Radiologist Reporting and Operational Management for Patients With Suspected COVID-19

J Am Coll Radiol. 2020 Aug;17(8):1056-1060. doi: 10.1016/j.jacr.2020.06.006. Epub 2020 Jun 11.


Purpose: The aim of this study was to evaluate the adoption and outcomes of locally designed reporting guidelines for patients with possible coronavirus disease 2019 (COVID-19).

Methods: A departmental guideline was developed for radiologists that specified reporting terminology and required communication for patients with imaging findings suggestive of COVID-19, on the basis of patient test status and imaging indication. In this retrospective study, radiology reports completed from March 1, 2020, to May 3, 2020, that mentioned COVID-19 were reviewed. Reports were divided into patients with known COVID-19, patients with "suspected" COVID-19 (having an order indication of respiratory or infectious signs or symptoms), and "unsuspected patients" (other order indications, eg, trauma or non-chest pain). The primary outcome was the percentage of COVID-19 reports using recommended terminology; the secondary outcome was percentages of suspected and unsuspected patients diagnosed with COVID-19. Relationships between categorical variables were assessed using the Fisher exact test.

Results: Among 77,400 total reports, 1,083 suggested COVID-19 on the basis of imaging findings; 774 of COVID-19 reports (71%) used recommended terminology. Of 574 patients without known COVID-19 at the time of interpretation, 345 (60%) were eventually diagnosed with COVID-19, including 61% (315 of 516) of suspected and 52% (30 of 58) of unsuspected patients. Nearly all unsuspected patients (46 of 58) were identified on CT.

Conclusions: Radiologists rapidly adopted recommended reporting terminology for patients with suspected COVID-19. The majority of patients for whom radiologists raised concern for COVID-19 were subsequently diagnosed with the disease, including the majority of clinically unsuspected patients. Using unambiguous terminology and timely notification about previously unsuspected patients will become increasingly critical to facilitate COVID-19 testing and contact tracing as states begin to lift restrictions.

Keywords: COVID-19; diagnostic certainty; report terminology; reporting guidelines.

Publication types

  • Comparative Study

MeSH terms

  • COVID-19
  • Cohort Studies
  • Coronavirus Infections / diagnostic imaging*
  • Coronavirus Infections / epidemiology
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Male
  • Outcome Assessment, Health Care
  • Pandemics
  • Pneumonia, Viral / diagnostic imaging*
  • Pneumonia, Viral / epidemiology
  • Practice Guidelines as Topic*
  • Predictive Value of Tests
  • Radiography, Thoracic / methods
  • Radiography, Thoracic / statistics & numerical data
  • Radiologists / standards*
  • Radiology Department, Hospital / standards*
  • Research Design / standards*
  • Retrospective Studies
  • Tomography, X-Ray Computed / methods
  • Tomography, X-Ray Computed / statistics & numerical data
  • United States