Interpretation of chest radiography in patients with known or suspected SARS-CoV-2 infection: what we learnt from comparison with computed tomography.

Differently from computed tomography (CT), well-defined terminology for chest radiography (CXR) findings and standardized reporting in the setting of known or suspected COVID-19 are still lacking. We propose a revision of CXR major imaging findings in SARS-CoV-2 pneumonia derived from the comparison of CXR and CT, suggesting a precise and standardized terminology for CXR reporting. This description will consider asymptomatic patients, symptomatic patients, and patients with SARS-CoV-2-related pulmonary complications. We suggest using terms such as ground-glass opacities, consolidation, and reticular pattern for the most common findings, and characteristic chest radiographic pattern in presence of one or more of the above-mentioned findings with peripheral and mid-to-lower lung zone distribution.

The use of lung ultrasound in COVID-19.

This review article addresses the role of lung ultrasound in patients with coronavirus disease 2019 (COVID-19) for diagnosis and disease management. As a simple imaging procedure, lung ultrasound contributes to the early identification of patients with clinical conditions suggestive of COVID-19, supports decisions about hospital admission and informs therapeutic strategy. It can be performed in various clinical settings (primary care facilities, emergency departments, hospital wards, intensive care units), but also in outpatient settings using portable devices. The article describes typical lung ultrasound findings for COVID-19 pneumonia (interstitial pattern, pleural abnormalities and consolidations), as one component of COVID-19 diagnostic workup that otherwise includes clinical and laboratory evaluation. Advantages and limitations of lung ultrasound use in COVID-19 are described, along with equipment requirements and training needs. To infer on the use of lung ultrasound in different regions, a literature search was performed using key words "COVID-19", "lung ultrasound" and "imaging". Lung ultrasound is a noninvasive, rapid and reproducible procedure; can be performed at the point of care; requires simple sterilisation; and involves non-ionising radiation, allowing repeated exams on the same patient, with special benefit in children and pregnant women. However, physical proximity between the patient and the ultrasound operator is a limitation in the current pandemic context, emphasising the need to implement specific infection prevention and control measures. Availability of qualified staff adequately trained to perform lung ultrasound remains a major barrier to lung ultrasound utilisation. Training, advocacy and awareness rising can help build up capacities of local providers to facilitate lung ultrasound use for COVID-19 management, in particular in low- and middle-income countries.

The use of imaging in COVID-19-results of a global survey by the International Society of Radiology.

OBJECTIVES: This survey conducted by the International Society of Radiology and supported by the European Society of Radiology aimed to collect information regarding radiology departments' current practices in the management of patients with COVID-19. METHODS: Responses from 50 radiology departments involved in the management of COVID-19 patients representing 33 countries across all continents were analyzed. The analysis revealed important variations in imaging practices related to COVID-19 across the world for different disease severity and various clinical scenarios. RESULTS: Imaging is usually not performed in asymptomatic patients (69% of institutions do not image) but is used at the end of confinement (in 60% of institutions). In the majority of institutions, chest imaging is used in suspected or confirmed patients with COVID-19 (89% and 94%). All imaging departments involved in this survey reported the use of imaging in COVID-19 patients showing severe symptoms or who were critically ill. However, there is a wide variation in imaging modality type used for each clinical scenario. The use of imaging is applied in line with existing guidelines and recommendations in 98% of institutions with structured reporting recorded in 58% of institutions. The vast majority of institutions reported a significant impact of the COVID-19 pandemic on the imaging department's routine activity (83%). CONCLUSION: We believe that the results of this survey will help to understand current heterogeneities in radiology practice and to identify needs and gaps in the organization and function of radiology departments worldwide in relation to the COVID-19 pandemic. The results of this survey may inform the development of an overall strategy for radiology department organization and imaging protocols in pandemic conditions. KEY POINTS: • The results of this survey, which included responses from 50 radiology departments representing 33 countries, showed important variations in imaging practices related to COVID-19 across the world. • While imaging is usually not performed in asymptomatic patients (69% of institutions), it is used in suspected or confirmed patients with COVID-19, in COVID-19 patients showing severe symptoms or who were critically ill, and at the end of confinement (89%, 94%, 100%, 100%, 60% of institutions, respectively). However, there is a wide variation in imaging modality type used for each clinical scenario. • In 98% of institutions, the use of imaging is applied in line with existing guidelines and recommendations, with structured reporting recorded in 58% of institutions. COVID-19 pandemic made a significant impact on the imaging department's routine activity in 83% of institutions.

Use of Chest Imaging in the Diagnosis and Management of COVID-19: A WHO Rapid Advice Guide.

The World Health Organization (WHO) undertook the development of a rapid guide on the use of chest imaging in the diagnosis and management of coronavirus disease 2019 (COVID-19). The rapid guide was developed over 2 months by using standard WHO processes, except for the use of "rapid reviews" and online meetings of the panel. The evidence review was supplemented by a survey of stakeholders regarding their views on the acceptability, feasibility, impact on equity, and resource use of the relevant chest imaging modalities (chest radiography, chest CT, and lung US). The guideline development group had broad expertise and country representation. The rapid guide includes three diagnosis recommendations and four management recommendations. The recommendations cover patients with confirmed or who are suspected of having COVID-19 with different levels of disease severity, throughout the care pathway from outpatient facility or hospital entry to home discharge. All recommendations are conditional and are based on low certainty evidence (n = 2), very low certainty evidence (n = 2), or expert opinion (n = 3). The remarks accompanying the recommendations suggest which patients are likely to benefit from chest imaging and what factors should be considered when choosing the specific imaging modality. The guidance offers considerations about implementation, monitoring, and evaluation, and also identifies research needs. Published under a CC BY 4.0 license. Online supplemental material is available for this article.