Radiological Findings
To define clinically relevant categories for describing X-ray findings,
we conducted a rapid literature review in PubMed, Web of Science,
Cochrane, and Scopus databases. Medical subject heading terms
(MESH-term) were used for the search, and only articles in Spanish or
English were included. Three pairs of authors carefully reviewed all
selected publications.
Based on the insights gathered from the literature review, a group
consisting of pediatricians, epidemiologists, and radiologists
collaborated to develop patterns of radiological findings (as depicted
in Figure 2). The categories for these radiological findings were
established using the definitions provided in the Glossary of terms for
chest imaging suggested by the Fleischner Society and the International
Expert Consensus Statement on Chest Imaging in Pediatric COVID-19
Patient Management .
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A comprehensive database was constructed for the study, and the
radiologists’ performed evaluations on various aspects of the chest
X-rays. Specifically, they assessed the presence or absence of
interstitial or focal opacities, the distribution and affection of the
lungs, as well as the presence of any complications related to COVID-19,
such as pleural effusion or consolidations.
The initial group consisted of four radiologists with varying clinical
experience. Their experience as radiologists ranged from 8 to 22 years,
while their experience as pediatric radiologists ranged from 5 to 22
years. To ensure an unbiased evaluation, this group was divided into two
subgroups, and half of the X-ray images were randomly assigned to each
subgroup for assessment. In addition to the initial group, an additional
radiologist with 30 years of experience independently reviewed all the
X-ray images and was considered the gold standard for the study. This
expert’s evaluation served as a reference for comparison with the
assessments made by the initial group of radiologists.
In order to maintain consistency and establish a standardized
interpretation, the images were categorized according to their level of
quality, dividing them into three groups: ”excellent”, ”optimal” and
”suboptimal” quality. These categories were defined based on previously
agreed criteria supported by the literature, specifically the European
Commission guidelines on quality criteria for diagnostic radiographic
image . In performing the classification, several technical aspects were
considered, including image alignment and rotation, adequate
penetration, correct anatomical coverage and the presence of motion
artifacts. A chest radiograph that complied with all the technical
aspects was classified as ”excellent quality”; if it showed an
alteration in at least one of the characteristics, it was classified as
”optimal”; and if it showed more than two alterations, it was designated
as ”suboptimal”.
This standardization ensured that the quality of the images did not
impact the accuracy of the radiological interpretations. Here are some
examples (Figure 3) of X-ray classifications to provide visual
representations of the radiological findings and classifications.
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