A CT scan for COVID merits a word of caution

 What is the news ?

The director of All India Institute of Medical Sciences has warned against excessive CT scan in
mild COVID-19 cases and said it may be a potential risk of cancer as one CT scan equivalent to
300 - 400 chest x-ray.
 What is CT scan and why it is being used?
As COVID is a respiratory disease , doctors may use chest image to diagnosis( find the disease),
etiognosis( cause of disease) and prognosis( how it evolve).
CT scan is a computed Tomography scan uses computer to merge 2D x-ray image and convert
them in 3D, it provides more detailed information , there are diffrent types of CT scan and in
case of covid it detects the sign of pneumonia or white patch in lungs.
A pooled result showed that chest CT scan correctly diagnosis about 88% of infected individuals
and give 20 % false report of persons who did not have disease.
 Risk and advantage of CT scan

CT scanning of the chest has advantages over plain chest radiography: -

 Better resolution and detection of nodules as small as 3-4 mm.

NODULES - it is small masses of tissue in the lung , appear as round, white shadows on a chest X-
ray or (CT) scan.

 scanning is painless, noninvasive and accurate.

 Fast and simple.

Risk of CT scan

 In mild cases it can not dedect and repeated use can cause cancer.
 It mislabbled people who did not have disease cause implication, psychological consequences.
 It reflects the state of lungs at that time only , it can not predict the progess with time.
 Risk of transmission of virus through radiology technicians , staff and docters.
 Other tests used to detect
 RT - PCR TEST
Real-Time Reverse Transcriptase polymerase chain reaction
 This is a laboratory test that can identify the virus of COVID-19 by using nasal and oral
swabs .
 It has a capcity of 92 samples in one run.( Advantage)
 Give report in 24 -48 hours ( demerit ).
 In second wave it is not able to detect the new variants.( Demerit ).
 CBNATT or TrueNAT( indian variant )
  Runs on the same technology of RT - PCR.
 Quicker than RT CPR and give report in 45 minutes( advantage).
 Can be used for TB and other lungs disease( advantage).
 It is costlier than RTPCR( Demerit).
 Avilable across the country ( advantage).
 ABOTT ID NOW

Higher analytical sensitivity( advantage).

Based on Isothermal nucleic acid amplification( advantage).

It is quickest among all and give result in 5 minutes if positive( advantage).

Able to roll out results for 8 - 10 samples within eight hours( demerit).

Its costly than others.

 CHEST X - RAY
 It produce image of organs and structure in the chest by using radition to produce 2D image.
 Its accuracy upto 80% in general and 28% incorrectly identified.
 CHEST ULTRA SOUND
 It uses high frequency sound waves to produce an image.
 Its accuracy upto 86 % in general and 45% incorrectly diagnosised.
 Central Idea of published article.
 Article provides the information about study associated with CT sacn and how accuracy
matters in diagnosis , mislabbled reports and their side effects. It also awares the patients to
rise queries before diagnosis.
 Article does not include any alternative Test for patients.
 It does not tell about RT PCR and medical oxygen ( vital for lungs COVID patients ).

Reason and Response

 Self diagnosis nature of people over burdened the testing centres.

 Delay in RT - PCR test report and inefficiency of detecting new strain of virus.
 Misinformation about the symptoms and testing which created a panic and chaos in the
public.
 Inefficient technician and machine which caused confusion and to confirm it more
frequently ct scan performed.
 There may be nexus between doctor and testing centre.
 Lack of confidence on govt. Institution and policy.
 Govt. Failed to provide adequate oxygen supply and testing on ground level.
 It leads to hoarding and black marketing of medicines and medical eqquipments.
 ADDITIONAL INFORMATION
 Difference between medical oxygen and compressed oxygen.
 oxygen is a colorless gas found in air. It is one of the life-sustaining elements on Earth and is
needed by all animals. Oxygen is also used in many industrial, commercial, medical, and
scientific applications . Oxygen is made in two ways:-

Medical oxygen:

 it is made by separating the oxygen from other gases and impurities found in air by repeated
steps of compression, filtration and purification.
 Such medical oxygen reaches more than 99.5 percent purity.
 It can be highly compressed into a liquid form, but has to be maintained below -182°C.

Pressure swing adsorption (PSA)

 Compressed air (78% nitrogen, 21% oxygen, < 1% argon) is filtered, degreased and dried and the
production pressure is automatically regulated.
 Air passes through the molecular sieves where nitrogen is adsorbed by the zeolite, increasing
oxygen concentration up to 95%.
 The machines can be portable or larger to serve a hospital. However, these machines cannot
meet surges in demand hospitals as waves of Covid patients peaked.
Who are the main producers?

In 2019, Top exporters of Medical oxygen are Belgium ($30,683.49K ), France ($24,658.77K ), European
Union ($9,146.10K ), Germany ($8,279.38K , 48,330,600 m³), Portugal ($8,259.62K , 28,519,200 m³).

QA- WHAT IS PM CARE FUND ? Can foreign donation accepted in it ? Who audits it?

Suggestions
 Set up a data management system for vaccine rollout.
 Conference with SAARC nation and BIMSTEC members.
 More 2+2 dialogs for economic and medical research.

 Conclusion
 CT scan is more sensitive and moderatry specific for the diagnosis of COVID compare to x- ray
and ultrasound.
 It has more utility for excluding COVID than for differentially infection from other cause of
respiratory illness.
 Patients go for CT scan on the advice of doctors only.