax, subcutaneous emphysema and pneumomediastinum. Use of Portable CXR is helpful to avoid transport of patients to CT room and subsequently avoid frequent decontamination of the CT room. Portable CXR is of much value where CT facility is not available and its use reduces radiation dose to patients and radiation staff. The objective is to analyze chest X-ray findings in proven cases of COVID -19 as per classification of British Society of Thoracic Imaging (BSTI) in the form of various radiological patterns and severity assessment. Subjects and Methods: This is a retrospective study of chest x-ray of COVID-19 positive patients, confirmed by RT-PCR and was admitted to designate COVID center: LNMC and JK Hospital, Bhopal in the duration of 31 July 2020 to 31 Aug 2020. Chest X-ray of 739 patients was studied and the mean age group was calculated. Lung involvement and pattern of distribution of disease were analyzed and classified according to BSTI classification and documented in frequencies and percentages. Results: In our retrospective analysis of a total of 739 CXR of which the number of males was 457 (61.84% ) and the number of females was 282 (38.16%). The average age group was ranging from 0 (1month) year age to 90 years age with the mean age group of 41 to 50 (20.2%). The mean age of the patients was 40.5 years. 393 (53.1%) patients have normal chest radiographs. Conclusion:The radiological findings in patients with COVID-19 infection varies with the severity of the disease. In the early phase of the disease, CXR was normal. The most common findings are basal / lower lobe consolidation more on right, followed by ground glass densities, peripheral air space densities, diffuse airspace disease. Basal / lower lobe consolidation was the usual findings in the mild category. In the moderate category, a variable pattern of all findings was seen. In the severe category of disease, diffuse air space densities and peripheral air space opacities were seen. Pleural effusion is the least seen.

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

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. &#x0D; &#x0D; 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).&#x0D; &#x0D; &#x0D; Chest Computed Tomography (CT) has been reported to be more sensitive than chest x-ray in determining the presence of COVID-19.&#x0D; &#x0D; &#x0D; Chest x-ray findings in confirmed COVID-19 patients show:&#x0D; &#x0D;  Normal lung findings early in the illness and in mildly symptomatic patients&#x0D; Typical ground-glass opacities and consolidation in the lung periphery&#x0D; Lung abnormalities are non-specific and may likewise be present in other infections and coronavirus-types of pneumonia&#x0D; &#x0D; 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.&#x0D;

Adherence to NHS England-BSTI radiology decision tool in suspected COVID-19 patients

Category: General Background to the audit: Chest radiographs are typically the firstline imaging modality used for patients with suspected COVID-19.1 British Society of Thoracic Imaging (BSTI) and NHS England (NHSE) have released a COVID-19 radiology decision-support tool to aid clinicians on the optimal work-up of suspected COVID-19 patients.2 This audit aims to review adherence to this guidance when healthcare staff suspect hospital inpatients of newly developed COVID-19 infections. Standard: According to the NHSE-BSTI decision-support tool: 1. Every patient suspected of COVID-19 and clinically deteriorating should have a chest X-ray requested along with their COVID-19 swab 2. Clinical deterioration is defined as oxygen saturations < 94% or <90% in patients with COPD or scoring at least 3 on the National Early Warning Score (NEWS). Indicator: Degree of compliance with the standard guidance. Target: 100% compliance. Methodology: A retrospective study design was performed using electronic health records to identify inpatients who received COVID-19 PCR tests. A predetermined exclusion criterion was strictly adhered to: 1. Patients who did not co-present with clinical deteriorations were excluded. Included records were assessed to determine if chest X-rays were ordered alongside the COVID-19 PCR tests. Results of first audit round: 1. 50 hospital admissions who received COVID-19 PCR tests were identified through the electronic health records database. 2. 66.0% (33/50) co-presented with clinical deteriorations and were included. 3. 69.7% (23/33) of the clinical deteriorating patients have been found to not have a chest X-ray requested at the time of their swab. First action plan: 1. Present findings at hospital grand round. 2. Circulate NHSE-BSTI radiology support tool via email communication and posters in hospital wards. 3. Re-audit in three weeks.

Comparison of Chest CT Grading Systems in Coronavirus Disease 2019 (COVID-19) Pneumonia.

