key: cord-0837282-zx3nbpe2
authors: Tan, Bien Soo; Dunnick, N. Reed; Gangi, Afshin; Goergen, Stacy; Jin, Zheng-Yu; Neri, Emanuele; Nomura, Cesar Higa; Pitcher, R.D.; Yee, Judy; Mahmood, Umar
title: RSNA International Trends: A Global Perspective on the COVID-19 Pandemic and Radiology in Late 2020
date: 2020-12-08
journal: Radiology
DOI: 10.1148/radiol.2020204267
sha: 6a3772bb42f6df6968a920bc399226b257e2b7b3
doc_id: 837282
cord_uid: zx3nbpe2

The COVID-19 pandemic has challenged and changed our healthcare systems around the world. There has been a heterogeneity of disease burden, healthcare resources, and non-imaging testing availability, both geographically and over time. In parallel, there has been a continued increase in understanding of how the disease affects patients, effectiveness of therapeutic options, and factors that modulate transmission risk. Here we detail experiences from radiology experts in representative countries from around the world, to share insights gained from local experience. These insights provide a guidepost to help address management challenges as cases continue to rise in many parts of the world and suggest modifications in workflow that are likely to continue after this pandemic subsides.

Our lives have been fundamentally altered this year by the Coronavirus disease 2019 (COVID- 19) pandemic. From a medical imaging and healthcare perspective, we have learned a tremendous amount over the last eleven months about how the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects the body, and the major routes of transmission. Best practices have been rapidly implemented to address both aspects; however, with a rising number of cases in many regions of the world (Figure 1) we have reached new high case incidences in the fourth quarter of 2020. We will need to continue to innovate in our approaches to help manage this crisis.

In this perspective piece, radiology experts from around the world share their insights. The tradition of gathering key international thought leaders at the RSNA annual meeting "International Trends Session" has resulted in shared understanding of topics such as the impact of artificial intelligence (AI) on radiology; radiologist shortages; and medical student education. No topic has necessitated convocation and collaboration as compellingly as the COVID-19 pandemic, and we hope radiologists can use these perspectives from around the world to optimize the care of COVID-19 patients and help plan for a nearterm increase in the number of cases ( Figure 2 ).

These insights reflect some of the chaos initially experienced as a new infection spread rapidly throughout the world, as well as the rapid adjustments made to address our new reality. Healthcare systems optimized for workflows in one setting were quickly adapted to one in which patients were highly infectious to other patients and healthcare workers. Appropriate personal protective equipment (PPE) was extremely limited; there was a severe shortage of polymerase chain reaction (PCR) test kits and other non-imaging diagnostics; and critically ill COVID-19 patients overwhelmed hospital capacities.

The diversity of approaches in different regions highlight the local choices made based on CT scanner availability, PCR testing availability and turnaround time, PPE availability, and effectiveness of public health measures. The decisions implemented reflect the need to balance supply and demand of these constraints to optimize patient management and resource utilization.

Driven by innumerable advances, radiology has helped to greatly improve patient care in this new environment. As cases surged in different regions, RSNA served as a central point for radiologists to share findings and seek guidance from colleagues from more affected areas. Through journals, news, webinars and communities, radiologists were able to quickly access the latest research, learn practical applications, and improve COVID patient care in their communities ( Figure 3 ). RSNA has published over 130 articles related to COVID-19, with over 5 million page views. The international community came together to build the RSNA International COVID Open Radiology Database (RICORD) (1), which will be accessible to all investigators to further scientific knowledge and facilitate the development of rapid quantitative assessment tools. This is not a compendium of advancements in all regions, rather we have sought to detail some of the heterogeneity of approaches by highlighting challenges and solutions in representative countries. A snapshot in late 2020 provides a guidepost as we continue to battle this pandemic. We have focused on where we have been as a specialty in the initial response to the first wave, how we have planned for subsequent waves of COVID-19 infections, and what insights we have gained so that we are better prepared for unknown future pandemics. I n P r e s s CT was shown to be useful for follow-up evaluations and for prognosis (14, 15) . Although low-dose CT was recommended as the standard scanning protocol to minimize the radiation dose, studies showed that ultra-low-dose CT would make it more difficult to detect subtle GGOs (16) . Full radiation dose scanning was therefore established as the technological society consensus (17) . However, low dose CT may be useful in areas where there is a high prevalence of disease (18, 19) or where there is limited availability of PCR testing (20) . CXR is no longer recommended for COVID-19 screening, due to the high false negative rate, but it can help to assess disease severity (21, 22) . Given the association of thrombotic complications, including pulmonary embolism (PE), chest CT is recommended whenever there is suspicion of pulmonary embolism (23, 24) .

