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Escalation of Incidental Finding at Time of Imaging
Rationale
For any imaging examination the radiographer undertaking the exposure is the first to review the imaging and well placed to escalate any incidental findings. The aim of this document is to aid us as a team to identify changes in the lung that should be escalated during the covid-19 epidemic. Please refer to the covid-19 incidental findings SOP for guidance on how to escalate incidental findings.
A simple rule of thumb: if the chest radiograph or lungs on a CT look abnormal, regardless of what the abnormality is, please err on the side of caution and notify the Acute Team for immediate review while the patient is still in the room.
Example images CXR
Figure 1. Peripheral bilateral mid to lower zone predominant airspace opacity.
Arjun Nair & Thea Buchan 31/3/20 V1
Figure 2. Right mid-lower zone opacification. This is more suspicious for a community-acquired non-viral (ie non-COVID) pneumonia.
Figure 3. Right lower zone patch of rounded opacification. Without any history, this finding would be indeterminate for COVID (for example, it could represent any infection or even a lung cancer). However, if the clinical suspicion of COVID was high, we would be more suspicious of COVID.
Arjun Nair & Thea Buchan 31/3/20 V1
Example images CT
For each CT scan for a patient that is not suspected or confirmed covid-19 we ask that the scanning radiographer review the imaging. This may be for a chest CT or bases captured on an A/P scan. Images should be reviewed in lung windows. We are looking for peripheral and basal changes with ground glass and crazy paving. Below is a selection of images.
Figure 1. Bilateral ground-glass opacification. You may encounter this on a lung CT, but also a CT of the thoracic spine or cervical spine, or at the base of a CT cerebral angiogram!
Arjun Nair & Thea Buchan 31/3/20 V1
Figure 2. Peripheral ground-glass opacity (this is an organising pneumonia pattern).
Useful additional learning
Figure 3. Bibasal apparent ground-glass opacity. You might see this on the lung bases of abdominal scans. This is simply atelectasis, rather than the ground-glass of COVID- but we would want to know!
Arjun Nair & Thea Buchan 31/3/20 V1
Figure 4. Bibasal atelectasis which is denser. This too is a non-COVID appearance, but we would want this to be flagged so we can review it.
Please email [email protected] with any queries!
Learning resources
https://radiopaedia.org/articles/covid-19-3?lang=gb
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30086-4/fulltext
Please also visit the BSTI website for additional information and resources https://www.bsti.org.uk/covid-19-resources/
Arjun Nair & Thea Buchan 31/3/20 V1
