IRIA PRESS STATEMENT

(05-05-2021)

The Indian Radiological and Imaging Association is shocked and

disappointed at the recent comments by Dr Randeep Guleria,
Director AIIMS on the use of CT Scans in the evaluation of Covid
19 patients, which has been widely circulated by the press and
social media. The statement given by Dr Randeep are
misleading and creates confusion among the public and his
warning that one CT scan is equal to 300-400 X Rays and CT
scans cause cancer is outdated and wrong.

We would like to put out a few facts to clear the confusion.

1. RT PCR is the investigation of choice for diagnosing COVID 19

patients. However CT Scan is used in diagnosis in patients
who have typical features of Covid 19 but are RTPCR
negative due to mutant variant, technical errors or low viral
load. CT Chest helps to diagnose these patients and early
detection helps to start treatment and also stops them from being
super spreaders. It is for this reason several state governments
have asked the radiology departments to notify patients with
CORADS score of 4 or 5.

2. While RTPCR helps in the diagnosis, CT Chest helps to stage

the severity of disease, especially in symptomatic patients.
CT Score given for COVID 19 patients helps the clinicians initiate
treatment. This score helps the clinicians decide if the patient
can be in home quarantine or needs hospital admission.

3. CT Chest is helpful to stage the disease mild, moderate or severe

there by contributing significantly in management. More over
the progression of the disease can be monitored by CT especially
in patients who are deteriorating.

In a disease like Covid 19 which has a very unpredictable course

Identifying at risk individuals early and timely initiation of treatment
is of utmost importance. As CT is far more sensitive than
 saturation monitoring by pulse oximetry in detecting lung damage, in
the early phase of disease
Initiating steroids at the right time can halt the progression of lung
involvement before saturation starts falling. Already hospitals are
overburdened and with early administration of treatment, it might be
possible to manage the patients at home . Earlier the treatment is
started, easier it is to save a patient.

Now young people present with happy hypoxia (when patients have
low oxygen saturation, but do not feel any symptoms) and they do not
get alarmed till the disease has progressed with severe damage to
lungs. This is common with young patients who can with stand upto
Spo2 of 80 % , while older people can withstand upto 90% Spo2.

4. CT Chest can be performed quickly especially in emergencies when

RTPCR reports take time, and initiation of early treatment is a requirement.
CT Chest helps to alert the clinician of a suspicious patient, thus preventing
the exposure of healthcare professionals and also preventing a super spreader
scenario.

5. CT Chest also helps to diagnose several conditions that mimic Covid

19 like other bacterial and viral infections, cardiac failure etc…

6. CT Chest vs Chest X ray

The classical feature of Covid 19 is the ground glass opacities seen in the
subpleural region especially in the lower lobes. Several studies have concluded
that Chest X ray is useless in the diagnosis of early Covid and can be used
only in the follow of patients with severe Covid 19 pneumonia to monitor
progression. The study shows that CT scanning has demonstrated excellent
sensitivity and should strongly be considered during the pandemic in the
initial assessment of COVID-19. This needs to be balanced against the risk
of excess radiation with CT, where capacity allows.

1. Radiation in CT Imaging

Dr Randeep in his statement had claimed that one CT Chest is

equal to 300-400 X rays. This is a very retrograde and was the
situation 30-40 years ago. The modern CT Scanners use ultra low
dose CT which has radiation comparable to only 5 – 10 x-rays.
Radiologists all over the world follow the ALARA principle (As Low As
 Reasonably Achievable) and give the minimal radiation possible during the scan.
With the advent of low dose CT techniques and advancement in the software’,
the dose is reduced to one third to one fourth and with ultra low dose CT scan,
we can reduce to one tenth. The medical investigations and treatment are also
analysed based on the Risk vs Benefit Ratio and is very clear in this case the
Benefit far outweighs the Risk which is almost non-existent.

Also the statement that CT Chest can cause Lung Cancer is alarming.
The radiation dose from a single CT Chest is almost equivalent to the
back ground radiation received by any person over a year. At a time
when the Covid 19 pandemic is creating havoc and we are trying to triage the
patients and make use of the limited medical supplies to the best, such type of
unscientific and irresponsible statements from such senior health
authorities creates confusion among the public and hampers COVID 19
treatment.

