Physicians should decide on chest CT scans, say doctors

By Serena Josephine M.

The rise in coronavirus infections has led to several patients seeking chest CT scans on their own. Not everyone who tests positive for COVID-19 requires a CT scan, and the decision should be left to the treating physicians, according to doctors.

V. Anand Kumar, nodal officer, Tamil Nadu Government Multi Super Speciality Hospital, said, “Right now, we have to convince many persons who have tested positive for COVID-19 that not all require scans. People tell us that they have mild fever with cough and want to undergo a scan. We are telling them that cough and sore throat are quite common now, and scans are not required if there is no breathing difficulty and no dip in oxygen saturation. The second wave was different as we saw patients with lung involvement in the early days itself, and the same protocol need not be followed now.”

He said that at the COVID-19 outpatient department, the earlier protocol of prescribing a CT scan for persons who had tested positive was dropped, and home isolation was recommended with continuous monitoring for healthy and fully vaccinated individuals with a mild disease.

Koushik Muthu Raja M,, associate professor, Department of Pulmonary Medicine, Sri Ramachandra Medical Centre, said, “The number of persons voluntarily seeking CT scans is high. It is important that scans are performed judiciously and decided by healthcare providers. Self-medication and self-treatment is not correct. Whether a patient should be in home isolation or admitted to hospital or requires a scan should be decided in a clinical setting under the supervision of a healthcare provider.”

As of now, scans were required for persons who had a fall in oxygen saturation levels and those with co-morbidities and immune-compromised conditions, he said. Furthermore, “scans performed in the early phases of the disease can be normal and misleading”.

Another doctor said scan centres should perform scans only on prescription/request from physicians and not on patients’ request. “Most COVID-19 patients have a scan with them, often done by their referring doctor or hospital. In 80% of these cases, the scans are probably unnecessary,” said Srinivas Rajagopala, director of Transplant Pulmonology and Lung Failure Unit, Kauvery Hospital.

“We do a scan only if a patient has persistent fever for three days, breathing trouble and saturation of less than 93%, or any concerns on examination, or previous lung disease that they are worried could be worsened by COVID-19. Otherwise, we do not prescribe scans upfront for everybody. It is important to avoid unnecessary scans for two reasons. One is unnecessarily doing tests and coughing up money and secondly, scans involve radiation. A lot of people have undergone a lot of CT scans over the last two years, adding to the cumulative radiation. The State government has brought out guidelines, and we have to make sure that unnecessary tests are avoided,” he said.

R. Narasimhan, chairman, Respiratory Research Foundation of India, said the level of awareness among people had improved. “People are aware that Omicron does not affect the lungs or cause oxygen dependency. So, there is no increase in CT scan requirement unlike the scenario in the previous wave. Earlier, people used to walk in with CT scans. Now, the majority of them are asymptomatic. In general, there is no need for a scan and we do not suggest it unless they are symptomatic, have co-morbidities, or are unvaccinated,” he said.


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