Reporting radiographers' interpretation and use of the British Society of Thoracic Imaging's coding system when reporting COVID-19 chest x-rays

Radiography (Lond). 2021 Feb;27(1):90-94. doi: 10.1016/j.radi.2020.06.010. Epub 2020 Jun 18.

Abstract

Introduction: The United Kingdom (UK) has experienced one of the worst initial waves of the COVID-19 pandemic. Clinical signs help guide initial diagnosis, though definitive diagnosis is made using the laboratory technique reverse transcription polymerase chain reaction (RT-PCR). The chest x-ray (CXR) is used as the primary imaging investigation in the United Kingdom (UK) for patients with suspected COVID-19. In some hospitals these CXRs may be reported by a radiographer.

Methods: Retrospective review of CXR reports by radiographers for suspected COVID-19 patients attending the Emergency Department (ED) of a hospital in the UK. Interpretation and use of the British Society of Thoracic Imaging (BSTI) coding system was assessed. Report description and code use were cross-checked. Report and code usage were checked against the RT-PCR result to determine accuracy. Report availability was checked against the availability of the RT-PCR result. A confusion matrix was utilised to determine performance. The data were analysed manually using Excel.

Results: Sample size was 320 patients; 54.1% male patients (n = 173), 45.9% female patients (n = 147). The correct code matched report descriptions in 316 of the 320 cases (98.8%). In 299 of the 320 cases (93.4%), the reports were available before the RT-PCR swab result. CXR sensitivity for detecting COVID-19 was 85% compared to 93% for the initial RT-PCR.

Conclusion: Reporting radiographers can adequately utilise and apply the BSTI classification system when reporting COVID-19 CXRs. They can recognise the classic CXR appearances of COVID-19 and those with normal appearances. Future best practice includes checking laboratory results when reporting CXRs with ambiguous appearances.

Implications for practice: Utilisation of reporting radiographers to report CXRs in any future respiratory pandemic should be considered a service-enabling development.

Keywords: Advanced practice; BSTI; COVID-19; CXR; Reporting radiographers.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / diagnostic imaging*
  • Clinical Coding / standards*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Radiographic Image Interpretation, Computer-Assisted / standards*
  • Radiography, Thoracic*
  • Research Design / standards
  • Retrospective Studies
  • Societies, Medical
  • United Kingdom
  • Young Adult