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

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          Abstract

          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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          Most cited references20

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          Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic

          Megan Ranney, Valerie Griffeth, Ashish Jha (2020)
          New England Journal of Medicine
          Article 0 comments Cited 893 times – based on 0 reviews     Review now
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            Modelling the COVID-19 epidemic and implementation of population-wide interventions in Italy

            Giulia Giordano, Franco Blanchini, Raffaele Bruno … (2020)
            In Italy, 128,948 confirmed cases and 15,887 deaths of people who tested positive for SARS-CoV-2 were registered as of 5 April 2020. Ending the global SARS-CoV-2 pandemic requires implementation of multiple population-wide strategies, including social distancing, testing and contact tracing. We propose a new model that predicts the course of the epidemic to help plan an effective control strategy. The model considers eight stages of infection: susceptible (S), infected (I), diagnosed (D), ailing (A), recognized (R), threatened (T), healed (H) and extinct (E), collectively termed SIDARTHE. Our SIDARTHE model discriminates between infected individuals depending on whether they have been diagnosed and on the severity of their symptoms. The distinction between diagnosed and non-diagnosed individuals is important because the former are typically isolated and hence less likely to spread the infection. This delineation also helps to explain misperceptions of the case fatality rate and of the epidemic spread. We compare simulation results with real data on the COVID-19 epidemic in Italy, and we model possible scenarios of implementation of countermeasures. Our results demonstrate that restrictive social-distancing measures will need to be combined with widespread testing and contact tracing to end the ongoing COVID-19 pandemic.
            Article 0 comments Cited 696 times – based on 0 reviews     Review now
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              Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients

              Ho Yuen Frank Wong, Hiu Yin Sonia Lam, Ambrose Fong … (2020)
              Background Current COVID-19 radiological literature is dominated by CT and a detailed description of chest x-ray (CXR) appearances in relation to the disease time course is lacking. Purpose To describe the time course and severity of the CXR findings of COVID-19 and correlate these with real time reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-Cov-2 nucleic acid. Materials and Methods Retrospective study of COVID-19 patients with RT-PCR confirmation and CXRs admitted across 4 hospitals evaluated between January and March 2020. Baseline and serial CXRs (total 255 CXRs) were reviewed along with RT-PCRs. Correlation with concurrent CTs (total 28 CTs) was made when available. Two radiologists scored each CXR in consensus for: consolidation, ground glass opacity (GGO), location and pleural fluid. A severity index was determined for each lung. The lung scores were summed to produce the final severity score. Results There were 64 patients (26 men, mean age 56±19 years). Of these, 58, 44 and 38 patients had positive initial RT-PCR (91%, [CI: 81-96%]), abnormal baseline CXR (69%, [CI: 56-80%]) and positive initial RT-PCR with abnormal baseline CXR (59 [CI:46-71%]) respectively. Six patients (9%) showed CXR abnormalities before eventually testing positive on RT-PCR. Sensitivity of initial RT-PCR (91% [95% CI: 83-97%]) was higher than baseline CXR (69% [95% CI: 56-80%]) (p = 0.009). Radiographic (mean 6 ± 5 days) and virologic recovery (mean 8 ± 6 days) were not significantly different (p= 0.33). Consolidation was the most common finding (30/64, 47%), followed by GGO (21/64, 33%). CXR abnormalities had a peripheral (26/64, 41%) and lower zone distribution (32/64, 50%) with bilateral involvement (32/64, 50%). Pleural effusion was uncommon (2/64, 3%). The severity of CXR findings peaked at 10-12 days from the date of symptom onset. Conclusion Chest x-ray findings in COVID-19 patients frequently showed bilateral lower zone consolidation which peaked at 10-12 days from symptom onset.
              Article 0 comments Cited 593 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jenia Vassileva:
                ORCID: https://orcid.org/0000-0002-1788-4186
                Journal
                Journal ID (nlm-ta): Radiology
                Journal ID (iso-abbrev): Radiology
                Journal ID (publisher-id): Radiology
                Title: Radiology
                Publisher: Radiological Society of North America
                ISSN (Print): 0033-8419
                ISSN (Electronic): 1527-1315
                Publication date (Electronic): 10 November 2020
                Electronic Location Identifier: 203453
                Affiliations
                [1]Fom the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA (F.H., M.K.K.); Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria (O.H., J.V.); The Royal Hospital, Muscat, Oman (R.A.U.); Alfa Scan Radiology Center, Cairo, Egypt (S.A.); Department of Radiology, Lithuanian University of Health Sciences, Kaunas, Lithuania (A.B.); Institute of Physics, University of São Paulo, São Paulo, Brazil (P.R.C); Hamad Medical Corporation, Doha, Qatar (A.D.); Faculty of Natural Sciences and Mathematics, Ss. Cyril and Methodius University, Skopje, North Macedonia (V.G.); Tartu University Hospital; University of Tartu, Institute of Clinical Medicine, Department of Radiology, Tartu, Estonia (P.I.); Aleksandrovska University Hospital, Sofia, Bulgaria (D.K.); Institute of Radioprotection and Dosimetry, National Nuclear Energy Commission, Rio de Janeiro, Brazil (S.K.R.); Radiology Department, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran (I.M.); Medical Physics Unit, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy (O.R.); Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova (N.R.); Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Accra, Ghana (I.S.); University Hospital, Lomonosov Moscow State University, Moscow, Russian Federation (V.S.); University Hospital Osijek, Faculty of Medicine, J.J.Strossmayer University of Osijek, Osijek, Croatia (T.T.); Department of Radiology, Hôpital Européen Georges Pompidou, Paris, France (C.V.N.T.)
                Author notes
                Corresponding author: J.V. e-mail: J.Vassileva@ 123456iaea.org
                Author information
                https://orcid.org/0000-0003-0402-4037
                https://orcid.org/0000-0001-6036-2319
                https://orcid.org/0000-0003-2724-5035
                https://orcid.org/0000-0001-6610-410X
                https://orcid.org/0000-0002-4712-1454
                https://orcid.org/0000-0002-9747-8574
                https://orcid.org/0000-0002-8357-7029
                https://orcid.org/0000-0001-7956-6864
                https://orcid.org/0000-0002-8248-3354
                https://orcid.org/0000-0003-3078-5438
                https://orcid.org/0000-0003-3767-5872
                https://orcid.org/0000-0002-5649-2193
                https://orcid.org/0000-0003-1535-1359
                https://orcid.org/0000-0001-7241-6361
                https://orcid.org/0000-0001-9938-7476
                https://orcid.org/0000-0002-1788-4186
                Article
                Publisher-manuscript ID: 203453
                DOI: 10.1148/radiol.2020203453
                PMC ID: 7673104
                PubMed ID: 33170104
                SO-VID: 4b5a20d0-0b4e-4e9e-ad7f-b0f62c78c178
                Copyright © 2020 by the Radiological Society of North America, Inc.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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