27 March 2020
The UK surgical Royal Colleges have produced advice and guidelines on COVID-19. The use of additional chest CT to assess for the presence of likely COVID-19 infection may have a role in stratifying risk in patients presenting acutely and requiring a CT abdomen, particularly those needing emergency surgery. In the absence of rapid access to other forms of COVID testing, this is appropriate if it will change the management of the patient. However, a negative scan would not exclude COVID-19 infection. As with all other advice at the moment, this may change.
12 March 2020
As coronavirus infections become identified increasingly worldwide and the number of cases increase in the UK, we have received a number of queries about the use of computed tomography (CT) scanning in the diagnosis of patients with possible COVID-19 infection. Reports from other countries with greater disease prevalence state that CT has been used as a diagnostic tool, particularly where access to viral testing kits is or becomes limited.
As of 12 March 2020, our view is that there is no current role for CT in the diagnostic assessment of patients with suspected coronavirus infection in the UK. We do not believe that current evidence demonstrates a clear benefit in producing a definitive and positive management change on the basis of CT information.
CT does have a well-established role in the assessment of patients presenting with severe respiratory distress, particularly those that deteriorate clinically, based on specific advice from - and discussion with - intensive care and respiratory teams. This clinical assessment of the need for cross-sectional imaging will remain and while these requests may increase with increasing numbers of patients presenting with severe respiratory illness, we do not believe that patients with known or suspected coronavirus infection should be imaged any differently. The CT request should be based on clinical need and subsequent likely change to the clinical management plan.
There are a number of publications presenting the CT chest imaging appearances of patients with coronavirus infection and links to some of these will be provided in the forthcoming resources section of the website. It is important for radiologists to familiarise themselves with the recognised imaging appearances as some patients not suspected of having coronavirus infection will undergo CT chest for other reasons. It is important to stress however that these imaging appearances are generally non-specific and overlap with the appearances of other viral chest infections including influenza, MERS and SARS. The CT appearances alone will not obviate the need for viral testing and should not be viewed as equivalent to or replacing this.
CT departments should meticulously follow their local infection control policies and recommendations from NHS England/Improvement (NHSE/I). There will be disruption to patient flow through CT departments due to the need for cleaning and decontamination following imaging of infected patients but adherence to these infection control policies should limit delays.
There is every chance that this advice will change over the coming days and weeks as the situation is changing rapidly. We are in ongoing contact with colleagues at the Academy of Medical Royal Colleges, NHSE/I, Public Health England and in the devolved nations, together with experts from the British Society of Thoracic Imaging (BSTI) and other chest-specific special interest groups and the Chief Medical Officers of the four nations, and we are keen to ensure that our advice represents current best practice. Links to other useful sources of advice are available on our coronavirus resources page. In a rapidly changing medical environment, it is important to check the date of any advice to be sure that this reflects current guidance.
We will keep you updated as the situation in the UK develops.
Please note, links from the RCR website to external websites and material are provided for information only and do not constitute endorsement or approval. The RCR is not responsible for the accuracy, legality or content of any external sources referenced on this website.
Published on 12 March 2020. Updated 27 March 2020