Chest x-ray in the COVID-19 pandemic: Radiologists’ real-world reader performance

Abstract

Highlights Chest x-ray had a 89 % sensitivity detecting COVID-19 pneumonia during pandemic peak. Experienced radiologists had higher specificity than less-experienced ones. Overall and per-group sensitivity in detecting COVID-19 pneumonia increased over time. Overall and per-group accuracy in detecting COVID-19 pneumonia increased over time.

Performance of a Severity Score on Admission Chest Radiograph in Predicting Clinical Outcomes in Hospitalized Patients with Coronavirus Disease (COVID-19)

“…Chest radiography (CXR) is a widely used imaging test to assess for a variety of causes of dyspnea or hypoxia. CXR may be useful for initial triage of patients with suspected in the emergency department (ED) (3)(4)(5) or even at patients' homes (6), if access to laboratory testing is limited. Nonetheless, CXR is not recommended for screening or diagnosis of COVID-19 pneumonia if access to COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) laboratory testing is adequate given that the CXR findings are nonspecific and overlap with non-COVID-19 infections (7).…”

A Pictorial Review of the Role of Imaging in the Detection, Management, Histopathological Correlations, and Complications of COVID-19 Pneumonia

“…This is due to the experience of China, where access to CT was relatively easy at the outbreak of the pandemic [ 28 ], and the low sensitivity of CXR in revealing pulmonary involvement, particularly in the early stage of the disease [ 25 , 27 ]. Using RT-PCR as the gold standard, the sensitivity of CRX, which depends not only on the disease stage, but also on its severity, the prevalence of COVID-19 in the area, and the expertise of radiologists, with possible support of artificial intelligence (AI), differs widely from 41.7 to 90% and is still lower than CT (60 to 98%) [ 30 , 31 , 32 ]. The specificity, on the other hand, is between 33 and 60.6% [ 33 , 34 ].…”

“…Different protocols have been proposed for the use of CXR in radiology departments (RDs) and at the bedside in hospital wards and BUs, and in emergency departments (EDs) [ 35 , 39 ]. All CXRs are acquired as computed or digital radiographs [ 27 , 30 , 35 , 40 ]. In the current pandemic context, CXR protocols in isolation rooms in EDs are particularly significant.…”

Visceral adipose tissue area predicts intensive care unit admission in COVID-19 patients

“…Chest computed tomography (CT) has been up to now widely used for suspected COVID-19 patients, albeit with oscillating specificity and a high organizational burden on ED workflow [ 8 ]. Even if chest x-ray showed interesting diagnostic performance [ 9 , 10 ], chest CT was extensively used for patients’ staging and monitoring, since it allows to evaluate disease severity as well as pulmonary, extra-pulmonary, and vascular features [ 8 , 11 , 12 ]. CT-derived additional data to stratify patients’ risk could be provided by quantification and distribution analysis of abdominal fat, both obtainable with post-processing software including automatic and semiautomatic segmentation tools [ 13 , 14 ].…”