BOSTON — A 2006 graduate of Smethport Area Junior-Senior High School and now a physician, was the lead writer of two published professional papers that were focused on radiologic evaluation of pediatric COVID-19 patients.

Dr. Alexandra Foust, whose parents, Tony Alfieri and Michelle Alfieri-Causer, reside in Smethport, is a pediatric radiologic fellow at Boston Children’s Hospital, the primary pediatric program of Harvard Medical School, where her responsibilities include interpreting imaging studies, performing image guided procedures, optimizing techniques for imaging studies and overseeing the performance of imaging examinations.

“I will become a pediatric neuroradiologic fellow starting in July, also at Boston Children’s,” Foust told The Era.

Coronaviruses are common human and animal viruses, having been discovered in domestic poultry in the 1930s. Only seven coronaviruses are known to cause diseases in humans.

COVID-19 is the name of the disease caused by the novel (not previously identified in humans) coronavirus SARS-CoV-2. COVID-19 stands for coronavirus disease of 2019.

This pandemic can be traced back to late 2019 in Wuhan in central China, a major transportation center of more than 11 million people.

How were team members selected for contributing to the two papers?

“All the members on our team for both papers are pediatric radiologists from different countries on five continents,” Foust noted. “The majority of them also have a specialized focus in pediatric chest imaging. Several members were involved in imaging studies for prior SARS, MERS and H1N1 pandemics as well.”

The first study is “Pediatric SARS, H1N1, MERS, EVAL1, and Now Coronavirus Disease (COVID-19) Pneumonia: What Radiologists Need to Know.”

“This paper is actually a review, meaning that it examines and reports on findings from across existing literature,” Foust stated. “Review papers often include extensive literature review and serve to condense information about related topics from a variety of prior studies all in one place.

“The main goal of this paper was to discuss the epidemiology and imaging findings in pediatric patients presenting with Severe Acute Respiratory Syndrome (SARS), Swine-origin Influenza A (H1N1), Middle Eastern Respiratory Syndrome, E-cigarette and Vaping-Associated Lung injury (EVALI) and Coronavirus Disease 2019.”

“The panel also discussed pertinent imaging findings in each of these disorders and described a few key imaging features to help differentiate these entities.”

This paper has been accepted by the American Journal of Roentgenology and was published online on April 30. The print edition could possibly appear in September.

The AJR has invited Foust to submit a podcast related to this paper. She has agreed.

The second paper is titled “International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management: Imaging Findings, Imaging Study Reporting and Imaging Study Recommendations.”

For this study the six pediatric radiologists met via video conference.

“Basically, as a group, we decided when performance of chest radiograph (CXR) and/or chest computed tomography (CT) is indicated for pediatric patients,” according to Foust. “Pediatric patients have up to three times as much sensitivity to radiation as young adults and an even higher ratio when compared to middle-aged and older adults.”

As reported in this paper, “Although COVID-19 predominantly affects the adult population recently there have been increasing reports in the media of affected pediatric patients and young adults; especially in the United States. Furthermore, although pediatric patients are more likely to have a milder clinical course, they are just as likely as adults to become infected and thus play an important role in ongoing disease transmission.”

The group also created suggested reporting language for practicing radiologists to use in classifying the level of suspicion for COVID-19 infection in pediatric patients.

The medical journal, Radiology: Cardiovascular Imaging, has accepted this paper, which was published online on April 23. The date for the print edition hasn’t been announced.

The Radiology Society of North America has invited Foust to submit a video, basically a PowerPoint related to this article, with her narrating in the background.

Is it too early for physicians to incorporate these findings in their practices?

“I don’t think it’s too early at all,” Foust replied. “Many medical journals are publishing papers online quickly right now so that they can immediately be utilized by practicing physicians. Many physicians feel uneasy making a diagnosis without knowing much about COVID-19 so the hope is that this new information can help people in practice right away.”

The results of the two papers can benefit both physicians and parents by improving diagnostic accuracy and reducing unnecessary radiation exposure. By educating people about what imaging studies to use and when they should be considered, ordering physicians will hopefully be less likely to request a study that is not indicated, thus patients will not be exposed to unnecessary radiation.

Foust said, “By describing the imaging findings in pediatric patients, the goal is to educate radiologists so they can have a better idea of what imaging findings suggest the diagnosis of COVID-19 and what imaging findings suggest they should entertain as an alternative diagnosis.”

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