CT Chest for Covid-19 - Indications - Position Statement / White Paper from Society of Chest Imaging & Intervention - SCII

The Society of Chest Imaging and Intervention has created a position statement and white paper on the indications of Covid-19, including situations, where CT chest is not indicated. The paper also includes the scanning protocol to be followed as well as the points to be covered in the report, with a short discussion on CO-RADS and the CT severity score out of 25.

The document can be downloaded here and from this site as well.

Summary of Findings

CT Scan Indications

1. Diagnosis

a. Moderate to severe symptomatic patients (breathlessness, falling O2 saturations) suspected to have Covid-19 for quick triage. Cough is NOT an indication.

b. Asymptomatic to minimally symptomatic patients, only when
i. RT-PCR testing not available
ii. RT-PCR testing is available but results are delayed due to backlog or logistical issues by more than 48 hours and the delay will change the way the patient is managed.

c. High clinical suspicion of Covid-19 but a negative RT-PCR report, where the findings of the CT scan will make a difference to management.

d. Other unique or individual situations, e.g. a patient has to undergo emergency surgery and RT-PCR testing or rapid testing is not available or the results will not be available in time and the delay will change management. However, the routine use of CT scan as a pre-admission or pre-surgical test in non-emergency situations is strongly discouraged.

2. Management

a. The patient is symptomatic or symptoms are worsening, and the findings on the CT scan, as against on radiographs, make a difference to management

b. High clinical suspicion of co-existing disease such as tuberculosis or interstitial lung disease that would make a difference to the management of the patient

c. Any other clinical scenario where the findings on the CT scan are likely to make a tangible difference to management

3. Follow-Up

a. Specific clinical situation (patient not improving, worsening, symptomatically or on PFTs)

b. Any other clinical scenario where the findings on the CT scan are likely to make a tangible difference to management

CT Scan Non-Indications

1. Diagnosis

a. Routine evaluation of the lungs in asymptomatic, minimally symptomatic patients. Cough is not an indication

b. Routine pre-admission or pre-surgical evaluation when RT-PCR testing is available

c. Patient/relatives wanting/demanding a CT scan to check status of lungs

2. Management

a. Routine evaluation as part of a routine protocol

b. Patient/relatives wanting regular check CT scans

3. Follow-up

a. Routine follow-up to check the status of the lungs

b. Patient/relatives wanting to check the status of the lungs

This video also explains the white paper / position paper.