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. 2020 May;125(5):509-513.
doi: 10.1007/s11547-020-01200-3. Epub 2020 May 1.

COVID-19 Outbreak in Italy: Experimental Chest X-ray Scoring System for Quantifying and Monitoring Disease Progression

Free PMC article

COVID-19 Outbreak in Italy: Experimental Chest X-ray Scoring System for Quantifying and Monitoring Disease Progression

Andrea Borghesi et al. Radiol Med. .
Free PMC article


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 cases associated with severe respiratory disease that 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 the detection of lung abnormalities in early-stage disease and quantitative assessment of severity and progression of COVID-19 pneumonia. Although chest X-ray (CXR) is considered not sensitive for the detection of pulmonary involvement in the early stage of the 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 short communication, we present our experimental CXR scoring system that we are applying to 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.

Keywords: COVID-19; Chest X-ray; Computed tomography; SARS-CoV-2; Scoring system.

Conflict of interest statement

The authors declare that they have no conflict of interest.


Fig. 1
Fig. 1
Division of lungs into six zones on frontal chest radiograph. Line A is drawn at the level of the inferior wall of the aortic arch. Line B is drawn at the level of the inferior wall of the right inferior pulmonary vein. A and D upper zones; B and E middle zones; C and F lower zones
Fig. 2
Fig. 2
Examples of the chest X-ray scoring system in two patients with COVID-19 pneumonia
Fig. 3
Fig. 3
Serial chest X-ray findings in a 72-year-old male patient with COVID-19 pneumonia. a Baseline frontal chest radiograph performed on the day of admission (one day after the onset of fever). A rapid progression of the lung disease is shown on radiographic follow-ups performed at day 4 (b) and day 5 (c) post-hospitalization

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