Cardiac complications including arrhythmias, acute myocarditis, cardiomyopathy, and shock are also associated with COVID-19 infection (23, 25) . Cardiac magnetic resonance imaging (MRI) is used for differentiating types of myocardial injury and assessing the extent and severity of the injury (26).

Abdominal and/or pelvic organ injury is also commonly seen, and abdominal/pelvic CT is indicated when bowel complications, cholecystitis, solid organ infarctions or vascular thromboses are suspected (27, 28, 29) . Acute stroke (seen in patients older than 50 years without risk factors) have also been reported (30) . Brain MRI may help to diagnose COVID-19 related acute or subacute infarction, as well as diagnose parenchymal abnormalities unrelated to ischemic infarcts (31, 32) .

In France, the COVID-19 pandemic began in the east and soon spread throughout the country. General lockdowns and social distancing from March 17-May 11, 2020 resulted in major disruptions to radiology I n P r e s s services. During this period, daily routines were adjusted to take care of COVID-19 patients while implementing safety measures to keep the virus from spreading. Normal care was maintained for critical interventional procedures and emergency patients.

To prevent the spread of the disease within the hospital, the emergency department was divided into areas for patients suspected of having COVID-19 and non-COVID-19 patients. A triage station for all outpatients and staff was placed at the entrance of the emergency department. The CT scanner in the emergency department, which had a negative pressure environment and an air filtration system, was dedicated to COVID-19 patients. Because an insufficient number of PCR tests were available, all patients suspected of COVID-19 had a chest CT scan. At the peak of infection, two to four CT scanners were utilized for screening, and as many as 240 chest CT scans were completed in a day. The patients were masked and only the CT couch and gantry were cleaned between examinations. The diagnosis was based on the typical findings of bilateral, peripheral and basal ground glass opacities and/or consolidation. If the chest CT were negative and other pathologies were not suspected, the patient was discharged. When the CT was positive, the patient was sent for PCR testing. Those with mild symptoms were discharged and quarantined at their homes. Those with moderate and severe symptoms were admitted for further management. By July, when PCR tests were widely available, they replaced CT as the first line investigation. Ultrasound was used to examine the abdomen, but not the chest.

The COVID-19 pandemic had a profound impact on interventional radiology (IR) services, particularly for elective cases. Due to the scarcity of available hospital beds, IR procedures were limited to medical emergencies and high-priority procedures. The IR capacity was reduced from six operating rooms to three (two angiographic suites and one CT suite). Rooms with a negative pressure environment were I n P r e s s decontaminated immediately after each procedure. The most frequent IR procedures performed for COVID-19 patients were central venous catheter insertion, pleural drainage, percutaneous cholecystostomy, nephrostomy, gastrostomy, biopsy, and venous thrombectomy. Most of the IR procedures were performed under ultrasound guidance in the ICU to avoid transportation of these patients.

Radiology technologists contributed to frontline work by rotating to emergency radiology, thus doubling the number of staff handling COVID-19 positive patients. This modification in the rotation was possible because all non-urgent and non-emergent activity within the hospital was postponed. Some of the anesthesiology devices were also transferred to clinical areas that were converted to COVID-19 beds.

As the pandemic swept from Asia to Europe, a major challenge in Africa was remaining abreast of the enormous volume of emerging literature, while extracting appropriate and accurate information that could be implemented swiftly in a resource-constrained environment.

