Rama Co-RADS: Categorical Assessment Scheme of Chest Radiographic Findings for Diagnosing Pneumonia in Patients With Confirmed COVID-19

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Thitiporn Suwatanapongched
Chayanin Nitiwarangkul
Warawut Sukkasem
Sith Phongkitkarun


Due to the rapid spread of COVID-19 during the third wave of infection in Thailand, the number of confirmed COVID-19 cases has increased exponentially since April 2021. As a result, the country’s healthcare facilities and personnel are overwhelmed. Hence, many new intervention strategies have been designed and implemented. In such a resource-constrained condition, multiple alternate care sites, such as converted hotels (the so-called hospitels) and mobile field medical units, have been established for quarantine and taking care of confirmed COVID-19 cases having no or mild symptoms. In this context, it is essential to have clinical and chest radiographic assessment as a baseline screening for an accurate and rapid triage of patients and early detection of COVID-19 pneumonia, which significantly impacts patient outcomes. Therefore, a clear, concise and standardized chest radiographic report is mandatory. To facilitate this process, the authors have introduced Rama Co-RADS for the categorical assessment scheme of pulmonary involvement in COVID-19. After the pilot implementation of Rama Co-RADS in the routine radiology workflow for chest radiography screening in patients with confirmed COVID-19 at the Ramathibodi Hospitels, there is a 24% reduction in the median turnaround radiology reporting time. It also enhances the radiologist’s performance in establishing the diagnosis of COVID-19 pneumonia (especially in the early phase). Furthermore, the categorical assessment scheme in Rama Co-RADS facilitates communication among healthcare personnel, guiding effective management, triage, consultation and treatment of patients with confirmed COVID-19.


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Suwatanapongched, T., Nitiwarangkul, C. ., Sukkasem, W., & Phongkitkarun, S. (2021). Rama Co-RADS: Categorical Assessment Scheme of Chest Radiographic Findings for Diagnosing Pneumonia in Patients With Confirmed COVID-19. Ramathibodi Medical Journal, 44(2), 50–62. https://doi.org/10.33165/rmj.2021.44.2.251259
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Department of Disease Control, Ministry of Public Health. Coronavirus disease (COVID-19): Thailand situation. Accessed May 25, 2021. https://ddc.moph.go.th/viralpneumonia

Department of Medicine Services, Ministry of Public Health. Guidelines on clinical practice, diagnosis, treatment, and prevention of healthcare-associated infection for COVID-19. Published March 24, 2020. Updated May 6, 2021. Accessed May 25, 2021. https://ddc.moph.go.th/viralpneumonia/eng/file/guidelines/g_CPG_06may21.pdf

Kompaniyets L, Goodman AB, Belay B, et al. Body mass index and risk for COVID-19-related hospitalization, intensive care unit admission, invasive mechanical ventilation, and death-United States, March-December 2020. MMWR Morb Mortal Wkly Rep. 2021;70(10):355-361. doi:10.15585/mmwr.mm7010e4

Department of Disease Control, Ministry of Public Health. Guidelines on establishing of field hospital. Published January 7, 2021. Accessed May 25, 2021. https://covid19.dms.go.th/backend/Content/Content_File/Covid_Health/Attach/25640111082302AM_Field%20Hospital%20GL_V_5_08012021.pdf

Prutipinyo C. COVID-19 field hospital: alternative state quarantine hospital and hospitel. Public Health & Health Laws Journal. 2021;7(1):195-213.

Department of Medicine Services, Ministry of Public Health. Guidelines on triage individuals with confirmed COVID-19 in Bangkok. Published on April 19, 2021. Accessed May 25, 2021. https://covid19.dms.go.th/Content/Select_Landding_page?contentId=120

Angus DC, Derde L, Al-Beidh F, et al. Effect of hydrocortisone on mortality and organ support in patients with severe COVID-19: the REMAP-CAP COVID-19 corticosteroid domain randomized clinical trial. JAMA. 2020;324(13):1317-1329. doi:10.1001/jama.2020.17022

Larici AR, Cicchetti G, Marano R, et al. Multimodality imaging of COVID-19 pneumonia: from diagnosis to follow-up. A comprehensive review. Eur J Radiol. 2020;131:109217. doi:10.1016/j.ejrad.2020.109217

Stephanie S, Shum T, Cleveland H, et al. Determinants of chest radiograph sensitivity for COVID-19: a multi-institutional study in the United States. Radiol Cardiothorac Imaging. 2020;2(5):e200337. doi:10.1148/ryct.2020200337

Toussie D, Voutsinas N, Finkelstein M, et al. Clinical and chest radiography features determine patient outcomes in young and middle-aged adults with COVID-19. Radiology. 2020;297(1):E197-E206. doi:10.1148/radiol.2020201754

Litmanovich DE, Chung M, Kirkbride RR, Kicska G, Kanne JP. Review of chest radiograph findings of COVID-19 pneumonia and suggested reporting language. J Thorac Imaging. 2020;35(6):354-360. doi:10.1097/RTI.0000000000000541

Yoon SH, Lee KH, Kim JY, et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol. 2020;21(4):494-500. doi:10.3348/kjr.2020.0132

Kwee TC, Kwee RM. Chest CT in COVID-19: what the radiologist needs to know. Radiographics. 2020;40(7):1848-1865. doi:10.1148/rg.2020200159

Rubin GD, Ryerson CJ, Haramati LB, et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the Fleischner Society. Chest. 2020;158(1):106-116. doi:10.1016/j.chest.2020.04.003

Suwatanapongched T, Nitiwarangkul C, Sukkasem W, Phongkitkarun S. Categories and the corresponding levels of suspicion for pulmonary involvement for rapid triage of patients with confirmed COVID-19 by chest radiograph or Rama Co-RADS (Version 1). Updated May 9, 2021. Accessed May 25, 2021. https://www.rama.mahidol.ac.th/radiology/th/knowledge/radiology/05092021-1753-th

Prokop M, van Everdingen W, van Rees Vellinga T, et al. CO-RADS: a categorical CT assessment scheme for patients suspected of having COVID-19-definition and evaluation. Radiology. 2020;296(2):E97-E104. doi:10.1148/radiol.2020201473

De Sanctis V, Bedair EMA, Soliman AT, Nair AP, Al Masalamani MA, Yassin M. Proposed scoring system for evaluating clinico-radiological severity of COVID-19 using plain chest x-ray (CXR) changes (CO X-RADS): preliminary results. Acta Biomed. 2020;91(4):e2020172. doi:10.23750/abm.v91i4.10664

Yates A, Dempsey PJ, Vencken S, MacMahon PJ, Hutchinson BD. Structured reporting in portable chest radiographs: an essential tool in the diagnosis of COVID-19. Eur J Radiol. 2021;134:109414. doi:10.1016/j.ejrad.2020.109414

R8way, Ministry of Public Health. Case Management COVID-19. May 5, 2021. Accessed May 25, 2021 https://r8way.moph.go.th/r8way/covid-19