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. 2020 Sep;75(9):710.e9-710.e14.
doi: 10.1016/j.crad.2020.06.005. Epub 2020 Jun 17.

Validation of the British Society of Thoracic Imaging guidelines for COVID-19 chest radiograph reporting

S S Hare  1 , A N Tavare  1 , V Dattani  1 , B Musaddaq  1 , I Beal  1 , J Cleverley  1 , C Cash  1 , E Lemoniati  1 , J Barnett  2
Affiliations

Validation of the British Society of Thoracic Imaging guidelines for COVID-19 chest radiograph reporting

S S Hare et al. Clin Radiol. 2020 Sep.

Abstract

Aim: To validate the British Society of Thoracic Imaging issued guidelines for the categorisation of chest radiographs for coronavirus disease 2019 (COVID-19) reporting regarding reproducibility amongst radiologists and diagnostic performance.

Materials and methods: Chest radiographs from 50 patients with COVID-19, and 50 control patients with symptoms consistent with COVID-19 from prior to the emergence of the novel coronavirus were assessed by seven consultant radiologists with regards to the British Society of Thoracic Imaging guidelines.

Results: The findings show excellent specificity (100%) and moderate sensitivity (44%) for guideline-defined Classic/Probable COVID-19, and substantial interobserver agreement (Fleiss' k=0.61). Fair agreement was observed for the "Indeterminate for COVID-19" (k=0.23), and "Non-COVID-19" (k=0.37) categories; furthermore, the sensitivity (0.26 and 0.14 respectively) and specificity (0.76, 0.80) of these categories for COVID-19 were not significantly different (McNemar's test p=0.18 and p=0.67).

Conclusion: An amalgamation of the categories of "Indeterminate for COVID-19" and "Non-COVID-19" into a single "not classic of COVID-19" classification would improve interobserver agreement, encompass patients with a similar probability of COVID-19, and remove the possibility of labelling patients with COVID-19 as "Non-COVID-19", which is the presenting radiographic appearance in a significant minority (14%) of patients.

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Conflict of interest statement

Conflicts of interest Dr Hare is on the committee of the British Society of Thoracic Imaging.

Figures

Figure 1
Figure 1
Examples of the COVID BSTI categories for plain films, in each case all radiologists agreed on the categorisation. (a) Anteroposterior (AP) erect radiograph demonstrating “Classic COVID-19”. (b) AP erect chest radiograph “Indeterminate for COVID-19”. (c) AP erect radiograph classified as “COVID normal”. (d) AP erect radiograph classified as “Non-COVID”.
Figure 2
Figure 2
Examples of patients with SARS-CoV-2 infection, but admission chest radiographs classified as “Non-COVID”. (a) AP erect radiograph demonstrating lobar pneumonia. (b) AP erect radiograph showing congestive cardiac failure. (c) AP erect chest radiograph with unilateral pleural effusion. (d) AP semi-erect chest radiograph with left lower lung airways disease/thickening.
See this image and copyright information in PMC

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