COVID-19 Evidence Alerts
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Diagnosis Vicini S, Panvini N, Bellini D, et al. Radiographers and COVID-19 pneumonia: Diagnostic performance using CO-RADS. Radiography (Lond). 2021 Apr 30. pii: S1078-8174(21)00049-3. doi: 10.1016/j.radi.2021.04.010.

INTRODUCTION: A more structured role of radiographers is advisable to speed up the management of patients with suspected COVID-19. The purpose of our study was to evaluate the diagnostic performance of radiographers in the detection of COVID-19 pneumonia on chest CT using CO-RADS descriptors.

METHODS: CT images of patients who underwent RT-PCR and chest CT due to COVID-19 suspicion between March and July 2020 were analysed retrospectively. Six readers, including two radiologists, two highly experienced radiographers and two less experienced radiographers, independently scored each CT using the CO-RADS lexicon. ROC curves were used to investigate diagnostic accuracy, and Fleiss'? statistics to evaluate inter-rater agreement.

RESULTS: 714 patients (419 men; 295 women; mean age: 64 years ±19SD) were evaluated. CO-RADS> 3 was identified as optimal diagnostic threshold. Highly experienced radiographers achieved an average sensitivity of 58.7% (95%CI: 52.5-64.7), an average specificity of 81.8% (95%CI: 77.9-85.2), and a mean AUC of 0.72 (95%CI: 0.68-0.75). Among less experienced radiographers, an average sensitivity of 56.3% (95%CI: 50.1-62.2) and an average specificity of 81.5% (95%CI: 77.6-84.9) were observed, with a mean AUC of 0.71 (95%CI: 0.68-0.74). Consultant radiologists achieved an average sensitivity of 60.0% (95%CI: 53.7-65.8), an average specificity of 81.7% (95%CI: 77.8-85.1), and a mean AUC of 0.73 (95%CI: 0.70-0.77).

CONCLUSION: Radiographers can adequately recognise the classic appearances of COVID-19 on CT, as described by the CO-RADS assessment scheme, in a way comparable to expert radiologists.

IMPLICATIONS FOR PRACTICE: Radiographers, as the first healthcare professionals to evaluate CT images in patients with suspected SARS-CoV-2 infection, could diagnose COVID-19 pneumonia by means of a categorical reporting scheme at CT in a reliable way, hence playing a primary role in the early management of these patients.

Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Pediatric Hospital Medicine
Pediatric Emergency Medicine
Comments from MORE raters

Infectious Disease rater

The benefit of this article is that it enables radiographers to diagnose Covid-19, thus helping out radiologists in their day-to-day practice and effort.

Internal Medicine rater

The results showed little agreement in accurate Dx of Covid-19 unless the radiologist was an expert. What does one do when a busy ER uses a less expert radiologist? The MRI seemed to help make the early Dx, but it should remain a part of the diagnostic approach.

Respirology/Pulmonology rater

CT scan is controversial in COVID-19 because after PCR tests, the CT findings do not change management decisions.