Ernesto Piane

Giovanni Battista Scalera

Irene Piscioli

Michele Scialpi

Diagnostic and Interventional Radiology

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606Diagn Interv Radiol 2020; 26:606© Turkish Society of Radiology 2020L E T T E R  TO  T H E  E D I TO RSafety and role of chest CT in COVID-19 patientsMichele Scialpi Irene Piscioli Giovanni Battista Scalera Ernesto Piane From the Division of Diagnostic Imaging (M.S.  michelescialpi1@gmail.com, E.P.), Department of Surgical and   Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy; Department of Radiology (I.P.), Budrio Hospital, Bologna Italy; Division of Radiology 1 (G.B.S), Santa Maria della Misericordia Hospital,  Perugia, Italy.Dear Editor, We read with great interest the online published articles by An et al. (1) and Sverzellati et al. (2) in the March 2020 issue of Diagnostic and Interventional Radiology. The authors reported the manage-ment strategy of coronavirus disease 2019 (COVID-19) pneumonia emphasizing correctly the measures for safety of staff in the radiol-ogy department (1) and the proper use of imaging in COVID-19 outbreak (2). However, some considerations are needed with re-spect to the management of the CT unit in an adapted COVID-19 hospital and the role of chest CT in COVID-19 patients. In special fever (suspected COVID-19) patients, An et al. (1) indi-cate an independent control room for CT examination, an isolated CT room from normal working environment of the radiology de-partment, with a special channel between the CT room, the fever clinic, and the isolation area.Rapid spread of COVID-19 outbreak has resulted in an overload of hospital admissions, making it necessary to either reorganize the hospital or create a dedicated COVID-19 hospital to ensure safety and guarantee the clinical needs. In the adapted COVID-19 hospi-tals, the route towards CT room/area for suspected or confirmed COVID-19 patients must be dedicated and as short as possible.Identification of a dedicated CT unit, separate from the one used for routine examinations in the emergency area of the radiology departments, is necessary; the examination room should be in a strictly independent location, possibly not shared with other rooms or other CT equipment, in an isolated area or at least one that is separate from the radiology department. In hospitals with numerous CT units, an organizational model may be adopted to reduce the infection rate, such that different CT units may be ded-icated for different levels of suspicion for COVID-19. Additional measures to reduce the spread of infection include using a very short channel for transfer of suspected or confirmed patients, em-ploying a negative pressure disinfection method, and an anti-in-fection head-bag to protect the patient. Sverzellati et al. (2) outline that diagnosis of COVID-19 is based on reverse-transcription polymerase chain reaction (RT-PCR). Chest CT detects viral infection but it does not discriminate the COVID-19 infection from those caused by other viruses (H1N1, SARS-CoV and MERS-CoV); CT should not be used to screen for or as first-line test but  reserved for hospitalized, symptomatic patients with specific clinical indications (3). Epidemiologic history, routine blood work and other preliminary judgments are needed to classify the cases as low risk, suspected, or highly suspected, such that patients can be directed to different areas of the hospital (e.g., isolation wards for different levels of risk).In COVID-19 patients chest CT is helpful for early detection and follow-up of parenchyma patterns (4); in  critically ill COVID-19 pa-tients contrast-enhanced CT of the chest is mandatory to diagnose pulmonary thromboembolism. Finally, in patients recovered from COVID-19 a repeat chest CT may be considered before discharge from the hospital—in addi-tion to normal blood oxygen saturation, absence of symptoms, normal body temperature returned to normal for more than 1 week and at least two RT-PCR tests negative with sampling time at least 24 hours apart—in order to prevent the "relapse of infection" that can be observed in some patients after discharge. Conflict of interest disclosureThe authors declared no conflicts of interest.References1. An P, Ye Y, Chen M, Chen Y, Fan W, Wang Y. Management strategy of novel coronavirus (COVID-19) pneumonia in the radiology department: a Chi-nese experience Diagn Interv Radiol 2020, Mar 25. [Epub ahead of print] 2. Sverzellati N, Milone F, Balbi M. How imaging should be properly used in COVID-19 outbreak: an Italina experience. Diagn Interv Radiol 2020, Mar 31. [Epub ahead of print]  [Crossref]3. Acr.org. (2020). ACR recommendations for the use of chest radiogra-phy and computed tomography (CT) for suspected COVID-19 infection. https://www.acr.org/Advocacy-and-Economics/ACR-Position-State-ments/Recommendations-for-Chest-Radiography-and-CT-for-Suspect-ed-COVID19-Infection.4. Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019- nCoV). Radiology 2020, Feb 4. [Epub ahead of print] [Crossref]Received 16 April 2020; revision requested 24 April 2020; last revision received 01 May 2020; accepted 03 May 2020. Published online 21 May 2020.DOI 10.5152/dir.2019.20247You may cite this article as: Scialpi M, Piscioli I, Scalera GB, Piane E. Safety and role of chest CT in COVID-19 patients. Diagn Interv Radiol 2020; 26:606.

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Safety and role of chest CT in COVID-19 patients

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