A Multicenter Survey on the Trend of Chest CT Scan Utilization: Tracing the First Footsteps of COVID-19 in Iran

Abstract

Background: Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran. Objectives: To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018–2019. Results: A 50.2% increase was noted in the chest CT scan utilization in 2019–2020 compared to 2018–2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1–5 of 2019–2020, respectively. In Month 6 of 2019–2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018–2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018–19. Conclusion: The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.

Agreement between low-dose and ultra-low-dose chest CT for the diagnosis of viral pneumonia imaging patterns during the COVID-19 pandemic

“…Many medical centers adhered to the proposed strategy, and chest CT imaging was used for the triage of suspected patients. This in turn is translated to an increasing pattern in the number of chest CT scans and consequently a higher radiation dose [ 19 ]. When this high number of CT acquisitions is coupled with repeated imaging for following progression/absorption of the lesions, patients are exposed to high degrees of irradiation.…”

Findings of Abdominal Imaging in Patients with COVID-19 – Part 1: Hollow Organs

“…10 In the early approach in COVID-19 patients with respiratory symptoms, a chest computed tomography (CT) is a valuable modality to control the pandemic. 12 Still, in patients with a severe and atypical GI manifestation of COVID-19, cross-sectional abdominal imaging can be utilized to detect severe disease complications more quickly and start treatment as soon as possible. 10 According to prior findings, on abdominal CT, 65% of patients with COVID-19 had ground-glass opacities at the base of the lungs.…”

Radiation Exposure and Lifetime Attributable Risk of Cancer Incidence and Mortality from Low- and Standard-Dose CT Chest: Implications for COVID-19 Pneumonia Subjects

“…Since the novel coronavirus disease 2019 (COVID-19) pandemic, the role of chest CT has garnered increased attention for screening, diagnosis and management of patients with suspected or known COVID-19, as well as for monitoring the disease progress and its complications [ 17 , 18 ]. To date, more than 616 million cases of COVID-19 have been identified worldwide [ 19 , 20 ], many of whom were subjected to CT scanning [ 21 ] and some even underwent repeat CT examinations ranging between 2–8 scans [ 21 , 22 , 23 , 24 , 25 ]. The dramatic increase in the number of CT scans in a short span of time has raised concerns about patient safety [ 21 ].…”