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Imaging Guidelines for COVID-19 Patients

Imaging Guidelines for COVID-19 Patients

March 25, 2020

We are providing the following guidelines on imaging in patients with suspected or confirmed COVID-19 infection. The recommendations are based on consensus statements from the American College of Radiology, the Society of Thoracic Radiology and the American Society of Emergency Radiology.

The recommendations reflect several considerations. First the imaging findings of COVID-19 on both chest radiographs and chest CT are non-specific and overlap with other clinical conditions. Therefore, imaging cannot be used to definitively rule in or rule out the disease. Imaging should be directed toward assisting in initial patient assessment and monitoring the progress of the disease.

The following is the recommended approach to imaging in this condition. Following these guidelines will help decrease risk to patients and staff and will provide results most useful for the care of these patients.

  1. If chest imaging is felt to be clinically indicated, chest radiography should be the first and primary imaging examination in most patients. While the findings are non-specific, they can be combined with clinical presentation to support the suspected diagnosis of COVID19. Definitive diagnosis is based on laboratory testing.
  2. Follow-up radiography should be limited to the minimum imaging necessary to monitor progress and guide management decisions. Standing orders for imaging should be avoided unless the patient’s condition warrants it.
  3. Chest radiography should be done portably in nearly all cases. In most cases a portable radiograph is sufficient and this limits transport of patients through the hospital.
  4. At this time, CT imaging is only indicated in confirmed or suspected COVID-19 patients when a complicating condition such as empyema or lung abscess is suspected or if there is a clear suspicion of another clinical diagnosis, such as pulmonary embolus.
  5. CT imaging should be used sparingly in this population. A CT exam requires patient transport through the hospital and may result in the need for enhanced cleaning protocols after completion. This can limit or delay imaging of other patients that may need emergency imaging.
  6. MR imaging has little role in the diagnosis and management of this condition.
  7. With this population of patients, we want to limit unnecessary imaging studies and consultation before ordering may help limit exposure and resource use. Our radiologists at each MedStar site are available to consult with our clinical colleagues at any time
    regarding the best approach to imaging.

ACR Recommendations https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendationsfor-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection

STR Statement of Imaging and COVID-19
https://thoracicrad.org/