At the start of the South African (SA) pandemic in March 2020, the radiological literature was dominated by descriptions of the chest CT findings in patients with COVID-19 pneumonia. It was reported that CT was the preferred imaging examination, with greater sensitivity and specificity than CXR (33, 34) and since the sensitivity of the nasal swab test for PCR was low, a chest CT examination could serve as a substitute in screening patients for COVID-19 infection (35). However, these reports originated in I n P r e s s settings with an adequate number of CT scanners, usually between 6 and 11 CT scanners per million people (36) . By comparison, countries in sub-Saharan Africa have only 0.08 -1.7 CT scanners per million people in the public healthcare sector (37, 38, 39, 40) . Thus, the greatest initial challenge of the pandemic was managing the expectations of referring physicians that CT was needed for the early diagnosis and management of COVID-19 patients. The situation was addressed by the Radiological Society of South Africa (RSSA) which endorsed the ACR recommendations for patients suspected of COVID-19 infection, limiting the use of CT in the screening or first-line diagnosis setting (41) . PCR was relied upon for diagnosis of infection.

A major concern was availability of appropriate PPE for imaging staff. Radiology departments with available resources were proactive, funding the manufacture of reusable gowns and purchasing equipment to facilitate daily laundry of PPE. This model has proved sustainable and has served staff well at Tygerberg Hospital in Cape Town, where the infection rate among radiographers and radiologists has been five percent over the past six months, and these infections were likely unrelated to workplace exposure.

The impact of human immunodeficiency virus (HIV) infection and pulmonary tuberculosis (TB) on the clinical course and radiological features of COVID-19 pneumonia was not known. Research projects commenced, with expedited institutional ethics approval, to address these questions. Preliminary I n P r e s s findings show that both HIV and current TB are independently associated with increased COVID-19 mortality (42) .

During a 6-month lock-down, March through September, elective out-patient services were reduced by 70%, with a resultant 40% decrease in overall imaging workload. This aggravated already protracted waiting periods for advanced imaging such as MRI and CT.

Modelling data suggests that the interruption of services, with decreased diagnosis and treatment, could trigger an excess of 6 million TB deaths in high-prevalence areas, such as sub-Saharan Africa, in the next 5 years (43) . Similarly, a 6-month disruption in antiretroviral therapy delivery for patients with HIV could result in up to 500,000 additional deaths and double the rate of mother-to-child transmission over the next 5 years (44). 

The national health care system implemented an emergency plan by assigning priority to COVID-19 patients who had flocked to the emergency departments with severe symptoms. In parallel, the Italian radiology departments had to convert their activity to one dedicated completely or partially to COVID-19 patients (46) . Entire facilities were adapted with separate pathways for COVID-19 patients, thus reducing radiological activity for non-COVID-19 patients. This created a list of patients waiting for care.

Of particular concern were oncology patients who experienced a delay in both radiological diagnosis and follow-up. Many radiologists, even those not expert in thoracic radiology, found themselves at the forefront providing answers to two fundamental clinical questions: the presence of signs of pneumonia and the severity of the radiological findings. To help provide answers, the SIRM activated an initiative called "Coronavisible", publishing a freely accessible radiological case history of patients with COVID-19 pneumonia (47) . Further SIRM initiatives included the publication of guidelines on the appropriate use of radiological imaging in these patients and the use of artificial intelligence (AI) (48, 49) . In particular, SIRM recommended CXR for initial screening with CT as an additional examination showing the typical features of COVID-19 pneumonia, and the use of AI to predict the need for additional support. 

To standardize COVID patient evaluation, SIRM has developed a structured CT report model, through a consensus agreement among experts in thoracic radiology, that is accessible on its website (47) . The SIRM structured report, in line with the recommendations of the RSNA and other scientific societies, represents a guideline for reporting, and also serves as a system for collecting clinical and radiological data for research purposes.

In anticipation of a second pandemic wave, Italian hospitals are better prepared. PCR testing is widely available and is used as the first line test. Dedicated COVID-19 departments have been created, some of which are equipped with a radiological unit, and ICUs have been upgraded. For example, at the university hospital of the city of Pisa, a small COVID-19 hospital was created, funded by the Italian civil protection, with an ICU, a surgical department, an angiography suite and a dedicated radiological unit with CT, ultrasound and radiography. Radiologists go to the COVID-19 hospital to perform ultrasound examinations. These exams have often been in the setting of PCR-positive disease and severe symptoms of lung involvement. A team of a radiologist, radiographers and a nurse enter the COVID-19 hospital to perform CT examinations. Each access is regulated by security procedures, including donning and doffing of PPE according to a standard procedure to reduce the risk of contagion. To ensure the prompt availability of the radiological team, shifts of radiologists, radiographers and nurses were reorganized within institutions across Italy.

