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      The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society

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          Abstract

          With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first three months of 2020, the COVID-19 pandemic has emerged as an unprecedented healthcare crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, healthcare delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and healthcare workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. While mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography (CXR) and computed tomography (CT) are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pre-test probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing COVID-19 patients across a spectrum of healthcare environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based upon the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of CXR and CT in the management of COVID-19.

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          Most cited references 10

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          Coronavirus (COVID-19) Outbreak: What the Department of Radiology Should Know

          In December 2019, a novel coronavirus (COVID-19) pneumonia emerged in Wuhan, China. Since then, this highly contagious COVID-19 has been spreading worldwide, with a rapid rise in the number of deaths. Novel COVID-19–infected pneumonia (NCIP) is characterized by fever, fatigue, dry cough, and dyspnea. A variety of chest imaging features have been reported, similar to those found in other types of coronavirus syndromes. The purpose of the present review is to briefly discuss the known epidemiology and the imaging findings of coronavirus syndromes, with a focus on the reported imaging findings of NCIP. Moreover, the authors review precautions and safety measures for radiology department personnel to manage patients with known or suspected NCIP. Implementation of a robust plan in the radiology department is required to prevent further transmission of the virus to patients and department staff members.
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            Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic

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              Abandoning daily routine chest radiography in the intensive care unit: meta-analysis.

               Tareq Zaza,  Yuji Oba (2010)
              To systematically examine whether abandoning daily routine chest radiography would adversely affect outcomes, such as mortality and length of stay (LOS), and identify a subgroup in which daily routine chest radiography might be beneficial. This was a meta-analysis of clinical trials that examined the effect of abandoning daily routine chest radiography in adults in intensive care units (ICUs). Studies were identified through searches of MEDLINE, Cochrane Database, Database of Abstracts of Reviews of Effects, Biological Abstracts, and CINAHL. The results were expressed as odds ratios (ORs) or weighted mean difference (WMD) along with their 95% confidence intervals (CIs). Eight studies with a total of 7078 patients were identified. A pooled analysis revealed that the elimination of daily routine chest radiography did not affect either hospital or ICU mortality (OR, 1.02;[95% CI: 0.89, 1.17; P = .78 and OR, 0.92; 95% CI: 0.76, 1.11; P = .4, respectively). There was no significant difference in ICU LOS (WMD = 0.19 days; 95% CI: -0.13, 0.51; P = .25), hospital LOS (WMD = -0.29 days; 95% CI: -0.71, 0.13; P = .18), and ventilator days (WMD = 0.33 days; 95% CI: -0.12, 0.78; P = .15) between the on-demand and daily routine groups. Regression analyses failed to identify any subgroup in which performing daily routine chest radiography was beneficial. Systematic but unselective daily routine chest radiography can likely be eliminated without increasing adverse outcomes in adult patients in ICUs. Further studies are necessary to identify the specific patient population that would benefit from daily routine chest radiographs.
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                Author and article information

                Contributors
                Journal
                Radiology
                Radiology
                Radiology
                Radiology
                Radiological Society of North America
                0033-8419
                1527-1315
                07 April 2020
                Affiliations
                Department of Radiology, Duke University School of Medicine, Durham North Carolina (G.D.R); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (L.B.H); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (J.P.K); Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York (N.W.S); Division of Pulmonary and Critical Medicine, Seoul National University College of Medicine, Seoul, South Korea (J.J.Y); Director, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC (D.J.A); Department of Radiology, University of Missouri, Columbia, Missouri (T.A); Department of Radiology, Royal Brompton & Harefield NHS Foundation Trust, London AND National Heart and Lung Institute, Imperial College, London, United Kingdom (S.R.D); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G); Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan (Y.I); Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, China (F.L); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (M.P); Division of Pulmonary Medicine, Università Cattolica del Sacro Cuore, Rome, Italy (L.R); Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (N.T); Department of Radiology, Stanford University School of Medicine, Stanford, California (A.N.L); Department of Medicine, University of British Columbia, Vancouver, Canada (C.J.R); Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma Italy (N.S); Division of Pulmonary, Critical Care & Sleep Medicine, Lenox Hill Hospital, New York, New York (S.R); 1st Anestethesia and Intensive Care Unit, University Hospital of Parma, Parma, Italy (A.V); Department of Emergency Medicine The Medical College of Wisconsin School of Medicine, Milwaukee, WI (I.B.K.M); Medical Director of Pathology and Clinical Laboratory Medicine, Stanford University Medical Center, Stanford, California (C.K); Department of Paediatrics and Paediatric Respirology, Royal Brompton Hospital, London, United Kingdom (A.B); Department of Radiology, David Geffen School of Medline at University of California Los Angeles (J.G); Department of Respiratory and Intensive Care Medicine, Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.H); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany (H.U.K); Respiratory Institute, Cleveland Clinic, Cleveland, Ohio (P.J.M); Department of Thoracic Imaging - Hospital Calmette, University Centre of Lille. Lille, France (M.R.J); Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P); Department of Pulmonary Medicine, Royal Brompton Hospital, London, United Kingdom (A.U.W).
                Author notes
                Address correspondence to G.D.R., (e-mail: grubin@ 123456duke.edu ).
                Article
                201365
                10.1148/radiol.2020201365
                7233395
                32255413
                2020 by the Radiological Society of North America, Inc.

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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