RSNA releases Fleischner Society chest imaging guidance

By Kate Madden Yee, AuntMinnie.com staff writer

April 8, 2020 -- The RSNA has released a consensus statement from thoracic radiology organization the Fleischner Society on chest imaging's role in managing patients with COVID-19. The statement was published April 7 simultaneously in Radiology and Chest.

The document outlines the perspectives of a variety of experts with COVID-19 experience in 10 countries, according to a team led by Dr. Geoffrey Rubin of Duke University School of Medicine in Durham, NC.

"Written from multidisciplinary and multinational perspectives, this Fleischner statement is intended to provide context for the use of imaging to direct patient management during the COVID-19 pandemic in different practice settings, different phases of epidemic outbreak, and environments of varying critical resource availability," the authors wrote.

In the first three months of 2020, more than 900,000 COVID-19 cases have been confirmed around the world and almost 50,000 people have died of the disease, Rubin and colleagues wrote. The spread of the SARS-CoV-2 virus that causes the disease is unpredictable, affecting some countries and communities more severely than others. Those areas that are more severely affected are facing compromised healthcare delivery.

The role of chest CT and x-ray in the management of COVID-19 has not been fully explored, Rubin and colleagues noted. The Fleischner Society statement presents the perspectives of 15 thoracic radiologists, 10 pulmonologists, one pathologist, and experts from emergency medicine, infection control, and laboratory medicine. The panel included clinicians from the U.S., Italy, China, Germany, France, the U.K., the Netherlands, South Korea, Canada, and Japan -- nine of the 15 countries with the highest number of COVID-19 cases reported worldwide as of April 1.

The statement consists of the following:

  • Imaging is not routinely indicated in asymptomatic patients or those with suspected COVID-19 and mild symptoms unless they are at risk of disease progression.
  • Chest imaging is indicated in patients with COVID-19 with declining respiratory status, as well as those with moderate to severe features of COVID-19 regardless of test results.
  • In environments where supplies such as personal protective equipment or COVID-19 tests are scarce, imaging is recommended to triage patients with moderate or severe clinical features of the disease.
  • CT is indicated in patients with functional impairment or low levels of oxygen in the blood after recovery from COVID-19.
  • When COVID-19 is identified incidentally on chest CT, patients should have reverse transcription polymerase chain reaction (RT-PCR) testing.

The group hopes the consensus statement will help guide physicians on the best use of thoracic imaging for COVID-19.

"Currently, no therapy has been confirmed to alter the course of COVID-19, there is no known cure, and there is no vaccine for prevention," Rubin said in a statement released by the RSNA. "As effective treatments are developed, thoracic imaging may find new roles by establishing treatment response or characterizing patients as likely responders to novel therapies."


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