Global Radiology Guidelines Establish Best Practices for Post-COVID Chest CT Imaging

In an effort to standardize the evaluation and management of residual lung abnormalities following COVID-19, an international panel of experts from 14 countries has issued a comprehensive consensus statement in the journal Radiology. This guidance aims to optimize the use of computed tomography (CT) scans in patients experiencing persistent or worsening respiratory symptoms post-infection.

The panel emphasizes the importance of clear indications for performing chest CT scans, advocating for imaging when patients exhibit ongoing symptoms beyond three months after initial COVID-19 infection, especially if these symptoms last at least two months without alternative explanations. Additional follow-up imaging, occurring three to six months after hospital discharge, is recommended for individuals who had moderate to severe COVID-19, due to the high prevalence of residual lung changes.

A key component of the consensus is establishing uniform terminology to describe lung abnormalities seen on CT scans. The authors recommend adopting terms from the Fleischner Society Glossary to ensure precise and consistent reporting, avoiding the ambiguous term "interstitial lung abnormality (ILA)" which pertains to a different clinical context. Instead, they propose the term "post–COVID-19 residual lung abnormality" to accurately reflect COVID-related changes.

Radiologists are advised to employ low-dose CT protocols within a range of 1 to 3 millisieverts during serial follow-up scans, adhering to the ALARA (As Low As Reasonably Achievable) principle. This approach minimizes radiation exposure while maintaining the quality needed for accurate assessment.

The consensus also addresses the challenges faced by radiologists in distinguishing persistent COVID-19 lung findings from evolving fibrotic changes and other interstitial lung diseases. They highlight the importance of differentiating post–COVID-19 abnormalities, which tend to stabilize over time, from progressive conditions like interstitial lung diseases.

The authors stress the role of follow-up imaging in managing post-COVID patients but emphasize that such imaging should be performed judiciously based on clinical and radiological judgment. Properly guided follow-up can assist in monitoring residual changes, guiding treatment decisions, and improving patient outcomes.

This collaborative effort underscores a shared commitment to evidence-based, harmonized practices aimed at enhancing patient care globally. By establishing clear guidelines, the radiology community seeks to facilitate consistent, effective evaluation of post-COVID pulmonary abnormalities and contribute to ongoing research in this evolving field.

Source: https://medicalxpress.com/news/2025-07-international-radiology-consensus-outlines-covid.html