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Limit chest CT scan use in Covid diagnosis: Doctors

Various other pathogens and non-infectious causes can also lead to similar CT findings as seen in Covid-19 pneumonia, according to Dr Jitendra Oswal, deputy medical director of Bharati Hospital, who urged that a chest CT should not be used as a screening tool for Covid-19.

Written by Anuradha Mascarenhas | Pune |
September 5, 2020 10:19:41 am
With over 63,000 Covid infections in Sept, Haryana records 98.66% jump in cases in one monthAccording to the state Covid bulletins released daily, the total number of people who had got infected with novel coronavirus in Haryana till August 31 was 64,732.

Doctors have urged people not to unnecessarily undergo expensive chest CT scans and use them as a screening tool to detect Covid-19.

“A CT chest scan has been increasingly used as one of the first investigations of diagnosis for Covid-19. Unfortunately, there are limitations as CT findings — though sensitive — are not specific for Covid-19,” said Dr Jitendra Oswal, deputy medical director of Bharati Hospital.

Antigen and RT-PCR tests are freely available and are the gold standard for diagnosis of Covid-19, he said. “For some time now, people have been undergoing CT scans on the recommendation of their general practitioners. The scan should be limited to diagnosing Covid-19 only in certain patients,” Oswal added.

Various other pathogens and non-infectious causes can also lead to similar CT findings as seen in Covid-19 pneumonia, according to Dr Oswal, who urged that a chest CT should not be used as a screening tool for Covid-19.

There are at least 1.81 lakh Covid-19 cases in Pune district, of which 31,886 are active cases while the death toll is 4,222.

Dr Sujata Rege, an infectious diseases consultant at Bharati Hospital, said it had become a cause for concern as anyone with fever was being recommended a CT scan as the first modality for detecting Covid-19. Not only are the tests expensive but there is exposure to radiation, experts said.

“Also, this may delay the diagnosis,” Rege said and pointed out that at the Bharati Covid dedicated hospital, where more than 2,000 patients have been treated since April, the protocol was towards a judicious use of the chest CT scan.

Patients who are suspected Covid-19 cases based on clinical laboratory epidemiological and X-ray findings but test negative on consecutive RT PCR should get a chest CT done, Oswal said. If typical findings of bilateral, basal and peripheral ground glassing infiltrates are seen, these patients need to be isolated despite a negative PCR report, he added.

Dr Parikshit Prayag, infectious diseases specialist at Deenanath Mangeshkar Hospital, said Covid-19 starts as an upper respiratory infection and then goes on to involve the lower respiratory tract — so in select cases, if the PCR is negative after the fifth day of illness and is a clinically suspected Covid case — then a chest CT scan can be a sensitive tool to diagnose.

Meanwhile, a report in the May edition of the Journal of Association of Physicians of India experts said even if the chest CT might be a diagnostic tool with high sensitivity, RT-PCR still remains the gold standard diagnostic test for Covid-19.

According to experts like Oswal, a chest CT can also be used in hospitalised patients with severe Covid-19 disease for diagnosing sequelae like fibrosis and secondary infections. There is a need to judiciously use available resources and provide appropriate timely care, Oswal said.

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