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Chest x-ray in the COVID-19 pandemic: Radiologists’ real-world reader performance

Authors
  • Cozzi, Andrea1
  • Schiaffino, Simone2
  • Arpaia, Francesco3
  • Della Pepa, Gianmarco3
  • Tritella, Stefania2
  • Bertolotti, Pietro2
  • Menicagli, Laura2
  • Monaco, Cristian Giuseppe2
  • Carbonaro, Luca Alessandro2
  • Spairani, Riccardo2
  • Babaei Paskeh, Bijan2
  • Sardanelli, Francesco1, 2
  • 1 Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy
  • 2 Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
  • 3 Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
Type
Published Article
Journal
European Journal of Radiology
Publisher
Elsevier B.V.
Publication Date
Sep 10, 2020
Volume
132
Pages
109272–109272
Identifiers
DOI: 10.1016/j.ejrad.2020.109272
PMID: 32971326
PMCID: PMC7481070
Source
PubMed Central
Keywords
License
Unknown

Abstract

Purpose To report real-world diagnostic performance of chest x-ray (CXR) readings during the COVID-19 pandemic. Methods In this retrospective observational study we enrolled all patients presenting to the emergency department of a Milan-based university hospital from February 24th to April 8th 2020 who underwent nasopharyngeal swab for reverse transcriptase-polymerase chain reaction (RT-PCR) and anteroposterior bedside CXR within 12 h. A composite reference standard combining RT-PCR results with phone-call-based anamnesis was obtained. Radiologists were grouped by CXR reading experience (Group-1, >10 years; Group-2, <10 years), diagnostic performance indexes were calculated for each radiologist and for the two groups. Results Group-1 read 435 CXRs (77.0 % disease prevalence): sensitivity was 89.0 %, specificity 66.0 %, accuracy 83.7 %. Group-2 read 100 CXRs (73.0 % prevalence): sensitivity was 89.0 %, specificity 40.7 %, accuracy 76.0 %. During the first half of the outbreak (195 CXRs, 66.7 % disease prevalence), overall sensitivity was 80.8 %, specificity 67.7 %, accuracy 76.4 %, Group-1 sensitivity being similar to Group-2 (80.6 % versus 81.5 %, respectively) but higher specificity (74.0 % versus 46.7 %) and accuracy (78.4 % versus 69.0 %). During the second half (340 CXRs, 81.8 % prevalence), overall sensitivity increased to 92.8 %, specificity dropped to 53.2 %, accuracy increased to 85.6 %, this pattern mirrored in both groups, with decreased specificity (Group-1, 58.0 %; Group-2, 33.3 %) but increased sensitivity (92.7 % and 93.5 %) and accuracy (86.5 % and 81.0 %, respectively). Conclusions Real-world CXR diagnostic performance during the COVID-19 pandemic showed overall high sensitivity with higher specificity for more experienced radiologists. The increase in accuracy over time strengthens CXR role as a first line examination in suspected COVID-19 patients.

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