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

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 .

Impact of the COVID-19 pandemic on the activity of the Radiological Emergency Department: the experience of the Maggiore della Carità Hospital in Novara

“…According to a large multicentre study by the IAEA, most of the centres involved did not use CT for the first diagnosis, but possibly as a tool for assessing the severity of lung involvement. The use of CT at the patient’s entry point would be justified in a situation of high prevalence of suspicious clinical presentations and a lack of means to timely obtain RT-PCR swabs results [ 5 ]. This tendency was still apparent during phase 2, when the amount of chest CT scans failed to set back to the pre-COVID-19 levels as shown by the statistically significant differences observed in the respective frequency distribution between phase 0 and phase 2.…”

“…It is estimated that 70% of the Italian imaging providers have focused their activity on emergency studies and procedures [ 4 ]. Conversely, the rostering of the ERD reflected this, to accommodate the increasing demand for chest CTs, which have been widely used as a crucial diagnostic and prognostic tool in patients with both suspected and confirmed COVID-19 [ 5 ]. For instance, medical and technical staff presence in the ERD was doubled at all times.…”

Managing Radiation Dose from Chest CT in Patients with COVID-19

“…In this issue of Radiology , the article by Homayounieh et al ( 1 ) provides valuable descriptive data to begin filling these knowledge gaps by presenting variations in CT utilization, protocols, and dose in COVID-19 patients across 34 countries. The authors surveyed 62 healthcare sites from these countries across four continents covering Africa, Asia, Europe, and Latin America between May and July 2020, in a coordinated effort by the International Atomic Energy Agency.…”

Determination of radiation exposure with related to the use of chest CT in during COVID-19 pandemic in pediatric patients

“…CT acquisition with either low or standard dose is controversial, as well. International Atomic Energy Agency (IAEA) coordinated a multicenter study about CT use in 28 countries in COVID-19 and found that only 20% of the centers used reduced-dose (lower than routine protocol) (18). Some authors had reliable results using low-dose CT (19,20).…”