COVID-19 outbreak in Italy: Experimental chest x-ray scoring system for quantifying and monitoring disease progression

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus recently isolated from humans. SARS-CoV-2 was discovered to be the pathogen responsible for a cluster of pneumonia associated with severe respiratory disease occurred in December 2019 in China. This novel pulmonary infection, formally called coronavirus disease 2019 (COVID-19), has spread rapidly in China and beyond. On 8 March 2020, the number of Italians with SARS-CoV-2 infection was 7375 with a 48% hospitalization rate. At present, chest computed tomography imaging is considered the most effective method for detection of lung abnormalities in early-stage disease and for quantitative assessment of severity and progression of COVID-19 infection. Although chest x-ray (CXR) is considered not sensitive for the detection of pulmonary involvement in the early stage of disease, we believe that, in the current emergency setting, CXR can be a useful diagnostic tool for monitoring the rapid progression of lung abnormalities in infected patients, particularly in intensive care units. In this article we present our experimental CXR scoring system that we are applying in hospitalized patients with COVID-19 pneumonia to quantify and monitor the severity and progression of this new infectious disease. We also present the results of our preliminary validation study on a sample of 100 hospitalized patients with SARS-CoV-2 infection for whom the final outcome (recovery or death) was available.

Chest X-ray findings monitoring COVID-19 disease course and severity

“…The increased number of hospitalized patients and the consequent increase in radiological examinations would make the constant use of chest CT scan (from diagnosis to discharge) difficult to sustain over time [ 24 ]. The dependence on CT creates a huge burden on radiology departments and this makes the CXRs greatly substitute the CT examinations [ 1 – 4 ].…”

“…Although chest X-ray (CXR) is considered less sensitive for the detection of pulmonary involvement in early-stage disease, it is useful for monitoring the rapid progression of lung abnormalities in COVID-19, especially in critical patients admitted to intensive care units [ 24 ].…”

Two months of Radiation Oncology in the heart of Italian “red zone” during COVID-19 pandemic: paving a safe path over thin ice.

“…Chest CT-scan con rmed its high sensitivity, as suggestive ndings were reported in all the examinations performed. Differently from previous reports, chest radiograph assessed with a dedicated score [30][31] cases among our staff were identi ed before March 17. In the rst phases, the extent of the outbreak in Italy was underestimated and according the availability of PPE and preventive measures was sub-optimal.…”

Role of Chest Radiographs during COVID-19 Pandemic

“…Recently, CXR is being used more frequently than CT to monitor the "day-to day" progression of the pulmonary involvement of SARS-CoV-2. This was first emphasized in an Italian study 16 and its role emphasized in the setting of a rising number of SARS CoV-2 cases and resultant ICU admissions. If CXR is to be used as a tool for monitoring disease progression, it is important to express the extent of involvement quantitatively.…”

“…The first scoring system employed by a S. Korea 6 based group considers the entire lung together, and it is mainly based in the expected pattern of progression of the pneumonia (►Table 2). In the second scoring system employed and validated by Italian investigators, 16 each lung was divided into three zones, with the maximum score for each zone being 3 and the total score being 18. The description within the zones was based predominantly on the pattern within the zone, whether interstitial, alveolar or combined, with alveolar opacities representing more severe disease.…”