Chest CT practice and protocols for COVID-19 from radiation dose management perspective
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COMPUTED TOMOGRAPHY
Chest CT practice and protocols for COVID-19 from radiation dose management perspective Mannudeep K. Kalra 1,2 & Fatemeh Homayounieh 1,2
&
Chiara Arru 1,2 & Ola Holmberg 3 & Jenia Vassileva 3
Received: 17 April 2020 / Revised: 5 June 2020 / Accepted: 12 June 2020 # European Society of Radiology 2020
Abstract The global pandemic of coronavirus disease 2019 (COVID-19) has upended the world with over 6.6 million infections and over 391,000 deaths worldwide. Reverse-transcription polymerase chain reaction (RT-PCR) assay is the preferred method of diagnosis of COVID-19 infection. Yet, chest CT is often used in patients with known or suspected COVID-19 due to regional preferences, lack of availability of PCR assays, and false-negative PCR assays, as well as for monitoring of disease progression, complications, and treatment response. The International Atomic Energy Agency (IAEA) organized a webinar to discuss CT practice and protocol optimization from a radiation protection perspective on April 9, 2020, and surveyed participants from five continents. We review important aspects of CT in COVID-19 infection from the justification of its use to specific scan protocols for optimizing radiation dose and diagnostic information. Key Points • Chest CT provides useful information in patients with moderate to severe COVID-19 pneumonia. • When indicated, chest CT in most patients with COVID-19 pneumonia must be performed with non-contrast, low-dose protocol. • Although chest CT has high sensitivity for diagnosis of COVID-19 pneumonia, CT findings are non-specific and overlap with other viral infections including influenza and H1N1. Keywords COVID-19 . Pandemics . Radiation protection . Tomography, X-ray computed
Abbreviations ACR CDC cDNA COVID-19 CT CTDI DNA IAEA kV mRNA
American College of Radiology Center for Disease Control Single-strand DNA Coronavirus disease 2019 Computed tomography CT dose index Deoxyribonucleic acid International Atomic Energy Agency Kilovolt Messenger RNA
* Fatemeh Homayounieh [email protected] 1
Department of Radiology, Webster Center for Quality and Safety, Massachusetts General Hospital, 75 Blossom Court, Suite 236, Room 248, Boston, MA 02114, USA
2
Harvard Medical School, Boston, MA, USA
3
International Atomic Energy Agency, Vienna, Austria
RCR RNA RT-PCR SARS-CoV-2 US WHO
Royal College of Radiologists Ribonucleic acids Reverse-transcription polymerase chain reaction Severe acute respiratory syndrome coronavirus 2 Ultrasonography World Health Organization
Since its identification in the Hubei province of China in December 2019, the coronavirus disease of 2019 (COVID19) has exploded into a pandemic with more than 6.6 million confirmed cases and at least 391,000 deaths worldwide [1]. With prolonged shutdowns, the economic fallout may also prove devastating, especially on the most vulnerable sections of the population. To slow and halt the spread of infection, widespread testing of the population with suspected COVID19 infection followed by isolation is the
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