Initial experiences in the use of portable chest radiography as a tool to guide clinical management of COVID-19 positive patients in resource limited settings

ABSTRACT

Introduction: Radiological diagnosis of COVID-19 has shifted from the use of routine chest X-rays (CXRs) early on during the pandemic to high-resolution computed tomography (HRCT) of the chest to accurately describe the pattern of COVID involvement of the lungs. The morphological patterns seen at HRCT are increasingly being tapped into by a clinician in the management of this uncharted territory, for example, HRCT lung findings are categorized into three distinct phenotypes by an intensivist for guiding advanced ventilatory management of COVID patients. However, in resource-limited settings, HRCT places a heavy burden on the radiology departments and poses an enormous challenge to infection control in the CT suite. Our study aims to describe CXR patterns of COVID-19 acquired by portable radiography units and correlate them to symptom onset and progression in an attempt to enroll it as a reliable tool to assist clinical management including intensive unit care and ventilatory support. Methodology: Our study was a retrospective observational study of portable CXR findings in all patients diagnosed as COVID-19 positive by reverse transcription-polymerase chain reaction at a tertiary medical center from April to May 2020. Results: A total of fifty patients were included in the study, and the presence or absence of CXR findings in the presence or absence of clinical symptoms was analyzed. Our study showed that 24 (48%) patients had baseline features of lung involvement on CXR. Patients who presented with fever or breathlessness were found to be highly likely to show changes on the CXR. The most commonly noted changes were ground-glass opacities in 31 (63%) of patients with a bilateral, peripheral pattern of involvement seen in the lower zones of the lungs. Conclusion: While the higher sensitivity of the HRCT is of great clinical value, the portable CXR offers a feasible alternative to screen, follow clinical progress, and assist management of COVID-19 patients and should be considered as a means to reduce radiological service demands and reduce the risk of cross-infection.