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Coronavirus & American College of Radiologists

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Coronavirus & American College of Radiologists

Following our latest update on ACE inhibitors and AR blockers, we have had further
enquiries regarding the use of lung CT scanning for the diagnosis of COVID-19. This
technique poses a number of difficulties, firstly and most importantly that the radiological
findings can be suggestive of a viral or other pneumonitis, but are not specific for
Coronavirus. Secondly it involves the use of machinery that then needs to be sterilised
between one patient and the next, as well as exposure of patient to staff or staff to patient.
Thirdly is the consideration of radiation exposure to a patient that may not be required.
Below is the latest recommendation from the American College of Radiologists:
• CT should not be used to screen for or as a first-line test to diagnose COVID-19
• CT should be used sparingly and reserved for hospitalized, symptomatic patients with specific
clinical indications for CT. Appropriate infection control procedures should be followed before
scanning subsequent patients.
• Facilities may consider deploying portable radiography units in ambulatory care facilities for
use when CXRs are considered medically necessary. The surfaces of these machines can be
easily cleaned, avoiding the need to bring patients into radiography rooms.
• Radiologists should familiarize themselves with the CT appearance of COVID-19 infection in
order to be able to identify findings consistent with infection in patients imaged for other
• (Updated March 22, 2020) As an interim measure, until more widespread COVID-19 testing
is available, some medical practices are requesting chest CT to inform decisions on whether
to test a patient for COVID-19, admit a patient or provide other treatment. The ACR strongly
urges caution in taking this approach. A normal chest CT does not mean a person does not
have COVID-19 infection – and an abnormal CT is not specific for COVID-19 diagnosis. A
normal CT should not dissuade a patient from being quarantined or provided other clinically
indicated treatment when otherwise medically appropriate. Clearly, locally constrained
resources may be a factor in such decision making.
We would therefore recommend that the patient be isolated for 14 days and a PCR Covid-
19 test by nasopharyngeal swab for high risk patients or persisting symptoms.
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