COVID-19 Compatible Chest Radiograph Pattern

Value Proposition

Chest radiography is often the first-line imaging modality used for patients with suspected COVID-19 after positive testing with RT-PCR.  

Chest radiographs are often normal in early or mild disease (up to 60%). Of patients with COVID-19 requiring hospitalization, most have an abnormal chest radiograph at the initial time of admission, and approximately 80% have radiographic abnormalities sometime during hospitalization.  Radiographic findings are most evident at approximately 10-12 days after symptom onset and are relatively slow to resolve. The hallmarks of COVID-19 on chest radiographic imaging are bilateral and peripheral ground-glass and consolidative opacities, most prominent in the mid to lower lung zones.. There is notable absence of ancillary findings such as lymphadenopathy, pleural effusions, pulmonary nodules, and lung cavitation. Described patterns  of disease are  similar to that described in other coronavirus outbreaks such as SARS and MERS, and similar to the response to acute lung injury whereby an initial (often infectious or inflammatory) acute insult causes ground-glass opacities that may coalesce into dense consolidative lesions, and then progressively evolve and organize with predilection for the lung periphery. Chest radiography is limited for identifying specific viruses and distinguishing between viruses emphasizing the need for RT-PCR testing in a high-probability environment. 

Narrative(s)

A 82 year-old man who resides in a long term nursing care facility presents with fever (T > 101o F or 38.3o C) , rhinorrhea, cough, and new onset shortness of breath of duration two days.

A 49 year-old woman who initially presents with productive cough, new onset shortness of breath, muscle soreness, and malaise develops increasing fever (T > 101o F or 38.3o C)  and profound hypoxia requiring intensive care unit admission and mechanical ventilation,  without alternative explanatory diagnosis.

A 37 year-old woman who is a front-line healthcare employee at a local hospital who had close contact with a laboratory confirmed COVID-19+ patient,  developed new onset shortness of breath, cough, headache, and fatigue with fever (T > 101o F or 38.3o C) over the course of five days.

Workflow Description

Image obtained from modality and sent to PACS and the AI engine. Image analyzed by engine. System returns a likelihood score for COVID-19 compatible disease and returns prediction along with any relevant clinical information. An alert message is sent to PACS from the engine with the prediction and graphic highlighting the most important features the model drew upon for its prediction of COVID-19.

Inputs

DICOM Study

Primary Outputs

COVID-19 Detection

Secondary Outputs

Extent of lung involvement

• Track serial/temporal examination changes.

• Include identification of change from prior CXRs (in order to differentiate opacities due to chronic changes rather than COVID-19, or identify new opacities due to COVID-19 superimposed upon chronic changes)