Brazil, the fifth largest country in the world, has marked social inequality, income distribution and access to the healthcare system. COVID-19 infection peaked at different times among Brazil's 27 states, beginning at the end of February 2020, and starting to show a continuous drop in September, but still I n P r e s s reporting 800 deaths daily in the beginning of October. 80% of the Brazilian population uses a public Unified Health System (SUS) (51), which despite limited resources, played a fundamental role in combating the pandemic, by centrally regulating basic health units, emergency rooms and hospitals. The major state capitals of Brazil built field hospitals in soccer stadiums and convention centers, which allowed for a rapid expansion of beds for less complex patients, leaving the most critical cases to be treated in referral hospitals. With respect to imaging, chest CT was always the first choice for initial evaluation when available; however, only chest x-rays were available at many sites in Brazil.

In one of the most affected cities, São Paulo, with approximately 13 million inhabitants, three field hospitals were built totaling 1,339 beds. At the same time, the Hospital das Clinicas of the University of São Paulo (HCFMUSP) (52) which has 6 hospitals and 2,500 beds, dedicated the central hospital with 900 general beds and 300 ICU beds, exclusively for the treatment of severe cases of COVID-19, becoming the largest hospital center in the fight against COVID-19 in Brazil. More than 5,000 patients were hospitalized between March-September 30: 3,000 in ICUs and 80% were on mechanical ventilation. As an intensive care reference center and telemedicine service provider, the knowledge acquired in the management of critically ill patients was shared with 16 affiliated public hospitals.

In order to assist hospitals without chest radiologists and to help provide a faster diagnosis, the HCFMUSP innovation center in partnership with private sector and the federal government, created the Radvid-19 project (53). Using this AI platform (Figure 4) , any hospital in Brazil can send its chest CT examination to a server, where two AI algorithms (Huawei and Siemens) return a report with a COVID-19 probability analysis and the extent of the affected lung parenchyma. The facility operates 24 hours a day at no cost to the user, and reports are delivered within 10 minutes ( Figure 5 ).

Several lessons were learned about the pandemic from developing and using Radvid-19. One of the most important was that with technology, innovation and solidarity, it is possible to shorten distances, democratize knowledge, and reduce healthcare costs. Another lesson is that radiologists are accustomed to high technological environments and are quick to adopt digital tools like teleradiology.

Our experience in Brazil suggests that radiologists should assume a leadership role in healthcare institutional strategic planning for global pandemic response.

The United States (U.S.) leads the world in the number of COVID-19 cases and deaths by an extremely large margin. The first case of COVID-19 in the U.S. was reported on January 19, 2020 in a man returning to Seattle, Washington from Wuhan, China (54) . The virus hit early hotspots like New York City fast and hard and healthcare systems had to respond rapidly to the increased need for PPE, hospital and ICU beds, ventilators, and viral testing. New workflows were developed to safely deal with a deluge of critically ill patients. Most elective surgeries, procedures, and imaging tests were postponed for months which has delayed critical healthcare for many patients and devastated healthcare systems financially.

As the virus waned in early hotspots, new processes and safety precautions were implemented to address patients whose care was deferred. Hospitals and outpatient centers routinely required safeguards such as universal masking, hand hygiene, and COVID-19 testing prior to specific procedures.

New workflows include socially distanced waiting areas, transparent barriers, one-way traffic I n P r e s s passageways, and frequent cleaning of equipment and patient areas. Instant messaging allows patients to wait at a distant location with notification when ready for expedited arrival thereby minimizing physical contact and improving distancing.

The clinical impact of COVID-19 with additional waves is expected to be less deadly on a per infection basis because of learned techniques such as placing patients in a prone position and identification of effective chemotherapeutic agents such as dexamethasone and remdesivir (55) . With successive waves, many hospitals and outpatient imaging centers hope to continue to safely perform elective imaging and procedures while healthcare systems simultaneously treat COVID-19 patients. Of concern is the anticipation that a second wave of COVID-19 will occur concurrently with the influenza season.

