Chest CT in COVID-19 pneumonia: A review of current knowledge

The current COVID-19 pandemic has highlighted the essential role of chest computed tomography (CT) examination in patient triage in the emergency departments, allowing them to be referred to “COVID” or “non-COVID” wards. Initial chest CT examination must be performed without intravenous administration of iodinated contrast material, but contrast material administration is required when pulmonary embolism is suspected, which seems to be frequent in severe forms of the disease. Typical CT features consist of bilateral ground-glass opacities with peripheral, posterior and basal predominance. Lung disease extent on CT correlates with clinical severity. Artificial intelligence could assist radiologists for diagnosis and prognosis evaluation.     

COVID-19 pneumonia: A review of typical CT findings and differential diagnosis

The standard of reference for confirming COVID-19 relies on microbiological tests such as real-time polymerase chain reaction (RT-PCR) or sequencing. However, these tests might not be available in an emergency setting. Computed tomography (CT) can be used as an important complement for the diagnosis of COVID-19 pneumonia in the current epidemic context. In this review, we present the typical CT features of COVID-19 pneumonia and discuss the main differential diagnosis.     

Incidental diagnosis of Covid-19 pneumonia on chest computed tomography

PurposeThe purpose of this study was to determine the prevalence and imaging characteristics of incidentally diagnosed COVID-19 pneumonia on computed tomography (CT).Materials and methodsThis retrospective study was conducted between March 20th and March 31st, 2020 at Cochin hospital, Paris France. Thoracic CT examinations of all patients referred for another reason than a suspicion of SARS-CoV-2 infection were reviewed. CT images were analyzed by a chest radiologist to confirm the presence of findings consistent with COVID-19 pneumonia and quantify disease extent. Clinical and biological data (C-reactive protein serum level [CRP] and white blood cell count) of patients with CT findings suggestive for COVID-19 pneumonia were retrieved from the electronic medical chart.ResultsDuring the study period, among 205 diagnostic CT examinations, six examinations (6/205, 3%) in 6 different patients (4 men, 2 women; median age, 57 years) revealed images highly suggestive of COVID-19 pneumonia. The final diagnosis was confirmed by RT-PCR. Three inpatients were suspected of extra thoracic infection whereas three outpatients were either fully asymptomatic or presented with fatigue only. All had increased CRP serum level and lymphopenia. Disease extent on CT was mild to moderate in 5/6 patients (83%) and severe in 1/6 patient (17%).ConclusionCumulative incidence of fortuitous diagnosis if COVID-19 pneumonia did not exceed 3% during the highest pandemic phase and was predominantly associated with limited lung involvement.     

Interventional oncology at the time of COVID-19 pandemic: Problems and solutions

The COVID-19 pandemic has deeply impacted the activity of interventional oncology in hospitals and cancer centers. In this review based on official recommendations of different international societies, but also on local solutions found in different expert large-volume centers, we discuss the changes that need to be done for the organization, safety, and patient management in interventional oncology. A literature review of potential solutions in a context of scarce anesthesiologic resources, limited staff and limited access to hospital beds are proposed and discussed based on the literature data.     

Radiology indispensable for tracking COVID-19

With the rapid spread of COVID-19 worldwide, early detection and efficient isolation of suspected patients are especially important to prevent the transmission. Although nucleic acid testing of SARS-CoV-2 is still the gold standard for diagnosis, there are well-recognized early-detection problems including time-consuming in the diagnosis process, noticeable false-negative rate in the early stage and lacking nucleic acid testing kits in some areas. Therefore, effective and rational applications of imaging technologies are critical in aiding the screen and helping the diagnosis of suspected patients. Currently, chest computed tomography is recommended as the first-line imaging test for detecting COVID-19 pneumonia, which could allow not only early detection of the typical chest manifestations, but also timely estimation of the disease severity and therapeutic effects. In addition, other radiological methods including chest X-ray, magnetic resonance imaging, and positron emission computed tomography also show significant advantages in the detection of COVID-19 pneumonia. This review summarizes the applications of radiology and nuclear medicine in detecting and diagnosing COVID-19. It highlights the importance for these technologies to curb the rapid transmission during the pandemic, considering findings from special groups such as children and pregnant women.     

Imaging of COVID-19: An update of current evidences

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been reported as a global emergency. As respiratory dysfunction is a major clinical presentation of COVID-19, chest computed tomography (CT) plays a central role in the diagnosis and management of patients with COVID-19. Recent advances in imaging approaches using artificial intelligence have been essential as a quantification and diagnostic tool to differentiate COVID-19 from other respiratory infectious diseases. Furthermore, cardiovascular involvement in patients with COVID-19 is not negligible and may result in rapid worsening of the disease and sudden death. Cardiac magnetic resonance imaging can accurately depict myocardial involvement in SARS-CoV-2 infection. This review summarizes the role of the radiology department in the management and the diagnosis of COVID-19, with a special emphasis on ultra-high-resolution CT findings, cardiovascular complications and the potential of artificial intelligence.     

