Demographic changes in the Western world associated with an increasing elderly population, increased life expectancy, and especially cancer patients and patients with chronic diseases, who are often entrusted to home care or medical facilities, highlight the exponential growth in the need for diagnostic tests at home. Traditional radiological examinations such as chest, musculoskeletal and abdominal images are most needed and are important first level diagnostic tests. To date, especially in COVID-19 emergencies, these patients have needed to be transferred to the hospital for radiological examinations, which can increase the cost to the health system and increase the health risks for these patients, who are already often frail and immunocompromised.
When the coronavirus disease (COVID-19) pandemic first emerged in China, initial reports indicated that the virus primarily infected the lungs. Most of the patients who developed symptoms presented with pulmonary symptoms such as chest discomfort and shortness of breath. In addition to pulse oximetry, the most common imaging test for these patients was a chest X-ray. Since then, there have been many reports indicating that a CT scan of the lungs is far superior to a chest x-ray because it provides more detailed information about the disease.
Unfortunately, CT scanning is not practical. Not only is it time-consuming, expensive and labor-intensive, but there is always the risk of transmitting the virus to health care workers. Performing a procedure on a patient on a ventilator is also a difficult procedure because of the time and effort required to move the patient and bring them to the radiology department for a CT scan. The potential for virus transmission is also very high in such cases.
To better address these issues, some experts recommend the use of portable chest X-rays. But the important question is: Is this imaging test sensitive enough to detect lung lesions caused by coronaviruses?
In this study, researchers studied 229 patients in the intensive care unit who were mechanically ventilated. A total of 542 mobile chest X-rays were performed. Patients ranged in age from 24 to 95 years, with 147 men and 82 women.
The types of comorbidities in 229 patients showed 165 (72%) underlying diseases, hypertension (31%), heart disease (13%), COPD (12%) and 11% malignancy. As of March 30, 95 (41%) of the 229 patients died and 134 (59%) survived. Of these, 58 were discharged from the hospital and 76 were still being treated in the hospital.
Follow-up X-rays showed disease progression in 119 (38%), no change in 57 (18%), and improvement in 137 (44%). Initial chest X-rays in all patients revealed massive pneumonia. Other findings on chest x-ray included pneumothorax (7%) and pleural effusion (23%). Rare findings included esophageal hiatal hernia, subcutaneous emphysema, and intrapulmonary cavity. All patients who developed a pneumothorax died. When follow-up chest X-rays were compared with the initial X-rays, increased solidity was seen in 119 patients, while 57 patients had no change and 137 patients had improvement.
Of the non-survivors who had chest X-rays after the initial imaging study, 53 (96%) patients showed progression. Among survivors, 118 patients underwent an X-ray, 26% of whom showed progression but later began to show improvement.
In this study, physicians found that mobile chest X-rays were of sufficient quality to diagnose pneumonia and pneumothorax in critically ill patients. Although the information obtained was not as comprehensive compared to CT scans, mobile chest X-rays were able to detect pleural effusions and pneumothorax and allowed clinicians to follow the progression of pneumonia.