COVID-19 Imaging Considerations and Recommendations

Considerations and Recommendations for COVID-19 Imaging 

As COVID-19 spreads in the U.S. and local southwest Ohio region, there is growing interest in the role and appropriateness of chest radiographs (CXR) and computed tomography (CT) for the screening, diagnosis, and management of patients with suspected or known COVID-19 infection. Contributing to this interest are limited availability of viral testing kits to date, concern for test sensitivity from earlier reports in China, and the growing number of publications describing the CXR and CT appearance in the setting of known or suspected COVID-19 infection.  

The following is a summary of the current American College of Radiology (ACR) statement on COVID-19 and their current recommendations for imaging. 

The ACR believes that the following factors should be considered regarding the use of imaging for suspected or known COVID-19 infection: 

  • The Centers for Disease Control (CDC) does not currently recommend CXR or CT to diagnose COVID-19Viral testing remains the only specific method of diagnosis. Confirmation with the viral test is required, even if radiologic findings are suggestive of COVID-19 on CXR or CT. 
  • For the initial diagnostic testing for suspected COVID 19 infection, the CDC recommends collecting and testing specimens from the upper respiratory tract (nasopharyngeal AND oropharyngeal swabs) or from the lower respiratory tract when available for viral testing.  
  • Generally, the findings on chest imaging in COVID 19 are not specific, and overlap with other infections including influenza, H1N1, SARS and MERS. Being in the midst of the current flu season with a much higher prevalence of influenza in the U.S. than COVID-19, further limits the specificity of CT. 

Current ACR recommendations for imaging: 

  • CT should not be used to screen for or as a first line test to diagnose COVID-19 
  • CT should be used sparingly and reserved for hospitalized, symptomatic patients with specific clinical indications for CT. Appropriate infection control procedures should be followed before scanning subsequent patients. 
  • Radiologists should familiarize themselves with the CT appearance of COVID-19 infection in order to be able to identify findings consistent with infection in patients imaged for other reasons. 
  • (Updated March 19, 2020) As an interim measure, until more widespread COVID-19 testing available, some medical practices are using chest CT to inform decisions on whether to test a patient for COVID-19. The ACR strongly urges caution in taking this approach. A normal chest CT does not mean a person does not have COVID-19 infection and an abnormal CT is not specific for diagnosis. A normal CT should not dissuade a patient from being quarantined when otherwise medically appropriate. Clearly, locally constrained resources may be a factor in such decision making. 

We want to emphasize that knowledge of this new condition is rapidly evolving, and not all of the published and publicly available information is complete or up to date. We will update this information as new developments occur. Below are some additional educational links regarding the role of Imaging during this COVID-19 crisis. 

March 21, 2020