Low-dose CT in COVID-19 outbreak: radiation safety, image wisely, and image gently pledge

Tofighi, Salar; Najafi, Saeideh; Johnston, Sean; Gholamrezanezhad, Ali

doi:10.1007/s10140-020-01784-3

Cited by 35 publications

(29 citation statements)

References 23 publications

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“…To our knowledge, no other studies have performed repeat lung biopsies for post-discharge surveillance. Most studies perform repeat HRCTs, but given the inherent radiation, there may be a role for low-dose or ultra-low-dose CTs in longitudinal follow-ups [ 24 ]. This is important to understand organizing pneumonia can develop either an active or aberrant pulmonary repair or recovery process during the evolution of COVID-19 [ 25 ].…”

Section: Possibility Of Long-term Pulmonary Abnormalitiesmentioning

confidence: 99%

The lingering manifestations of COVID-19 during and after convalescence: update on long-term pulmonary consequences of coronavirus disease 2019 (COVID-19)

Shaw

Daskareh²,

Gholamrezanezhad

2020

Radiol med

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The long-term sequelae of coronavirus disease 2019 (COVID-19) are still unknown. Lessons from past viral epidemics reveal that, after recovery, patients with viral pulmonary infections can suffer from irreversible pulmonary dysfunction and demonstrate residual imaging or functional abnormalities. Residual ground glass opacities, consolidations, reticular and linear opacities, residual crazy paving pattern, melted sugar sign, and parenchymal fibrotic bands are several features found in the late or remission stages of COVID-19. These radiologic findings have been observed weeks after symptom onset, even after hospital discharge, and they may or may not correlate with clinical manifestations. High-resolution CT may be indicated to establish new baselines and track changes in residual impairments. In our previous review, we observed significant pulmonary sequelae in some COVID-19 survivors at follow-up. In this update, we review the current literature on the clinical and radiologic manifestations of post-recovery COVID-19 toward the end of hospital admission and after discharge.

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Section: Possibility Of Long-term Pulmonary Abnormalitiesmentioning

confidence: 99%

The lingering manifestations of COVID-19 during and after convalescence: update on long-term pulmonary consequences of coronavirus disease 2019 (COVID-19)

Shaw

Daskareh²,

Gholamrezanezhad

2020

Radiol med

Self Cite

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“…Also, the high false-negative rate of RT-PCR in early disease and its inability to assess disease severity and progression have led to the growing use of cross-sectional imaging such as CT for diagnosis and assessing disease severity, progression, complications, and treatment response [8]. Although a few single-center studies reported use of chest CT for diagnosis and work-up of patients with COVID-19 pneumonia [9,10], a recent survey suggested that only a very few sites use reduced-dose scan protocols (with lower radiation dose compared to routine or general chest CT protocol) for imaging patients with the suspected or known disease [8]. Despite reports on chest radiography and non-ionizing radiation-based imaging with ultrasonography [11,12], CT remains the preferred imaging modality in COVID-19 pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Variations in CT Utilization, Protocols, and Radiation Doses in COVID-19 Pneumonia: Results from 28 Countries in the IAEA Study

