Low-dose computed tomography in COVID-19: systematic review

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Abstract

BACKGROUND: The increased number of computed tomography scans during the COVID-19 pandemic has emphasized the task of decreasing radiation exposure of patients, since it is known to be associated with an elevated risk of cancer development. The ALARA (as low as reasonably achievable) principle, proposed by the International Commission on Radiation Protection, should be adhered to in the operation of radiation diagnostics departments, even during the pandemic.

AIM: To systematize data on the appropriateness and effectiveness of low-dose computed tomography in the diagnosis of lung lesions in COVID-19.

MATERIALS AND METHODS: Relevant national and foreign literature in scientific libraries PubMed and eLIBRARY, using English and Russian queries “low-dose computed tomography” and “COVID-19,” published between 2020 and 2022 were analyzed. Publications were evaluated after assessing the relevance to the review topic by title and abstract analysis. The references were further analyzed to identify articles omitted during the search that may meet the inclusion criteria.

RESULTS: Published studies summarized the current data on the imaging of COVID-19 lung lesions and the use of computed tomography scans and identified possible options for reducing the effective dose.

CONCLUSION: We present techniques to reduce radiation exposure during chest computed tomography and preserve high-quality diagnostic images potentially sufficient for reliable detection of COVID-19 signs. Reducing radiation dose is a valid approach to obtain relevant diagnostic information, preserving opportunities for the introduction of advanced computational analysis technologies in clinical practice.

About the authors

Ivan A. Blokhin

Moscow Center for Diagnostics and Telemedicine

Author for correspondence.
Email: BlokhinIA@zdrav.mos.ru
Russian Federation, Moscow

Denis А. Rumyantsev

Moscow Center for Diagnostics and Telemedicine

Email: x.radiology@mail.ru
ORCID iD: 0000-0001-7670-7385
SPIN-code: 8734-2085
Russian Federation, Moscow

Maria M. Suchilova

Moscow Center for Diagnostics and Telemedicine

Email: SuchilovaMM@zdrav.mos.ru
ORCID iD: 0000-0003-1117-0294
SPIN-code: 4922-1894
Russian Federation, Moscow

Anna P. Gonchar

Moscow Center for Diagnostics and Telemedicine

Email: GoncharAP@zdrav.mos.ru
ORCID iD: 0000-0001-5161-6540
SPIN-code: 3513-9531
Russian Federation, Moscow

Olga V. Omelyanskaya

Moscow Center for Diagnostics and Telemedicine

Email: OmelyanskayaOV@zdrav.mos.ru
ORCID iD: 0000-0002-0245-4431
SPIN-code: 8948-6152
Russian Federation, Moscow

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2. Figure 1. Comparison of a dedicated low-dose computed tomography protocol for COVID-19 (SD = 36) with standard and low-dose computed tomography for lung cancer screening. Data on radiation exposure and axial tomograms of the phantom at the level of the lower and middle zones of the lungs. Low-dose computed tomography for lung cancer screening was developed considering the need for radiation exposure limitation as preventive measures according to SanPin (disease control and prevention standards) and has the lowest signal-to-noise ratio. The proposed protocol for low-dose computed tomography for COVID-19 considers the densitometric characteristics of ground-glass lesions with a significant reduction in radiation exposure.

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3. Figure 2. Radiation exposure is reduced by 5 times. Patient, 59 y. o., BMI 29 kg/m2. Computed tomography with a soft tissue filter (effective dose: 9.7 mSv), low-dose computed tomography with a soft tissue filter (effective dose: 2.1 mSv). In the upper lobe of the left lung, there was a peripheral ground-glass lesion.

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4. Figure 3. Radiation exposure is reduced by 1.5 times. Patient, 44 y. o., BMI 46 kg/m2. Computed tomography with a soft tissue filter (effective dose: 15.3 mSv), low-dose computed tomography with a soft tissue filter (effective dose: 10.5 mSv). Bilateral peripheral ground-glass lesions.

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