Can a chest HRCT-based crash course on COVID-19 cases make inexperienced thoracic radiologists readily available to face the next pandemic?

OBJECTIVE: To test the inter-reader agreement in assessing lung disease extent, HRCT signs, and Radiological Society of North America (RSNA) categorization between a chest-devoted radiologist (CR) and two HRCT-naïve radiology residents (RR1 and RR2) after the latter attended a COVID-19-based chest high-resolution computed tomography (HRCT) "crash course". METHODS: The course was built by retrospective inclusion of 150 patients who underwent HRCT for COVID-19 pneumonia between November 2020 and January 2021. During a first 10-days-long "training phase", RR1 and RR2 read a pool of 100/150 HRCTs, receiving day-by-day access to CR reports as feedback. In the subsequent 2-days-long "test phase", they were asked to report 50/150 HRCTs with no feedback. Test phase reports of RR1/RR2 were then compared with CR using unweighted or linearly-weighted Cohen's kappa (k) statistic and intraclass correlation coefficient (ICC). RESULTS: We observed almost perfect agreement in assessing disease extent between RR1-CR (k = 0.83, p < 0.001) and RR2-CR (k = 0.88, p < 0.001). The agreement between RR1-CR and RR2-CR on consolidation, crazy paving pattern, organizing pneumonia (OP) pattern, and pulmonary artery (PA) diameter was substantial (k = 0.65 and k = 0.68), moderate (k = 0.42 and k = 0.51), slight (k = 0.10 and k = 0.20), and good-to-excellent (ICC = 0.87 and ICC = 0.91), respectively. The agreement in providing RSNA categorization was moderate for R1 versus CR (k = 0.56) and substantial for R2 versus CR (k = 0.67). CONCLUSION: HRCT-naïve readers showed an acceptable overall agreement with CR, supporting the hypothesis that a crash course can be a tool to readily make non-subspecialty radiologists available to cooperate in reading high burden of HRCT examinations during a pandemic/epidemic.

Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia.

OBJECTIVE: In patients with mild COVID-19 pneumonia, chest high-resolution computed tomography (HRCT) is advised when risk factors for severe disease (i.e., age > 65 years and/or comorbidities) are present, and can influence management strategy. The objective was to assess whether HRCT is associated to short-time development of severe disease in patients with COVID-19 pneumonia. METHODS: Seventy-seven consecutive patients (mean age, 64 ± 15 years) with mild COVID-19 pneumonia (no or mild respiratory failure) that underwent HRCT were retrospectively identified. Fifty-two on 77 patients had reported risk factors for severe disease. A chest-imaging devoted radiologist recorded, on a per-examination basis, the following HRCT features: ground-glass opacity, crazy-paving pattern, consolidation, organizing pneumonia (OP) pattern, mosaic attenuation, and nodules. The extent of each feature (total feature score, TFS) was semi-quantitatively assessed. Total lung involvement (TLI) was defined as the sum of all TFSs. The study outcome was defined as the occurrence of severe disease (moderate-to-severe respiratory failure) within 15 days from HRCT. Logistic regression analysis was performed to assess if age, comorbidities, and HRCT features were associated to severe disease. RESULTS: On univariable analysis, severe disease was significantly associated with age > 59 years (29/47 patients, 61.7%) (p = 0.013), and not significantly associated with having comorbidities (22/44 patients, 50.0%). On multivariable analysis, TLI >15 and OP pattern >5 were independently associated to severe disease, with odds ratio of 8.380 (p = 0.003), and of 4.685 (p = 0.035), respectively. CONCLUSION: Short-time onset of severe COVID-19 was associated to TLI >15 and OP pattern score > 5. Severe disease was not associated to comorbidities.

Inter-reader agreement of high-resolution computed tomography findings in patients with COVID-19 pneumonia: A multi-reader study.

PURPOSE: To investigate the inter-reader agreement in assessing high-resolution computed tomography (HRCT) features of coronavirus disease 2019 (COVID-19) pneumonia. METHOD: Seventy-seven consecutive patients (mean age, 64 ± 15 years) with mild COVID-19 pneumonia that underwent HRCT were retrospectively included. Three radiologists [two devoted to thoracic imaging (R1, R2), and one generalist (R3)] on a per-examination basis independently assessed ground-glass opacity (GGO), consolidation, and crazy-paving pattern. The extent of each feature (total feature score, TFS) was semi-quantitatively assessed, and each TFS summed up to obtain total lung score (TLS). Presence of organizing pneumonia (OP) pattern was also recorded. The inter-reader agreement was calculated with Cohen's Kappa (k) and Free-Marginal Multirater k. Multivariable analysis was run to determine whether imaging features were predictive of short-term evolution to severe disease (need for ventilation). RESULTS: Most features showed substantial inter-reader agreement, including TLS > 6 (k = 0.69), which was an independent predictor of short-term occurrence of severe disease, regardless of the reader (OR 9-53.19). Consolidation TFS > 2 and OP pattern showed substantial and moderate agreement, respectively, only when comparing R1 and R2. Consolidation TFS > 2 and OP pattern were independent predictors of severe disease for R2 (OR 4.87) and R1 (OR 6), respectively. CONCLUSIONS: The inter-reader agreement for most HRCT features of COVID-19 pneumonia ranges moderate-to-substantial, though it depends on readers' experience in the case of consolidation and OP pattern.

Breast imaging and cancer diagnosis during the COVID-19 pandemic: recommendations from the Italian College of Breast Radiologists by SIRM.

The Italian College of Breast Radiologists by the Italian Society of Medical Radiology (SIRM) provides recommendations for breast care provision and procedural prioritization during COVID-19 pandemic, being aware that medical decisions must be currently taken balancing patient's individual and community safety: (1) patients having a scheduled or to-be-scheduled appointment for in-depth diagnostic breast imaging or needle biopsy should confirm the appointment or obtain a new one; (2) patients who have suspicious symptoms of breast cancer (in particular: new onset palpable nodule; skin or nipple retraction; orange peel skin; unilateral secretion from the nipple) should request non-deferrable tests at radiology services; (3) asymptomatic women performing annual mammographic follow-up after breast cancer treatment should preferably schedule the appointment within 1 year and 3 months from the previous check, compatibly with the local organizational conditions; (4) asymptomatic women who have not responded to the invitation for screening mammography after the onset of the pandemic or have been informed of the suspension of the screening activity should schedule the check preferably within 3 months from the date of the not performed check, compatibly with local organizational conditions. The Italian College of Breast Radiologists by SIRM recommends precautions to protect both patients and healthcare workers (radiologists, radiographers, nurses, and reception staff) from infection or disease spread on the occasion of breast imaging procedures, particularly mammography, breast ultrasound, breast magnetic resonance imaging, and breast intervention procedures.