et al. 2021

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Background There is lack of guidance on specific CT protocols for imaging patients with coronavirus disease 2019 (COVID-19) pneumonia. Purpose To assess international variations in CT utilization, protocols, and radiation doses in patients with COVID-19 pneumonia. Materials and Methods In this retrospective data collection study, the International Atomic Energy Agency (IAEA) coordinated a survey between May and July 2020 regarding CT utilization, protocols, and radiation doses from 62 healthcare sites in 34 countries across five continents for CT exams performed in COVID-19 pneumonia. The questionnaire obtained information on local prevalence, method of diagnosis, most frequent imaging, indications for CT, and specific policies on use of CT in COVID-19 pneumonia. Collected data included general information (patient age, weight, clinical indication), CT equipment (CT make and model, year of installation, number of detector rows), scan protocols (body region, scan phases, tube current and potential), and radiation dose descriptors (CT dose index (CTDI vol ) and dose length product (DLP)). Descriptive statistics and generalized estimating equations were performed. Results Data from 782 patients (median age (interquartile range) of 59(15) years) from 54 healthcare sites in 28 countries were evaluated. Less than one-half of the healthcare sites used CT for initial diagnosis of COVID-19 pneumonia and three-fourth used CT for assessing disease severity. CTDI vol varied based on CT vendors (7-11mGy, p<0.001), number of detector-rows (8-9mGy, p<0.001), year of CT installation (7-10mGy, p=0.006), and reconstruction techniques (7-10mGy, p=0.03). Multiphase chest CT exams performed in 20% of sites (11 of 54) were associated with higher DLP compared with single-phase chest CT exams performed in 80% (43 of 54 sites) (p=0.008). Conclusion CT use, scan protocols, and radiation doses in patients with COVID-19 pneumonia showed wide variation across healthcare sites within the same and different countries. Many patients were scanned multiple times and/or with multiphase CT scan protocols. See also the editorial by Lee .

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“…A recent study by Tofighi et al has discussed the application of low-dose CT in COVID-19 pneumonia and stated that low-dose and ultralow-dose CT have a comparable efficacy in the detection of ground glass and consolidative opacities. They have suggested comparison of low-dose and conventional protocol in early stages of the disease, because in intermediate and advanced stages, the low-dose CT protocol will provide adequate image quality and diagnostic accuracy [ 23 ]. More recently published studies on applying low radiation dose chest CT scan in COVID-19 pneumonia have suggested acceptable diagnostic accuracy [ 17 , 24 ], although they are all non-comparison studies.…”

Section: Introductionmentioning

confidence: 99%

A low-dose chest CT protocol for the diagnosis of COVID-19 pneumonia: a prospective study

et al. 2020

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Purpose The increasing trend of chest CT utilization during the COVID-19 pandemic necessitates novel protocols with reduced dose and maintained diagnostic accuracy. We aimed to investigate the diagnostic accuracy of 30-mAs chest CT protocol in comparison with a 150-mAs standard-dose routine protocol for imaging of COVID-19 pneumonia. Methods Upon IRB approval, consecutive laboratory-confirmed positive COVID-19 patients aged 50 years or older who were referred for chest CT scan and had same-day normal CXR were invited to participate in this prospective study. First, a standard-dose chest CT scan (150 mAs) was performed. Only if typical COVID-19 pneumonia features were identified, then a low-dose CT (30 mAs) was done immediately. Diagnostic accuracy of low-dose and standard-dose CT in the detection of typical COVID-19 pneumonia features were compared. Results Twenty patients with a mean age of 64.20 ± 13.8 were enrolled in the study. There was excellent intrareader agreement in detecting typical findings of COVID-19 pneumonia between low-dose and standard-dose (intraclass correlation coefficient [ICC] = 0.98–0.99, P values < 0.001 all readers). The mean effective dose values in standard- and low-dose groups were 6.60 ± 1.47 and 1.80 ± 0.42 mSv, respectively. Also, absolute cancer risk per mean cumulative effective dose values obtained from the standard- and low-dose CT examinations were 2.71 × 10 −4 and 0.74 × 10 −4 , respectively. Conclusions According to our study, it was found that proposed low-dose CT chest protocol is reliable in detecting COVID-19 pneumonia in daily practice with significant reduction in radiation dose and estimated cancer risk.

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Low-dose CT in COVID-19 outbreak: radiation safety, image wisely, and image gently pledge

Cited by 35 publications

References 23 publications

The lingering manifestations of COVID-19 during and after convalescence: update on long-term pulmonary consequences of coronavirus disease 2019 (COVID-19)

The lingering manifestations of COVID-19 during and after convalescence: update on long-term pulmonary consequences of coronavirus disease 2019 (COVID-19)

Variations in CT Utilization, Protocols, and Radiation Doses in COVID-19 Pneumonia: Results from 28 Countries in the IAEA Study

A low-dose chest CT protocol for the diagnosis of COVID-19 pneumonia: a prospective study

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