Correspondence Address:
Prof. Donald Nzeh
Department of Radiology, University of Ilorin Teaching Hospital, Ilorin, Kwara State
Nigeria

Full Text



The novel coronavirus disease 2019 (COVID-19) has precipitated a global health crisis of unprecedented proportions in the year 2020. This invisible enemy has waged a war against people that has brought humanity to its knees and the world has stood still ever since. As of June 12, 2020, there were 7.54 million confirmed cases, 3.78 million patients had recovered from the disease, while about 425,044 infected persons had died worldwide.

COVID-19 has devastated economies of nations across the globe, educational institutions are shut at all levels, businesses are closed, job losses run into tens of millions, while air travel and public transportation have become paralyzed. Places of religious worship are shut. Sports activities in stadia and other mass gatherings are suspended. All these have been as a result of lockdowns and stay-at-home restrictions imposed by governments across the globe to contain the spread of the virus and guarantee the safety of citizens in their countries.

Despite the present global effort to combat COVID-19, there are still some things that are baffling and unknown about the virus causing this disease, and its ability to do severe damage to the human body. The virus primarily attacks the lungs although other organs of the body may be affected. Typically, it produces acute respiratory distress syndrome (ARDS) with cough, fever, shortness of breath, headache, loss of appetite, and loss of the sense of smell. Some patients develop diarrhea.

Virologists, immunologists, epidemiologists, as well as medical experts in infectious and communicable diseases have predicted that COVID-19 will not disappear suddenly, but continue to be with us albeit at lower intensity, for several months or even a couple of years to come, until a reliable treatment regimen or vaccine has been developed, to overcome the virus.

The cheering news is that these lockdowns are beginning to be eased by policymakers in different nations because the situation is getting under control and statistics is improving. As life gradually returns to normal and travel bans and other restrictions are slowly lifted, we shall be faced with new challenges like how radiologists handle patients in the workplace. Resumption of economic activities, journeys, sports, and everyday events will mean more patients arriving in the departments for both routine and emergency radiological investigations. Some of these emergencies may be life-threatening conditions from traumatic injuries or acute illnesses that require immediate attention. The first consideration will be how to save the life of such a patient even if there is a high index of suspicion for COVID-19.

A number of radiological investigations bring us in close proximity and direct contact with patients such as ultrasound examinations (especially endocavity scans), hysterosalpingograms, urethrocystograms, intravenous urograms, barium studies, and interventional radiology procedures (in particular, vascular studies). The time has come for us to have a rethink on how to protect ourselves against COVID-19 and come up with ways to overcome the challenges that lie ahead.

Hitherto, the emphasis had been on how to shield ourselves from the harmful effects of ionizing radiation by using lead aprons. The new reality of COVID-19 means that we shall also take precautionary measures beyond wearing of face masks and surgical gloves. For high-risk patients, in addition to wearing lead aprons, it would be necessary to wear personal protective equipment (PPE) such as jump suit-like clothing and face shield. The sheer weight on a radiologist, wearing a combination of lead apron and PPE, will be enormous, but that is the inconvenience we have to put up with for our safety. Interestingly, PPEs are now produced locally which makes them more readily available and affordable. As is the case with storage of lead aprons, radiology equipment rooms would have to be repurposed to create space for PPEs.

Among medical specialists, there is still divergence of views regarding the mechanism for pulmonary damage by COVID-19. Some of these opinions are based on solid scientific evidence, while others are putative assertions. What is obvious to us as radiologists is that COVID-19 manifests with features of interstitial pneumonia on both plain chest radiograph and computed tomography (CT). The classical features of COVID-19 on chest radiograph are those of bilateral basal patchy opacities due to consolidation that have predominantly peripheral distribution. In the early stages of pulmonary disease, there may be faint opacities giving ground-glass appearance in both lungs. On CT images, the appearance of pulmonary lesions in COVID-19 is that of bilateral patchy hyperdensities with basal and peripheral distribution.

New but unconventional phrases are creeping into the radiological lexicon, that do not follow the traditional approach to image interpretation and reporting. There is emergence of an uncontrolled usage of these terminologies for description of the radiological features of chest radiographs and CT scans in patients with COVID-19. A number of these authors are from countries that do not use English as their official language. If these descriptions are overlooked, they can easily bring confusion, especially among trainee radiologists. We should be wary of these neologisms in radiology that will erode the value of radiological reports. Plain chest radiographic lesions are described as radiolucency or opacity. On the other hand, CT lesions are referred to as hypodense, isodense, or hyperdense.

Let us continue to stay safe.

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Conflicts of interest

There are no conflicts of interest.