The impact of technical factors on the chest radiographic findings in COVID-19 pneumonia.

Cohort studyJournal of the colleges of medicine of South Africa· 2026

The impact of technical factors on the chest radiographic findings in COVID-19 pneumonia.

Zukiswa Sobetwa, Stephanie Griffith-Richards, Martin Kidd, Richard D Pitcher

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Cardiothoracic ImagingCohort studyDiagnosis

Poor inspiratory effort worsened apparent lung opacification on COVID-19 chest X-rays.

The impact of technical factors on the chest radiographic findings in COVID-19 pneumonia.

Zukiswa Sobetwa … Richard D Pitcher

Journal of the colleges of medicine of South Africa · 2026

Background

Published coronavirus disease 2019 (COVID-19) chest X-ray (chest X-ray) severity scoring systems do not consider the impact of technical factors on radiographic findings.

Purpose

This study aimed to describe the technical features of COVID-19 pneumonia CXRs, determine their impact on chest X-ray interpretation and reappraise published COVID-19 chest X-ray severity scoring systems based on these findings.

Methods

Admission frontal CXRs of 100 consecutive adults with proven COVID-19 pneumonia were analysed for technical features (projection, inspiratory excursion, exposure, vertical rotation) and pulmonary opacification.

n = 41 cases

Results

41

cases

poor breath in obscured lower lungs, making mid and upper zones look worse

n = 41 cases

More results

Under- ( n = 13) and over-penetration ( n = 39) were associated with increased and decreased basal opacification, respectively.

Eighty cases (80%) showed vertical rotation, without significant impact on opacification.

More results

Re-appraisal of published COVID-19 chest X-ray scoring systems revealed that all simply assessed the visible lung fields, without considering inspiration or penetration.

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Conclusion · 1 of 2

Published COVID-19 chest X-ray severity scoring systems could be refined by appropriate consideration of inspiratory excursion and penetration. More broadly, technical considerations should inform all chest X-ray interpretation.

Conclusion · 2 of 2

CONTRIBUTION: This study advocates incorporating technical factor assessment into chest X-ray severity scoring systems.

The impact of technical factors on the chest radiographic findings in COVID-19 pneumonia.

The impact of technical factors on the chest radiographic findings in COVID-19 pneumonia.

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