If COVID-19 Detected – Do not Hurry to Do CT

Svitlana Chernetska, deputy chief physician of the Family Medicine Center in the Odessa region, warns about this. Today, the situation with the spread of coronavirus in Ukraine is worsening. At the first symptoms of the disease, people do tests and, without further consultation with a doctor, prescribe a computed tomography (CT). “Don’t do it in any circumstances,” the doctor notes. “A positive test for COVID-19, provided the patient is in a satisfactory condition, is not a reason to prescribe CT.”

According to Svitlana Chernetska, a family doctor should decide whether to perform СT or radiography of the lungs. The physician will assess the clinical picture in a comprehensive manner: how long the patient has been sick, what indicators the fever reaches, what is the level of oxygen saturation in the blood, what is the cough and is there laboured breathing.

In the early days of the disease (COVID-19 – ed.), there is no point in CT, because there is a certain category of patients with the course of the disease without pneumonia,” the expert says. Usually, the need for CT may occur on the seventh – eighth day of the disease with a clearly represented clinical picture: when the fever is above 38 ° C, there is a dry paroxysmal cough, intoxication, sweating, lack of appetite and oxygen saturation in the blood is below 95%. “I know cases when patients, having learned about infection with COVID-19, immediately went to private clinics and had CT. Of course, the examination was not informative. On the seventh – eighth day, the situation worsened and they had to do CT again. This, believe me, is far from the most useful examination for the body, ” Svitlana Chernetska emphasized.

To the question is there an alternative to chest radiography and CT diagnostics, Svitlana Chernetska answers in the affirmative. “Such an alternative is ultrasound investigation (US) of the lungs. However, there are cases when this investigation is not enough to make a diagnosis. For example, the percentage of lung damage is not visualized using US,” the doctor notes.                        

Ruslana Tripailo, Deputy Chairman of the State Nuclear Regulatory Inspectorate of Ukraine – Deputy Chief State Inspector for Nuclear and Radiation Safety of Ukraine (SNRIU) talks about the risks from CT, chest radiography and the position of the domestic nuclear regulator.

“In the situation that has developed with the widespread CT of the chest organs for COVID-19 diagnostics, it is extremely important to comply with the basic principles of radiation protection in medical exposure, namely: justification and optimization of these diagnostic procedures for the public in general and for each patient in particular”, Ruslana Tripailo says.

To date, there are no protocols and diagnostic reference dose levels for chest CT for patients with COVID-19 in Ukraine. Under normal conditions of the investigation, the effective exposure dose for CT is up to 7 mSv per procedure (which refers to high doses of medical exposure), for a digital X-ray machine – up to 0.2 mSv.

According to IAEA recommendations, during the COVID-19 pandemic, it is very important to control medical exposure doses. International experts advise low-dose, single-phase, non-contrast CT of the chest organs (dose index (CTDIvol) value is less than 3 mGy for an adult and less than 1 mGy for a child).

According to Ruslana Tripailo, SNRIU requires meeting the requirements of legislation, standards and rules on nuclear and radiation safety during authorizing activities and oversight measures. Medical exposure should be performed only upon a written prescription of a doctor (family doctor), exhaustive consultations with a radiologist regarding the expected health benefits and risks, justification and advisability of CT for a particular patient and possible alternative (non-radiation) research methods.              

“The need for medical exposure is an exclusive priority right of the radiologist, who, in fact, is responsible for CT justification, quality control of the procedure and optimization of the patient’s radiation protection,” the SNRIU Deputy Chairman concludes.

Uatom.org Editorial Board