Increased Firearm Injury During the COVID-19 Pandemic: A Hidden Urban Burden

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3D-printed face protective shield in interventional radiology: Evaluation of an immediate solution in the era of COVID-19 pandemic

PurposeThe purpose of this study was to report the clinical evaluation of a 3D-printed protective face shield designed to protect interventional radiologists from droplet transmission of the SARS-Cov-2.Materials and methodsA protective face shield consisting in a standard transparent polymerizing vinyl chloride (PVC) sheet was built using commercially available 3D printers. The 3D-printed face shield was evaluated in 31 interventional procedures in terms of ability to perform the assigned intervention as usual, quality of visual comfort and tolerance using a Likert scale (from 1, as very good to 5, as extremely poor).ResultsThe mean rating for ability to perform the assigned intervention as usual was 1.7 ± 0.8 (SD) (range: 1–4). The mean visual tolerance rating was 1.6 ± 0.7 (SD) (range: 1–4). The mean tolerability rating was 1.4 ± 0.7 (SD) (range: 1–3).ConclusionThe 3D-printed protective face shield is well accepted in various interventions. It may become an additional option for protection of interventional radiologists.     

Effect of tin filter-based spectral shaping CT on image quality and radiation dose for routine use on ultralow-dose CT protocols: A phantom study

PurposeThe purpose of this study was to assess the impact of tin filter (TF) on X-ray beam quality, image quality and radiation dose and its suitability for routine use for chest and lumbar-spine/pelvis-hip ultralow-dose (ULD) CT examination protocols.Materials and methodsThe X-ray beam quality was determined by measuring the half-value layer (HVL) and calculating the mean weighted energy for 100, 120, 150 kVp (using standard filtration) and for 100 and 150 kVp using TF (Sn100 kVp and Sn150 kVp, respectively). Acquisitions were performed on a phantom at four dose levels for each previously defined kVp. The mean attenuation (N_CT), noise-power-spectrum (NPS) and task-based transfer function (TTF) were computed. The detectability index (d’) was computed to model the detection of two lesions in spine and pelvic/hip examination and two for chest exploration. Image quality and detectability using a TF were assessed for two routinely used ULD protocols.ResultsThe HVL and mean weighted energy increased using a TF for the same tube voltage. Using a TF for the same tube voltage changed N_CT for bone and acrylic inserts, decreased the NPS peak without changing the NPS spatial frequency and increased the TTF values. The d’ values were improved using a TF and with the dose increase. d’ values of all modeled lesions were improved using Sn100 kVp and Sn150 kVp for the lumbar-spine/pelvis-hip and chest ULD protocols except for sclerotic bone lesion using Sn150 kVp.ConclusionThe use of TF increases the X-ray beam quality and improves the image quality characteristics in phantom images, thus appearing as a promising tool for reducing dose and/or improving the image quality of ULD protocols.     

Understanding Hispanic Patient Satisfaction with Telehealth During COVID-19

BackgroundRecent studies have described the use of telehealth for pediatric surgical care during the COVID-19 pandemic. We aimed to evaluate equity in telehealth use by comparing rates of utilization and satisfaction with pediatric surgical telemedicine among Hispanic patients.MethodsWe conducted a retrospective cohort study of patients seen by a surgical subspecialty provider in the outpatient setting at a quaternary pediatric hospital between April 1 and June 30, 2020. Patients evaluated in the same three-month period in 2019 were analyzed as a historic control. Differences in Family Experience Survey (FES) responses based on race and ethnicity and preferred language of care were assessed using univariable and multivariable generalized linear modeling.ResultsThe pandemic cohort included fewer patients of Hispanic ethnicity and fewer Spanish-speakers. After controlling for visit type, comparison of Spanish-speaking and English-speaking patients revealed that Spanish-speaking families had significantly lower scores for FES items that evaluated healthcare provider explaining (IRR 0.74, 95% CI: 0.61–0.90), listening (IRR 0.76, 95% CI: 0.63–0.92), and time spent with the family (IRR 0.73, 95% CI: 0.60–0.89). There were no differences in FES responses based on insurance status or degree of medical complexity.ConclusionsTelehealth services were less commonly used among Hispanic and Spanish-speaking patients. Language may differentially affect family satisfaction with healthcare and telehealth solutions. Strategies to mitigate these inequities are needed and may include strengthening interpreter services and providing language-concordant care.Level of evidenceLevel IV.     

Rapid Response of an Academic Surgical Department to the COVID-19 Pandemic: Implications for Patients,Surgeons, and the Community

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