Prevention and decreased severity of influenza illness and decreased outpatient visits, hospitalizations, and ICU admissions through influenza vaccination could also help to reduce stress on the U.S. health care system. Acceleration of digital innovations is the silver lining of the COVID-19 crisis. Increased integration of AI into new radiology workflows to help with efficient patient communication and scheduling within the constraints of new safety measures include the use of predictive analytics and virtual assistants such as chatbots ( Figure 6 ) (56, 57, 58) . A chatbot is a computer application that uses AI to converse with a user typically through text chats or voice commands. Machine learning algorithms are being developed to detect and differentiate COVID-19 pulmonary findings from other etiologies on CT scan and CXR (59, 60) .

Virtual operations command centers, specifically focused on imaging, enable rapid decision-making and allow radiology departments to effectively manage staffing, resources, image quality and volumes across multiple sites. Thermal temperature-check devices and contactless check-in kiosks allow safe entry into imaging centers. Electronic workflows include symptom reporting, expanded online patient scheduling and preregistration. Patient portal websites allow easy access to imaging test preparation instructions and educational materials.

Digital communications technology has been employed for clinical image interpretation, patient care, conferencing and education. Teleradiology and remote reading have been well-received by radiologists and allow flexible work shifts and reduced stress. Telehealth has rapidly expanded to include remote patient consultation services for IR procedures and lung cancer screening. Teleconferencing and remote readout with screen sharing as well as new electronic teaching tools have been implemented in response to the profound impact of the pandemic on radiology training programs. Digital learning resources for trainees have expanded and are being offered as alternatives to in-person teaching (61).

These digital innovations have distinctly transformed the way radiologists work and the changes will continue in the daily practice of radiology after the pandemic ends. The challenge for radiologists will be how to deal with further loss of direct contact and interaction with patients.

Australia had a rapid, politically -bipartisan response to the pandemic in March, with implementation of social distancing, work from home orders, closures of non-essential businesses and remote education delivery by universities and schools. These measures were supported by government investment in income support and loan forbearance. International air and sea arrivals from non-Australian citizens and I n P r e s s non-permanent residents ceased. Elective surgery was cancelled nationwide to free beds and make PPE more available in both the private and public sectors for anticipated COVID -19 hospitalizations.

Widespread testing, mandatory isolation, intensive contact tracing and 14-day quarantine for international arrivals underpinned a successful national health strategy that saw the first wave end within a few weeks, and the country looking forward to "getting back to normal". The vast majority of first wave cases were acquired in other countries; community transmission was very low.

Dominating the Australian pandemic story is the heterogeneity of its second wave, a result of widespread community transmission in only one state, Victoria, following breaches of infection control in quarantine facilities. Strict lockdown, school and nonessential business closures, mandatory mask wearing, and police enforced curfews helped daily case numbers in Victoria plummet from over 800 to 21 within 5 weeks. The economic cost to individuals, businesses and government was significant but the number of cases and deaths prevented was also enormous. Radiology in Australia is not "post pandemic" but is adjusting to a new "COVID normal". Infrastructure support for remote reporting and provision of PPE has varied widely within each state and around the country and between public and private sectors. For example, radiologists employed in a large multicampus academic health science center already had access to home reporting workstations for on-call work, and the information technology (IT) systems and staff to support them were in place. This made it far easier to scale work from home. Institution sponsored online videoconferencing platforms were rapidly rolled out to all medical staff allowing supervision of trainees, tutorials and multidisciplinary meetings to be run remotely. Telehealth consultations increased from 20% to nearly 70% of outpatient clinic encounters in a few short months. These sudden, forced innovations transformed the way I n P r e s s business is done and have improved care for many patients who no longer need to travel to check in with their specialist or get a prescription. Improved efficiency of uninterrupted home diagnostic reporting and improved attendance at multidisciplinary case conferences have been unexpected side benefits. Paradoxically, increased remote work has made radiologists in Australia more connected to referring physicians, radiology colleagues, trainees and technologists. Increased videoconferencing has not only decreased geographical barriers to participation in international meetings, but has also made radiologists more directly accessible through real-time screen share of workstation images and case discussion, elevating the value of radiologists as consultants, experts, and members of patient care teams. It is likely that after an effective vaccine is developed, SARS-CoV-2 will transition from the virus of the pandemic to the seasonal influenza, just like MERS and the Spanish influenza before it, but it is unlikely radiologists in Australia will go back to previous workflows.

