Validation of the British Society of Thoracic Imaging guidelines for COVID-19 chest radiograph reporting. Issue 9 (September 2020)

• Record Type: Journal Article
• Authors: Hare, S.S.; Tavare, A.N.; Dattani, V.; Musaddaq, B.; Beal, I.; Cleverley, J.; Cash, C.; Lemoniati, E.; Barnett, J.
• Is Part Of: Clinical radiology. Volume 75:Issue 9(2020)
• Page Start: 710.e9
• Page End: 710.e14
• Publication Date: 2020-09
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2020.06.005
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : AIM: To validate the British Society of Thoracic Imaging issued guidelines for the categorisation of chest radiographs for coronavirus disease 2019 (COVID-19) reporting regarding reproducibility amongst radiologists and diagnostic performance. MATERIALS AND METHODS: Chest radiographs from 50 patients with COVID-19, and 50 control patients with symptoms consistent with COVID-19 from prior to the emergence of the novel coronavirus were assessed by seven consultant radiologists with regards to the British Society of Thoracic Imaging guidelines. RESULTS: The findings show excellent specificity (100%) and moderate sensitivity (44%) for guideline-defined Classic/Probable COVID-19, and substantial interobserver agreement (Fleiss' k=0.61). Fair agreement was observed for the "Indeterminate for COVID-19" (k=0.23), and "Non-COVID-19" (k=0.37) categories; furthermore, the sensitivity (0.26 and 0.14 respectively) and specificity (0.76, 0.80) of these categories for COVID-19 were not significantly different (McNemar's test p =0.18 and p =0.67). CONCLUSION: An amalgamation of the categories of "Indeterminate for COVID-19" and "Non-COVID-19" into a single "not classic of COVID-19" classification would improve interobserver agreement, encompass patients with a similar probability of COVID-19, and remove the possibility of labelling patients with COVID-19 as "Non-COVID-19", which is the presenting radiographic appearance in a significant minority (14%) of patients. Highlights: Classic COVID-19 on chest radiograph is very specific for SARS-CoV-2. There is substantial interobserver agreement for Classic COVID-19. There is only fair agreement for Indeterminate and Non-COVID appearances. Indeterminate and Non-COVID categories have a similar probability of SARS-CoV-2. These categories should be amalgamated into a 'Not Classic for COVID' category.