During this ragging Covid 19 pandamic, Radiologists and

radiographers are putting their life at risk and are contributing
significantly in this battle. IRIA is promoting the vaccination drive of
the nation and also all precautions suggestions by the Government of
India. I also salute all the radiation workers who are working with the
risk of COVID 19 and radiation.

Long Live IRIA !

Jai Hind !!

Prof.C.Amarnath,MD,FRCR,MBA,PhD
President
Indian Radiological and Imaging Association (IRIA),
amarrd02@yahoo.co.in /09884877622

REFERENCES:

1. European Respiratory Journal 2021; DOI: 10.1183/13993003.04188-2020

2. Borakati A, Perera A, Johnson J, et al

3. Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched

database study
 4. BMJ Open 2020;10:e042946. doi: 10.1136/bmjopen-2020-042946

5. Was non utilisation of computed tomography as a public health tool a costly

lapse in closing the pandemic? – Editorial IJRI. Dr Anirudh Kholi Chief
Radiologist Breach Candy Hospital Trust, 60 Bhulabhai Desai Road, Mumbai,
Maharashtra, India. E mail: dranirudhkohli@gmail.com, IJRI
6. Incidental chest computed tomography findings in asymptomatic Covid 19
patients. A multicentre Indian perspective Rochita V Ramanan, Anagha R
Joshi1, Akash Venkataramanan2, Senthur P Nambi3, Rashmi Badhe,
Departments of Radiology and 3Infectious Diseases, Apollo Hospitals Chennai,
2Intern, Madras Medical College, Chennai, Tamil Nadu, 1Department of
Radiology, Lokmanya Tilak Municipal Medical College and General Hospital,
Sion, 4Department of Radiology, Global Hospitals, Mumbai, Maharashtra,
India , IJRI

7. Does CT help in reducing RT PCR false negative rate for COVID 19? Anirudh
Kohli, Anagha Joshi1, Ankur Shah2, Richa D Jain3, Abhishek Gorlawar4,
Amol Dhapare5, Jigar Desai6, Aditya Shetty, Chirag Shah7, Prachi Ostwal8,
Anisha Talraja1  Department of Radiodiagnosis, Breach Candy Hospital,
Mumbai, 1Department of Radiodiagnosis, LTMMC Sion Hospital, Mumbai
2 3
,  Sadbhav Diagnostics, Ahmedabad, Department Of Radiodiagnosis, Aster
CMI Hospital, Bengaluru, 4Ravi Imaging and Jupiter Hospital, Mumbai,
5Nivaran and Pulse Scan Centre, Mumbai, 6NM Medical Centre, Mumbai,
7Advance RadioImaging Centre, Ahmedabad, Pinnacle Imaging Centre,
Mumbai, India

8. Coronavirus Disease 2019 (COVID-19): Role of Chest CT in

Diagnosis and Management. Yan Li1 and Liming Xia1

Read More: https://www.ajronline.org/doi/full/10.2214/AJR.20.22954

9. The accuracy of chest CT in the diagnosis of COVID-19: An umbrella

review. Jae Young Park, Rosemary Freer, Richard Stevens, Neil Soneji,
Nicholas Jone

10. Chest CT in COVID-19: What the Radiologist Needs to Know

11. Thomas C. Kwee , Robert M. Kwee, Oct 23 2020https://doi.org/10.1148/
rg.2020200159

12. Lung Cancer Screening CT Protocols Version 5.0, 24 July 2019

13. https://www.ajronline.org/doi/10.2214/ajr.181.4.1810923

14. https://pubmed.ncbi.nlm.nih.gov/11147626/

15. Effective dose equivalent ranges from 0.06 to 0.25 millisieverts (mSv) with
chest radiography (conventional) in 2 views, 3-27 mSv with computed
tomography (CT) using conventional examination parameters, and 0.3-0.55
mSv using low dose CT settings.

16. https://www.ajronline.org/doi/full/10.2214/AJR.14.13629

17. https://med.stanford.edu/content/dam/sm/cvimaging/documents/lectures/
18DEC13_Fleischmann_RadiationDoseRisk_final_HANDOUT.pdf

18. https://www.radiologyinfo.org/en/info/safety-xray

19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985882/

The average effective dose of the chest posteroanterior

examination (digital) was found to be 0.04 mSv, which was 1.3%
that of the chest CT examination.

20. https://sci-hub.st/10.1148/radiology.185.3.1438752

This means that if 1 million persons are exposed to 0.1 mSv of

radiation, five would develop a fatal cancer.