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Fleischner Society outlines suggestions for when chest imaging can beneficially contribute to infection management.
Even though industry consensus discourages the use of chest imaging for COVID-19 diagnosis, the role of both chest X-Ray (CXR) and chest CT continues to emerge. In an effort to provide clarity for implementing imaging, the international Fleischner Society published a consensus statement Tuesday, offering suggestions for scenarios where chest imaging is appropriate.
The 10-nation panel included representatives from the countries carrying the heaviest COVID-19 burden: the United States, Italy, China, Germany, France, United Kingdom, Netherlands, South Korea, Canada, and Japan. The group included 15 thoracic radiologists, 10 pulmonologists/intensivists, and 1 pathologist, as well as experts in emergency medicine, infection control, and laboratory medicine. They published their consensus statement simultaneously in Radiology and Chest.
The panel acknowledged that the clinical body of knowledge surrounding COVID-19 is growing and rapidly changing, adding that the agreed-upon recommendations represent the most actionable information available to date.
“We need to understand that conditions across the globe vary greatly,” said Geoffrey D. Rubin, M.D., George B. Geller Professor of Cardiovascular Research and professor of radiology and bioengineering at Duke University School of Medicine. “Our goal in developing this statement was to offer guidance that is sensitive to these differences and applicable broadly.”
To provide the clearest guidance, the group offered imaging suggestions based on three clinical scenarios with differing risk factors, community conditions, and resource constraints – a patient with mild COVID-19 features, a patient with moderate-to-severe COVID-19 features, and a patient with moderate-to-severe COVID-19 features in a resource-limited environment.
All guidance applies to adult patients who have presented with features consistent with COVID-19 infection.
Based on their discussions, the panel drafted five main recommendations, as well as three additional suggestions.
Overall, the panel offered this guidance:
In addition, the panel offered these additional suggestions:
The group reiterated that these guidelines are based on the best information gathered and could be changed in the future.
“[This statement] represents opinion at a moment in time within a highly dynamic environment where the status of regional epidemics and the availability of critical resources to combat those epidemics vary daily,” the team said. “The evidence base supporting the use of imaging across the scenarios presented is scant, and the advice presented herein may undergo refinement through rigorous scientific investigation, exposing nuances of image interpretation that may lead to prognostic information and guide management decisions.”
Ultimately, Rubin said, new roles for thoracic imaging could emerge in establishing treatment response or in characterizing patients that might be good responders to novel therapies.