As we balance 'business as usual' with COVID-19 care, it is imperative that radiologists reflect upon longrange permanent changes that radiology services must make in the post-COVID-19 world. We can start by learning from recent experience.

The Severe Acute Respiratory Syndrome (SARS) epidemic had a profound impact on health care systems, resulting in long-term adjustments. In one example (62) , transformative changes were instituted in a radiology service that prioritized infection control measures at the individual and system levels. These included scheduling of appointments that consider the infective risks of patients, regular cleaning of facilities undertaken by dedicated staff and including infection control measures in the planning of all future imaging facilities. Separate facilities for inpatients and outpatients were configured and at least I n P r e s s one CT and one MRI suite were equipped with negative air pressure for highly infectious cases.

Emergency planning also included scenarios for infectious disease outbreaks, coordinated from institutional to national levels. While some of these measures were rapidly implemented, most changes took resources time and resolve to realize. With the COVID-19 pandemic, these measures have stood the test as they were based on strong foundational principles (63) .

The scale and duration of the COVID-19 pandemic have, however, highlighted additional issues that radiology services must address in the 'new normal' post-COVID-19 world. Patients will demand the highest standard of infection control measures and these must be practiced consistently whether or not there is an infectious disease outbreak (Figure 7 ). Patients will demand 'just-in-time' service. To minimize patient dwell time, detailed preplanning of every patient visit will be required. This can create opportunities for new innovative operational processes, leveraging IT and AI. Radiology can take the lead in deciding on the imaging pathway for each patient rather than delegating this to the clinical teams. Consideration should be made for inpatient general radiography and ultrasound procedures to be performed at the bedside, reducing the need to transport patients to radiology facilities.

Organizations must look at sustaining working from home for radiologists and support staff where feasible. Radiology services should also explore how imaging can be delivered in a way that minimizes the need for patient contact and potential disease transmission. When a procedure has to be performed on-site, other processes such as appointment scheduling, counselling and consultation can be delivered virtually.

Facility planning must consider multi-functional facilities with the flexibility to pivot quickly to address different levels of disease outbreaks. In one example, an institution designed a parking garage as an overflow facility that can be converted during civil emergencies (64) . In this facility, medical consultation and treatment rooms and a lead lined room for portable x-ray were purpose-built and can be deployed on short notice. These facilities are optimized for providing care unlike make-shift tents and ad-hoc conversion of non-clinical areas. While many solutions will be complex and will take time to implement, radiology must seize the opportunity to transform and thrive in the post-COVID-19 world.

SARS-CoV-2 is easily transmitted among humans and has quickly spread throughout the world.

Healthcare professionals responded rapidly to better understand the disease, and developed systems to better diagnose and treat infected patients, protect healthcare workers, and impede spread. However, in the latter part of 2020, infections rose to an all-time high incidence in many parts of the globe. We face new management challenges in radiology departments, and it is imperative that we remain flexible and continue to evolve our approaches to optimize our patients' care. For example, as healthcare systems mobilized to care for COVID-19 patients, care of patients with other diseases was often delayed.

As the initial wave subsided, their care was prioritized based on the severity of disease and risk of further delays.

At the outset of the pandemic, testing kits were not readily available and chest CT examinations were often used to diagnose COVID-19 pneumonia in clinically suspected patients in many regions in the world. Criteria for the appropriate use of imaging examinations have gained consensus, with heterogeneity reflecting local imaging and in vitro testing availability. Improved workflows in radiology I n P r e s s departments along with methods for cleaning and extending PPE use have been implemented to decrease the transmission of COVID-19 in the hospital setting.

Radiology has played a crucial role in the assessment of better treatment methods, including measurement of disease changes and predicting prognosis. Moreover, pathophysiology identified by noninvasive imaging has also suggested novel interventions for clinical testing to decrease patient morbidity and mortality. AI approaches have helped make rapid image assessment more available to provide patient management guidance.

Although the responses to the COVID-19 pandemic were variable depending upon the number of infected individuals, effectiveness of governmental leadership and availability of resources, much has been learned and shared through the medical literature. We better understand the transmission of the virus and are more skilled in the treatment of infected patients. Efforts are now underway to prepare for an expected increase in patients as 2020 comes to a close.

Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19

CT Manifestations of Two Cases of 2019 Novel Coronavirus (2019-nCoV) Pneumonia

Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia

COVID-19): Spectrum of CT Findings and Temporal Progression of the Disease

CT Manifestations and Clinical Characteristics of 1115 Patients with Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-analysis

Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases

Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR

Office of state administration of traditional Chinese medicine. Notice on the issuance of a programme for the diagnosis and treatment of novel coronavirus (2019-nCoV)

Official: nucleic acid test results for fever outpatients is reported within 6 hours

Chinese Society of Radiology. Radiological diagnosis of COVID-19: expert recommendation from the Chinese Society of Radiology

ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection

CT should not be used as first-line tool against coronavirus, ACR warns following pandemic declaration

Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19)

Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis

Ultra-low-dose chest CT imaging of COVID-19 patients using a deep residual neural network

Expert consensus of radiological examination scheme and infection prevention of coronavirus disease 2019 (Trial version first)

The Role of Repeat Chest CT Scan in the COVID-19 Pandemic

Correlation Between Low-Dose Chest Computed Tomography and RT-PCR Results for the Diagnosis of COVID-19: A Report of 27,824 Cases in Tehran

COVID-19 Evaluation by Low-Dose High Resolution CT Scans Protocol

Clinical and Chest Radiography Features Determine Patient Outcomes in Young and Middle-aged Adults with COVID-19

Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19

Multisystem Imaging Manifestations of COVID-19, Part 1: Viral Pathogenesis and Pulmonary and Vascular System Complications

Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected with Pulmonary CT Angiography

Clinical infectious diseases : Publication of the Infectious Diseases Society of America

Society for Cardiovascular Magnetic Resonance (SCMR) guidance for the practice of cardiovascular magnetic resonance during the COVID-19 pandemic

Abdominal Imaging Findings in COVID-19: Preliminary Observations

COVID-19-Asspcoated Thromboembolic Events Causing Acute Mesenteric Ischaemia

Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young

MRI Brain Findings in 126 Patients with COVID-19: Initial Observations from a Descriptive Literature Review

Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases

The indispensable role of chest CT in the detection of coronavirus disease 2019 (COVID-19)

Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR

Equity assessment of the distribution of CT and MRI scanners in China: a panel data analysis

An analysis of licenced South African diagnostic imaging equipment

Defining the diagnostic divide: an analysis of registered radiological equipment resources in a low-income African country

Licensed radiology equipment resources as a measure of healthcare access and equity: A Zimbabwean study

An audit of licenced Zambian diagnostic imaging equipment and personnel

ACR recommendations for the use of chest radiography and computed tomography (CT) for suspected COVID-19 infection

Risk factors for COVID-19 death in a population cohort study from the Western Cape Province, South Africa

The potential impact of the COVID-19 response on tuberculosis in high-burden countries: a modelling analysis

Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models

Impact of coronavirus disease 2019 (COVID-19) emergency on Italian radiologists: a national survey

The Radiology Department during the COVID-19 pandemic: a challenging, radical change

SIRM. www.sirm.org. Accessed

Use of CT and artificial intelligence in suspected or COVID-19 positive patients: statement of the Italian Society of Medical and Interventional Radiology

Structured reporting of chest CT in COVID-19 pneumonia: a consensus proposal

First case of 2019 novel coronavirus in the United States

COVID-19) Treatment Guidelines. National Institutes of Health

Applications of digital technology in COVID-19 pandemic planning and response. Lancet Digit Health

Digital technologies in the public-health response to COVID-19

CT Quantification and Machine-learning Models for Assessment of Disease Severity and Prognosis of COVID-19 Patients

Artificial intelligence-enabled rapid diagnosis of patients with COVID-19

AI Augmentation of Radiologist Performance in Distinguishing COVID-19 from Pneumonia of

The Impact of COVID-19 on Radiology Trainees

Severe acute respiratory syndrome: 11 years later--a radiology perspective

Deja vu or jamais vu? How the severe acute respiratory syndrome experience influenced a Singapore radiology department's response to the coronavirus disease (COVID-19) epidemic

Reorganising the emergency department to manage the COVID-19 outbreak

The authors gratefully acknowledge the work of RSNA members around the world in response to the COVID-19 pandemic and in service to their patients. They also thank the Radiological Society of North America (RSNA) staff for its support in coordinating global input and cooperation, as well as technical assistance, in development of this paper.

I n P r e s s