Soon after reports of a novel coronavirus capable of causing severe pneumonia surfaced in late 2019, expeditious global spread of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) forced the World Health Organization to declare an international state of emergency. Although best known for causing symptoms of upper respiratory tract infection in mild cases and fulminant pneumonia in severe disease, Coronavirus Disease 2019 (COVID-19) has also been associated with gastrointestinal, neurologic, cardiac, and hematologic presentations. Despite concerns over poor specificity and undue radiation exposure, chest imaging nonetheless remains central to the initial diagnosis and monitoring of COVID-19 progression, as well as to the evaluation of complications. Classic features on chest CT include ground-glass and reticular opacities with or without superimposed consolidations, frequently presenting in a bilateral, peripheral, and posterior distribution. More recently, studies conducted with MRI have shown excellent concordance with chest CT in visualizing typical features of COVID-19 pneumonia. For patients in whom exposure to ionizing radiation should be avoided, particularly pregnant women and children, pulmonary MRI may represent a suitable alternative to chest CT. Although PET imaging is not typically considered among first-line investigative modalities for the diagnosis of lower respiratory tract infections, numerous reports have noted incidental localization of radiotracer in parenchymal regions of COVID-19-associated pulmonary lesions. These findings are consistent with data from Middle East Respiratory Syndrome-CoV cohorts suggesting an ability for 18 F-FDG PET to detect subclinical infection and lymphadenitis in subjects without overt clinical signs of infection. Though highly sensitive, use of PET/CT for primary detection of COVID-19 is constrained by poor specificity, as well as considerations of cost, radiation burden, and prolonged exposure times for imaging staff. Even still, decontamination of scanner bays is a time-consuming process, and proper ventilation of scanner suites may additionally require up to an hour of downtime to allow for sufficient air exchange. Yet, in patients who require nuclear medicine investigations for other clinical indications, PET imaging may yield the earliest detection of nascent infection in otherwise asymptomatic individuals. Especially for patients with concomitant malignancies and other states of immunocompromise, prompt recognition of infection and early initiation of supportive care is crucial to maximizing outcomes and improving survivability.

Background Efforts to reduce nosocomial spread of COVID-19 have resulted in unprecedented disruptions in clinical workflows and numerous unexpected stressors for imaging departments across the country. Our purpose was to more precisely evaluate these impacts on radiologists through a nationwide survey. Methods A 43-item anonymous questionnaire was adapted from the AO Spine Foundation's survey and distributed to 1521 unique email addresses using REDCap™ (Research Electronic Data Capture). Additional invitations were sent out to American Society of Emergency Radiology (ASER) and Association of University Radiologists (AUR) members. Responses were collected over a period of 8 days. Descriptive analyses and multivariate modeling were performed using SAS v9.4 software. Results A total of 689 responses from radiologists across 44 different states met the criteria for inclusion in the analysis. As many as 61% of respondents rated their level of anxiety with regard to COVID-19 to be a 7 out of 10 or greater, and higher scores were positively correlated the standardized number of COVID-19 cases in a respondent's state (RR = 1.11, 95% CI: 1.02–1.21, p = 0.01). Citing the stressor of “personal health” was a strong predictor of higher anxiety scores (RR 1.23; 95% CI: 1.13–1.34, p < 0.01). By contrast, participants who reported needing no coping methods were more likely to self-report lower anxiety scores (RR 0.4; 95% CI: 0.3–0.53, p < 0.01). Conclusion COVID-19 has had a significant impact on radiologists across the nation. As these unique stressors continue to evolve, further attention must be paid to the ways in which we may continue to support radiologists working in drastically altered practice environments and in remote settings.

Since first report of a novel coronavirus in December of 2019, the Coronavirus Disease 2019 (COVID-19) pandemic has crippled healthcare systems around the world. While many initial screening protocols centered around laboratory detection of the virus, early testing assays were thought to be poorly sensitive in comparison to chest computed tomography, especially in asymptomatic disease. Coupled with shortages of reverse transcription polymerase chain reaction (RT-PCR) testing kits in many parts of the world, these regions instead turned to the use of advanced imaging as a first-line screening modality. However, in contrast to previous Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome coronavirus epidemics, chest X-ray has not demonstrated optimal sensitivity to be of much utility in first-line screening protocols. Though current national and international guidelines recommend for the use of RT-PCR as the primary screening tool for suspected cases of COVID-19, institutional and regional protocols must consider local availability of resources when issuing universal recommendations. Successful containment and social mitigation strategies worldwide have been thus far predicated on unified governmental responses, though the underlying ideologies of these practices may not be widely applicable in many Western nations. As the strain on the radiology workforce continues to mount, early results indicate a promising role for the use of machine-learning algorithms as risk stratification schema in the months to come.

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