The diagnostic value of CT for SARS-CoV-2 infection has been widely reported [1, 2]. However, performing CT is very difficult in critically ill patients in ICU, whereas mobile X-rays serve as an alternative. From Feb. 20 to Mar. 20, 542 mobile chest X-rays were performed in 229 COVID patients who were under assisted ventilation. Table 1 summarizes the main characteristics of the cohort.
Among the 229, a significant underlying disease existed in 165 (72%): hypertension in 31%, chronic heart disease in 13%, chronic pulmonary disease in 12%, and malignancy in 11%. As of Mar. 30, 95 (41%) of 229 patients had died, and 134 (59%) survived. Among them, 58 were discharged and 76 still in hospital.
Table 1 shows the number of X-rays performed per patient. There were 229 initial examination and 313 were follow-ups. The image quality was diagnostic for all these X-rays.
Extensive pneumonia was seen on the initial X-rays in all patients. Other findings were pneumothorax (7%) and pleural effusion (23%). Subcutaneous emphysema, hiatal hernia, and intrapulmonary cavity were rare findings (Table 1). All patients with pneumothorax died. Compared to previous X-rays, increase of pneumonia was seen in 119 (38%) of 313 follow-up X-rays, while no changes were seen in 57 (18%), and improvement in 137 (44%).
Among non-survivors (n = 95), 61 patients did not have follow-up X-rays and died 1~4 days after the initial examination; 34 patients had 55 follow-up X-rays. Pneumonia progress was seen in 53 (96%) out of 55 follow-up X-rays when compared to previous radiograph (Fig. 1).
Among survivors (n = 134), 111 patients had 258 follow-up X-rays. Pneumonia progress was seen in 66/258 radiographs (26%) of follow-up X-rays in 37 survivors; however, improvement was seen later.
We found mobile X-rays provided adequate image quality for diagnosing pneumonia, at least in this population of severely ill patients. Although obviously less informative than CT, X-rays can nevertheless detect serious complications like pneumothorax or lung cavitation, and estimate the evolution of pneumonia. Therefore, it is a simple but reliable alternative in critically ill SARS-CoV-2 patients who could not undergo chest CT.
Ye Z, Zhang Y, Wang Y, Huang Z, Song B (2020) Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol. https://doi.org/10.1007/s00330-020-06801-0
Kim H (2020) Outbreak of novel coronavirus (COVID-19): what is the role of radiologists? Eur Radiol. https://doi.org/10.1007/s00330-020-06748-2
This work received financial support from the National Natural Science of Foundation of China, No. 81801663, 31630025, and 81571643.
The scientific guarantor of this publication is Wenzhen Zhu.
Conflict of interest
The authors declare that they have no conflict of interest.
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Wu, G., Li, X. Mobile X-rays are highly valuable for critically ill COVID patients. Eur Radiol 30, 5217–5219 (2020). https://doi.org/10.1007/s00330-020-06918-2