Review of the Guidelines For Radiology Practice During COVID -19 Pandemic by Nepal Radiologists’ Association

Abstract

Nepal is also affected by Corona Virus Disease (COVID-19) pandemic which is likely to last for several months. The Reverse Transcriptase-Polymerase Chain Reaction is the current gold standard diagnostic test. Chest X-ray or Computed Tomography scan is considered inappropriate according to most society recommendations for screening though are emerging as frontline diagnostic modalities in conjunction with clinical history and laboratory parameters.Multiple guidelines have been released by prominent radiological societies worldwide to facilitate preparedness of radiology department in the war against COVID-19. Based on these, the Nepal Radiologists’ Association has proposed its guidelines, endorsed by the Nepal Medical Council, practical in our context, with the aim to limit exposure to the infection while ensuring best use of imaging, protection of health care personnel and other patients and maintenance of uninterrupted radiology department operations.This review article aims to summarize the highlights from various guidelines focusing on role of chest X-ray and Computed Tomography including the indications, specific findings, reporting format and important differentials and also addresses the safety issues.

Clinical Characteristics and Chest X-Ray and Computed Tomography Findings in Different Clinical Severity Grading of Covid-19 Patients

“…Imaging is not recommended for screening and the role of chest imaging is best utilized for the management of COVID patients with moderate or severe and/or worsening symptoms to look for complications. 9,27 The number of pulmonary lobes involved in HRCT were not significantly associated with clinical severity of COVID-19 (p >0.05). Similarly, there was no difference in CXR findings between different clinical severities of COVID-19 (p >0.05) (Table 3).…”

“…Typical chest X-ray findings in COVID-19 infection include bilateral patchy opacities with mid to lower lung zone predominance, often peripheral and rounded, bilateral multifocal or diffuse air space disease. [9][10][11] Bilateral lower zone consolidation is frequently seen in COVID- 19. 11 In the studies of chest X-ray and HRCT focusing on their diagnostic performance of COVID-19 infection, HRCT scan is reported to have better performances than chest X-ray in detecting the positive COVID-19 infection.…”

“…[15][16][17] Influenza and other viral pneumonia, organizing pneumonia, drug toxicity and connective tissue disease can, however, cause a similar imaging pattern like the typical HRCT appearance of COVID-19. 9 The American College of Radiology strongly urges caution that an abnormal HRCT is not specific for COVID-19 diagnosis. 26 For infective conditions, microbiological diagnosis is required.…”

“…From the nasopharynx and oropharyngeal swabs COVID-19 infection was diagnosed by reverse transcription polymerase chain reaction (RT-PCR) test, which is the currently the gold standard diagnostic test for COVID-19 with sensitivity of >70%. 9 The patients were managed by the pulmonary and critical care unit. Consecutive Covid-19 adult patients age 18 years and above admitted in the COVID-19 wards and intensive care unit (ICU) having both Chest X-ray and HRCT imaging were included in this study.…”

“…Typical CXR appearances in COVID-19 are now described. [9][10][11][12] High-resolution computed tomography (HRCT) of chest is sensitive to detect pneumonia in COVID-19. 13,14 There are studies of CXR and HRCT with some of them focusing on their diagnostic performance of COVID-19 pneumonia.…”