key: cord-0691484-dneycnyr
authors: Khan, T.; Lopez, T.; Khan, T.; Ali, A.; Syed, S.; Patil, P.; Hatoum, A.
title: Re: a British Society of Thoracic Imaging statement: considerations in designing local imaging diagnostic algorithms for the COVID-19 pandemic
date: 2020-05-27
journal: Clin Radiol
DOI: 10.1016/j.crad.2020.05.009
sha: 49e1b27e3c501e0e5a1c0f5ba9ef35d61ee4c74b
doc_id: 691484
cord_uid: dneycnyr

nan

Re: a British Society of Thoracic Imaging statement: considerations in designing local imaging diagnostic algorithms for the COVID-19 pandemic Q3 Q2

SirdWe read with great interest the statement from Nair and colleagues of the British Society of Thoracic Imaging (BSTI), which provides a thorough insight into the role of imaging in combating the COVID-19 pandemic; however, we noticed a potentially consequential error within the text. In answering Question 2, the authors comment that "CXR may be abnormal in the majority of COVID-19 cases", incorrectly inferring that the study of Huang et al. found "bilateral radiographic abnormalities in 40/41 (98%) of cases". 1 The study of Huang et al. in The Lancet does mistakenly state that they found "bilateral involvement of chest radiographs" in 40/41 patients in Table 2 of their results; however, from reading the main text, it is clear that the imaging method they are referring to is actually chest computed tomography (CT), not chest radiography (CXR): "On admission, abnormalities in chest CT images were detected among all patients. Of the 41 patients, 40 (98%) had bilateral involvement ( Table 2 )". 2 The mismatch between the results table and the main text in The Lancet may have contributed to this error.

In fact, it is evident from current literature that the sensitivity of CXR is limited for COVID-19. The study of Guan et al., also cited by Nair et al., reported CXR abnormalities in only 162/274 (59.1%) of COVID-19 patients. 3 In addition, a more recent study by Wong et al. reported abnormal CXR in 44/64 (68.8%) of COVID-19 patients on presentation 4 ; however, it is important to note that both of these studies included hospitalised patients, representing individuals with more severe illness.

A recently published study from New York City presents a different picture of the sensitivity of CXR in ambulatory care. Weinstock et al. reported CXR findings of 636 COVID-19 patients presenting to urgent-care centres and found that only 168 (26.4%) were reported originally as abnormal. 5 Subsequently, they had 11 board-certified radiologists re-read these radiographs with prior knowledge of the patients' COVID-19 diagnosis. In spite of this, the panel classified only 41.7% of CXR findings as abnormal. 5 Therefore, in light of the above, it is possible that CXR may not be abnormal in the majority of COVID-19 cases presenting to emergency departments.

The authors declare no conflict of interest.

A British Society of Thoracic Imaging statement: considerations in designing local imaging diagnostic algorithms for the COVID-19 pandemic

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Clinical characteristics of coronavirus disease 2019 in China

Frequency and distribution of chest radiographic findings in COVID-19 positive patients

Chest X-ray findings in 636 ambulatory patients with COVID-19 presenting to an urgent care center: a normal chest X-ray is no guarantee

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