CT Examinations for COVID-19: A Systematic Review of Protocols, Radiation Dose, and Numbers Needed to Diagnose and Predict
Purpose Although chest CT has been discussed as a first-line test for coronavirus disease 2019 (COVID-19), little research has explored the implications of CT exposure in the population. To review chest CT protocols and radiation doses in COVID-19 publications and explore the number needed to dia...
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The Korean Society of Radiology
2021
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oai:doaj.org-article:4927c5a98af3408a9d283abcb489ac7f2021-11-29T11:01:20ZCT Examinations for COVID-19: A Systematic Review of Protocols, Radiation Dose, and Numbers Needed to Diagnose and Predict2288-2928https://doaj.org/article/4927c5a98af3408a9d283abcb489ac7f2021-11-01T00:00:00Zhttps://doi.org/10.3348/jksr.2021.0096https://doaj.org/toc/2288-2928Purpose Although chest CT has been discussed as a first-line test for coronavirus disease 2019 (COVID-19), little research has explored the implications of CT exposure in the population. To review chest CT protocols and radiation doses in COVID-19 publications and explore the number needed to diagnose (NND) and the number needed to predict (NNP) if CT is used as a first-line test. Materials and Methods We searched nine highly cited radiology journals to identify studies discussing the CT-based diagnosis of COVID-19 pneumonia. Study-level information on the CT protocol and radiation dose was collected, and the doses were compared with each national diagnostic reference level (DRL). The NND and NNP, which depends on the test positive rate (TPR), were calculated, given a CT sensitivity of 94% (95% confidence interval [CI]: 91%–96%) and specificity of 37% (95% CI: 26%–50%), and applied to the early outbreak in Wuhan, New York, and Italy. Results From 86 studies, the CT protocol and radiation dose were reported in 81 (94.2%) and 17 studies (19.8%), respectively. Low-dose chest CT was used more than twice as often as standarddose chest CT (39.5% vs.18.6%), while the remaining studies (44.2%) did not provide relevant information. The radiation doses were lower than the national DRLs in 15 of the 17 studies (88.2%) that reported doses. The NND was 3.2 scans (95% CI: 2.2–6.0). The NNPs at TPRs of 50%, 25%, 10%, and 5% were 2.2, 3.6, 8.0, 15.5 scans, respectively. In Wuhan, 35418 (TPR, 58%; 95% CI: 27710–56755) to 44840 (TPR, 38%; 95% CI: 35161–68164) individuals were estimated to have undergone CT examinations to diagnose 17365 patients. During the early surge in New York and Italy, daily NNDs changed up to 5.4 and 10.9 times, respectively, within 10 weeks. Conclusion Low-dose CT protocols were described in less than half of COVID-19 publications, and radiation doses were frequently lacking. The number of populations involved in a first-line diagnostic CT test could vary dynamically according to daily TPR; therefore, caution is required in future planning.Jong Hyuk LeeHyunsook HongHyungjin KimChang Hyun LeeJin Mo GooSoon Ho YoonThe Korean Society of Radiologyarticlecoronavirustomographyx-ray computedradiation dosagemass screeningclinical protocolsMedical physics. Medical radiology. Nuclear medicineR895-920ENKO대한영상의학회지, Vol 82, Iss 6, Pp 1505-1523 (2021) |
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coronavirus tomography x-ray computed radiation dosage mass screening clinical protocols Medical physics. Medical radiology. Nuclear medicine R895-920 |
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coronavirus tomography x-ray computed radiation dosage mass screening clinical protocols Medical physics. Medical radiology. Nuclear medicine R895-920 Jong Hyuk Lee Hyunsook Hong Hyungjin Kim Chang Hyun Lee Jin Mo Goo Soon Ho Yoon CT Examinations for COVID-19: A Systematic Review of Protocols, Radiation Dose, and Numbers Needed to Diagnose and Predict |
| description |
Purpose Although chest CT has been discussed as a first-line test for coronavirus disease 2019
(COVID-19), little research has explored the implications of CT exposure in the population. To review
chest CT protocols and radiation doses in COVID-19 publications and explore the number
needed to diagnose (NND) and the number needed to predict (NNP) if CT is used as a first-line test.
Materials and Methods We searched nine highly cited radiology journals to identify studies discussing
the CT-based diagnosis of COVID-19 pneumonia. Study-level information on the CT protocol
and radiation dose was collected, and the doses were compared with each national diagnostic
reference level (DRL). The NND and NNP, which depends on the test positive rate (TPR),
were calculated, given a CT sensitivity of 94% (95% confidence interval [CI]: 91%–96%) and specificity
of 37% (95% CI: 26%–50%), and applied to the early outbreak in Wuhan, New York, and Italy.
Results From 86 studies, the CT protocol and radiation dose were reported in 81 (94.2%) and 17
studies (19.8%), respectively. Low-dose chest CT was used more than twice as often as standarddose
chest CT (39.5% vs.18.6%), while the remaining studies (44.2%) did not provide relevant information.
The radiation doses were lower than the national DRLs in 15 of the 17 studies (88.2%)
that reported doses. The NND was 3.2 scans (95% CI: 2.2–6.0). The NNPs at TPRs of 50%, 25%,
10%, and 5% were 2.2, 3.6, 8.0, 15.5 scans, respectively. In Wuhan, 35418 (TPR, 58%; 95% CI:
27710–56755) to 44840 (TPR, 38%; 95% CI: 35161–68164) individuals were estimated to have
undergone CT examinations to diagnose 17365 patients. During the early surge in New York
and Italy, daily NNDs changed up to 5.4 and 10.9 times, respectively, within 10 weeks.
Conclusion Low-dose CT protocols were described in less than half of COVID-19 publications,
and radiation doses were frequently lacking. The number of populations involved in a first-line diagnostic CT test could vary dynamically according to daily TPR; therefore, caution is required in future
planning. |
| format |
article |
| author |
Jong Hyuk Lee Hyunsook Hong Hyungjin Kim Chang Hyun Lee Jin Mo Goo Soon Ho Yoon |
| author_facet |
Jong Hyuk Lee Hyunsook Hong Hyungjin Kim Chang Hyun Lee Jin Mo Goo Soon Ho Yoon |
| author_sort |
Jong Hyuk Lee |
| title |
CT Examinations for COVID-19: A Systematic Review of Protocols, Radiation Dose, and Numbers Needed to Diagnose and Predict |
| title_short |
CT Examinations for COVID-19: A Systematic Review of Protocols, Radiation Dose, and Numbers Needed to Diagnose and Predict |
| title_full |
CT Examinations for COVID-19: A Systematic Review of Protocols, Radiation Dose, and Numbers Needed to Diagnose and Predict |
| title_fullStr |
CT Examinations for COVID-19: A Systematic Review of Protocols, Radiation Dose, and Numbers Needed to Diagnose and Predict |
| title_full_unstemmed |
CT Examinations for COVID-19: A Systematic Review of Protocols, Radiation Dose, and Numbers Needed to Diagnose and Predict |
| title_sort |
ct examinations for covid-19: a systematic review of protocols, radiation dose, and numbers needed to diagnose and predict |
| publisher |
The Korean Society of Radiology |
| publishDate |
2021 |
| url |
https://doaj.org/article/4927c5a98af3408a9d283abcb489ac7f |
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