PurposeTo compare the performance and interobserver agreement of the COVID-19 Reporting and Data System (CO-RADS), the COVID-19 imaging reporting and data system (COVID-RADS), the RSNA expert consensus statement, and the British Society of Thoracic Imaging (BSTI) guidance statement.Materials and MethodsIn this case-control study, total of 100 symptomatic patients suspected of having COVID-19 were included: 50 patients with COVID-19 (59±17 years, 38 men) and 50 patients without COVID-19 (65±24 years, 30 men). Eight radiologists independently scored chest CT images of the cohort according to each reporting system. The area under the receiver operating characteristic curves (AUC) and interobserver agreements were calculated and statistically compared across the systems.ResultsA total of 800 observations were made for each system. The level of suspicion of COVID-19 correlated with the RT-PCR positive rate except for the “negative for pneumonia” classifications in all the systems (Spearman’s coefficient: ρ=1.0, P=<.001 for all the systems). Average AUCs were as follows: CO-RADS, 0.84 (95% confidence interval, 0.83–0.85): COVID-RADS, 0.80 (0.78–0.81): the RSNA statement, 0.81 (0.79–0.82): and the BSTI statement, 0.84 (0.812-0.86). Average Cohen’s kappa across observers was 0.62 (95% confidence interval, 0.58–0.66), 0.63 (0.58–0.68), 0.63 (0.57–0.69), and 0.61 (0.58-0.64) for CO-RADS, COVID-RADS, the RSNA statement and the BSTI statement, respectively. CO-RADS and the BSTI statement outperformed COVID-RADS and the RSNA statement in diagnostic performance (P=.<.05 for all the comparison).ConclusionsCO-RADS, COVID-RADS, the RSNA statement and the BSTI statement provided reasonable performances and interobserver agreements in reporting CT findings of COVID-19.

Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study

ObjectivesTo identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and CT, for diagnosis of COVID-19 in the general emergency population in the UK and to find the...

The Role of the Computed Tomography (CT) Thorax in the Diagnosis of COVID-19 for Patients Presenting with Acute Surgical Emergencies. A Single Institute Experience.

The current Coronavirus disease 2019 (COVID-19) pandemic has had a huge impact on emergency surgical services in the UK. The Royal College of Surgeons (RCS) published guidelines about COVID-19 pandemic in March, 2020 to aid decision making for the surgeons. These guidelines recommended that all patients requiring urgent surgery should have reverse transcriptase polymerase chain reaction (RT-PCR) and/or computed tomography (CT) thorax pre-operatively. However, it is currently unclear whether the use of CT thorax is a sensitive and specific diagnostic test. The objective of this study was to find out whether CT thorax is a reliable and accurate test in the diagnosis of COVID-19 compared to RT-PCR. This is particularly important in surgical patients where there is no time to wait for RT-PCR results. A prospective cohort study of patients presented with acute surgical emergencies at a University Teaching Hospital was conducted. Data was collected from March 23, to May 15, 2020, during the peak of the crisis in the UK. All adult patients presented with operable general surgical emergencies were considered eligible. Another group of patients, admitted with acute medical emergencies but with suspected COVID-19 infection, was used for comparison. Data was manually collected, and sensitivity, specificity and predictive value were calculated using the MedCalc statistical software version 19.2.6. Standard reporting for COVID-19 infection for CT chest based on guidelines from British Society of Thoracic Imaging (BSTI) and Radiological Society of North America (RSNA) was used. Patients who had their CT thorax reported as typical or classic of COVID 19 (high probability) were treated as infected cases with extra precautions in the wards and surgical theatres as suggested by health and safety executive (HSE). These patients had serial RT-PCR during their admissions or in the post-operative phase, if the first swab was negative. For the study, 259 patients were considered eligible for inclusion from both groups. Patients admitted for acute surgical emergencies were treated according to RCS guidelines and subjected to RT-PCR test and/or CT scan of the thorax. There were 207 patients with high clinical suspicion of COVID-19. Of those 207 patients, 77 patients had CT thorax with radiographic features consistent with COVID-19 pneumonia. However, only 40 patients had a positive RT-PCR result. CT thorax was normal in 130 patients, out of which 29 patients were found to have COVID-19 diagnosis after swab test. Sensitivity of CT scan to diagnose COVID-19 infection was found to be 58% (95% CI; 45.48% to 69.76%) whilst specificity was 73% (95% CI; 64.99% to 80.37%) with a negative predictive value of 77.69% (95% CI; 72.17% to 82.39%). CT scan was found to be a reliable tool in the diagnosis of COVID-19. With a negative predictive value of up to 82.4%, CT thorax can play an important role to help surgeons in their decision making for asymptomatic suspected cases of COVID-19. However, over-reliance on CT scan which also has a high false positive rate for diagnosis of COVID-19 infections can lead to overtreatment, overuse of resources and delays in decision-making process. Hence, results should be interpreted with caution and correlated with clinical presentation and swab test results.