Optimization of Patient Management During the COVID-19 Pandemic: Chest CT Scan and PCR as Gatekeepers of the Radiation Therapy Workflow

Introduction Following the Covid-19 pandemic spread, changes in clinical practice were necessary to limit the pandemic diffusion. Also, oncological practice has undergone changes with radiotherapy (RT) treatments playing a key role. Although several experiences have been published, the aim of this review is to summarize the current evidence after 2 years of pandemic to provide useful conclusions for clinicians. Methods A Pubmed/MEDLINE and Embase systematic review was conducted. The search strategy was “Covid AND Radiotherapy” and only original articles in the English language were considered. Results A total of 2.733 papers were obtained using the mentioned search strategy. After the complete selection process, a total of 281 papers were considered eligible for the analysis of the results. Discussion RT has played a key role in Covid-19 pandemic as it has proved more resilient than surgery and chemotherapy. The impact of the accelerated use of hypofractionated RT and telemedicine will make these strategies central also in the post-pandemic period.

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“…Thirteen studies recommended the use of telemedicine [ 22 , 27 , 29 , 30 , 33 , 36 , 40 , 42 , 44 , 50 – 53 ].…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies analyzed the results suggesting the omission or postponement of RT when possible [ 14 , 21 , 23 – 25 , 30 , 42 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

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Covid-19 and radiotherapy: a systematic review after 2 years of pandemic

Piras¹,

Venuti

D’Aviero³

et al. 2022

Clin Transl Imaging

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“…This might have been attributed to variabilities in viral load depending on the disease stage and sampling error, as well as the low availability and high demand of the test in the early days of the pandemic [ 50 ]. In this regard, some studies have recommended parallel testing using CT and RT-PCT, especially when consecutive tests are required to confirm the infection for treatment planning [ 51 – 53 ]. Currently, the RT-PCR test is the most commonly used diagnostic tool for COVID-19 detection, and some scientific societies do not recommend the use of chest CT for COVID-19 screening.…”

Section: Discussionmentioning

confidence: 99%

Robust framework for COVID-19 identication from a multicenter dataset of chest CT scans

Khademi

Heidarian²,

Afshar³

et al. 2023

PLoS ONE

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The main objective of this study is to develop a robust deep learning-based framework to distinguish COVID-19, Community-Acquired Pneumonia (CAP), and Normal cases based on volumetric chest CT scans, which are acquired in different imaging centers using different scanners and technical settings. We demonstrated that while our proposed model is trained on a relatively small dataset acquired from only one imaging center using a specific scanning protocol, it performs well on heterogeneous test sets obtained by multiple scanners using different technical parameters. We also showed that the model can be updated via an unsupervised approach to cope with the data shift between the train and test sets and enhance the robustness of the model upon receiving a new external dataset from a different center. More specifically, we extracted the subset of the test images for which the model generated a confident prediction and used the extracted subset along with the training set to retrain and update the benchmark model (the model trained on the initial train set). Finally, we adopted an ensemble architecture to aggregate the predictions from multiple versions of the model. For initial training and development purposes, an in-house dataset of 171 COVID-19, 60 CAP, and 76 Normal cases was used, which contained volumetric CT scans acquired from one imaging center using a single scanning protocol and standard radiation dose. To evaluate the model, we collected four different test sets retrospectively to investigate the effects of the shifts in the data characteristics on the model’s performance. Among the test cases, there were CT scans with similar characteristics as the train set as well as noisy low-dose and ultra-low-dose CT scans. In addition, some test CT scans were obtained from patients with a history of cardiovascular diseases or surgeries. This dataset is referred to as the “SPGC-COVID” dataset. The entire test dataset used in this study contains 51 COVID-19, 28 CAP, and 51 Normal cases. Experimental results indicate that our proposed framework performs well on all test sets achieving total accuracy of 96.15% (95%CI: [91.25–98.74]), COVID-19 sensitivity of 96.08% (95%CI: [86.54–99.5]), CAP sensitivity of 92.86% (95%CI: [76.50–99.19]), Normal sensitivity of 98.04% (95%CI: [89.55–99.95]) while the confidence intervals are obtained using the significance level of 0.05. The obtained AUC values (One class vs Others) are 0.993 (95%CI: [0.977–1]), 0.989 (95%CI: [0.962–1]), and 0.990 (95%CI: [0.971–1]) for COVID-19, CAP, and Normal classes, respectively. The experimental results also demonstrate the capability of the proposed unsupervised enhancement approach in improving the performance and robustness of the model when being evaluated on varied external test sets.

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“…17 However, the downside of such examinations appeared to be low for patients with cancer undergoing radiation therapy and could have been interesting when access to RT-PCR tests was limited. 18 CT simulation is needed in radiation therapy for treatment planning, and although free-breathing images are usually performed, breath-hold chest acquisition can be easily added without modifying the patient workflow. Moreover, radiation exposure might be considered negligible with regard to radiation therapy, even for extrathoracic treatments.…”

Section: Discussionmentioning

confidence: 99%

Systematic Screening of COVID-19 Disease Based on Chest CT and RT-PCR for Cancer Patients Undergoing Radiation Therapy in a Coronavirus French Hotspot

Sun

Achkar

Bockel

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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Background Cancer patients are presumed to be more vulnerable to COVID-19. We evaluated a screening strategy combining chest computed-tomography (CT) and reverse transcription polymerase chain reaction (RT-PCR) for patients treated with radiotherapy (RT) in our cancer center located in a COVID-19 French hotspot during the first wave of the pandemic. Methods Chest CT images were proposed during the radiotherapy CT simulation. Images were reviewed by an expert radiologist according to the CO-RADS classification. Nasal swabs with RT PCR assay were initially proposed in case of suspicious imaging or clinical context and were eventually integrated into the systematic screening. A dedicated radiotherapy workflow was proposed for COVID-19 patients to limit the risk of contamination. Results From March 18, 2020 to May 1, 2020, 480 patients were screened by chest CT, with 313 patients having both chest CT and RT-PCR (65%). Cumulative incidence of COVID-19 was 5.4%, 95%CI [3.6, 7.8] (26 patients out of 480). Diagnosis of COVID-19 was made before RT for 22 patients (84.6%) and during RT for 4 patients (15.3%). Chest CT directly aided the diagnosis of 7 cases for whom the initial RT-PCR was negative or not feasible; out of a total of 480 patients (1.5%) and 517 chest CT acquisition. Four patients with COVID-19 at the time of the chest CT screening had a false negative CT. Sensitivity and specificity of chest CT screening in patients with both RT-PCR and chest CT testing were estimated to be 0.82, 95% CI [0.60, 0.95] and 0.98, 95% CI [0.96, 0.99] respectively.Adaptation of the radiotherapy treatment was made for all the patients with seven postponed treatments (median=5 days, IQR [1.5, 14.8]). Conclusion The benefit of systematic use of chest CT screening during CT simulation for patients undergoing radiotherapy during the COVID-19 pandemic seemed limited.

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Optimization of Patient Management During the COVID-19 Pandemic: Chest CT Scan and PCR as Gatekeepers of the Radiation Therapy Workflow

Cited by 4 publications

References 41 publications

Covid-19 and radiotherapy: a systematic review after 2 years of pandemic

Covid-19 and radiotherapy: a systematic review after 2 years of pandemic

Robust framework for COVID-19 identication from a multicenter dataset of chest CT scans

Systematic Screening of COVID-19 Disease Based on Chest CT and RT-PCR for Cancer Patients Undergoing Radiation Therapy in a Coronavirus French Hotspot

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