Multi-Contrast Chest Radiography (MC-CXR) for COVID-19 Diagnosis and Screening

摘要 截至2020年4月30日，冠状病毒病2019(新冠肺炎)已感染100多万人和 在美国造成600,057人死亡。无论是临床症状还是放射学特征- 19个是该病特有的，这给该病的筛查和早期诊断带来了巨大的挑战 高度传染性疾病。目前诊断新冠肺炎的金标准方法是逆转录酶 聚合酶链式反应(RT-PCR)检测，具有较长的周转时间。胸部X光摄影(CXR) 自美国报告首例病例以来，已在美国被广泛用于新冠肺炎评估。 然而，使用CXR的主要挑战是对新冠肺炎的敏感性和特异性较低，即 很大程度上归因于早期对轻度牙槽骨损伤缺乏x射线吸收对比敏感性。 新冠肺炎。在这一紧急竞争版本中，我们提供对迫切的临床需求的快速响应 利用多对比X线成像提高X线胸片对新冠肺炎的诊断准确率 我们正在进行的R01项目(EB020521)中开发的技术。特别是，x射线暗场对比度 机制是更敏感的数量级部分填充或塌陷的肺泡，因此是预期的 显著提高CXR对牙槽骨损伤的敏感性。我们将快速构建一个多对比的 胸部X射线摄影(MC-CXR)系统，表征其物理性能，评价其辐射安全性， 并优化其扫描方案。最后，我们将进行一项试验性的人体研究，以收集初步证据 它在新冠肺炎诊断中的临床价值。考虑到新冠肺炎出现第二波浪潮的可能性很高， 拟议的MC-CXR系统的启用可以帮助医院系统应对额外的 通过提供新冠肺炎的快速“入口”评估，患者激增。

Abstract As of 4/30/2020, the Coronavirus Disease 2019 (COVID-19) has infected more than one million people and caused 60,057 deaths in the United States. Neither the clinical symptoms nor the radiological features of COVID- 19 are specific to the disease, resulting in significant challenges to the screening and early diagnosis of this highly infectious disease. The current gold standard method for COVID-19 diagnosis, the reverse transcriptase polymerase chain reaction (RT-PCR) test, has a relatively long turnaround time. Chest x-ray radiography (CXR) has been widely used in the United States for COVID-19 assessment since the first case reported in the US. However, the major challenge with the use of CXR is its low sensitivity and specificity to COVID-19, which is largely attributed to the lack of x-ray absorption contrast sensitivity to mild alveolar damages in the early phases of COVID-19. In this Emergency Competitive Revision, we offer a quick response to the imperative clinical need to improve the diagnostic accuracy of CXR to COVID-19 by leveraging the multi-contrast x-ray imaging technology developed in our ongoing R01 project (EB020521). In particular, the x-ray dark field contrast mechanism is orders of magnitude more sensitive to partial fillings or collapses of alveoli and thus is expected to offer a significant boost to CXR’s sensitivity to alveolar damage. We will quickly construct a multi-contrast chest x-ray radiography (MC-CXR) system, characterize its physical performance, evaluate its radiation safety, and optimize its scan protocols. Finally, we will conduct a pilot human subject study to collect initial evidence for its clinical value in diagnosing COVID-19. Considering the high likelihood for a second wave of COVID-19, the availability of the proposed MC-CXR system can facilitate the hospital systems to cope with additional rounds of patient surge by providing rapid “entrance” assessment of COVID-19.