Since the introduction of the novel virus known as COVID-19, the world has been forced to evolve quickly in order to understand the virus and manage the care of those who have become infected.
Medical workers have been on the front lines of this “learn as you go” approach. Thanks to the committed brave men and women in healthcare today, we have been able to care for patients who have contracted the virus, as well as keep hospitals and care centers open and operational.
Diagnosing COVID-19 has proven difficult, erroneous, and drawn-out. In many cases, patients who receive COVID testing do not obtain their results for days or even weeks after testing. Patients are turning to their providers for other options, and radiology is a powerful tool for diagnosis.
With all that being said, radiology has not proven to be the answer to diagnosing COVID. To understand why this is, it’s important to understand what type of virus COVID is and how it presents itself in radiologic imaging.
COVID causes a variety of symptoms from fever and coughing to headaches and loss of smell and taste. While the virus affects many areas of the body, it is still primarily considered a respiratory virus.
The most coming methods of imaging the respiratory system/lungs is through chest x-rays and CT scans of the lungs. Most commonly, respiratory infections present as “cloudy” regions on x-rays and present as bright areas on CT.
One of the biggest problems with using X-Ray or CT for COVID screening is that COVID presents in a similar fashion as other respiratory infections. A patient may be symptomatic for COVID, have a positive x-ray or CT scan, and still not have a diagnosis. This is because influenza, SARS, H1N1, and MERS have overlapping features in radiologic imaging; while the test may be positive, presentation on imaging and symptoms of COVID-19 are hard to distinguish from other viruses. Virus specific lab testing is the most reliable and specific way to diagnose COVID-19. Currently the American College of Radiology (ACR), as well as the CDC, does not recommend X-Ray or CT for Diagnosis of COVID. (ref:https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection)
Apart from the lack of specificity, sending patients suspected of having COVID into medical imaging facilities would propagate the spread of the virus into practices not equipped to handle the respiratory isolation precautions that COVID requires.
Physicians have exponentially learned about COVID-19 over the past year. They have strived to keep up with the latest CDC guidance including symptom management, screening, and proper protection for their patients and staff. With years of training, these providers are the most suited to judge whether radiologic imaging would be helpful in diagnosing and treating a respiratory infection.
In most cases, patients who present with classic COVID symptoms will be directed to a local testing COVID testing facility. Many institutions are offering drive up testing to create a safer environment for the patient being tested, other patients, and the staff. There are, however, patients who may have some isolated symptoms of COVID, but also have confounding factors such as asthma, heart disease, history of blood clots, or heavy smoking. While a COVID test may be recommended, an experienced provider will be able to distinguish symptoms, weigh options, and consider an X-Ray or CT to evaluate for other disease processes that may be causing symptoms.
In the case of patients who have had COVID, are currently testing negative for the virus, and still presenting with respiratory symptoms, radiographic imaging can be helpful in evaluating residual damage or infection from the disease. In rare cases, COVID can cause longstanding or permanent damage in the lungs. This is not thought to be common, but some patients develop scarring and continued infection or pneumonia even after the virus is no longer present. CT scans produce high resolution images of the lungs and are able to detect this type of scarring and consolidated infection. In these cases, radiographic imaging can be a critical step in diagnosis and treatment.
As time goes on, our understanding of the novel COVID virus evolves and aids us in the diagnosis, treatment, and care of patients suffering from the disease. If you feel that you may be symptomatic for COVID, or present with respiratory related symptoms, contact your provider. They can offer the guidance and expertise required to get you the answers you need. If radiographic imaging is ordered, The Radiology Clinic is ready to meet your needs and provide you with a safe, efficient experience.
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