Diagnostic Imaging's Weekly Scan: Nov. 21, 2020

November 20, 2020
Whitney J. Palmer

Rapid COVID-19 Diagnosis with CT and CO-RADS; Cooled Radiofrequency Ablation for Pain Relief; Inappropriate Abdominal CT and Ultrasound Scans; and Lead Shielding Guidance

Welcome to Diagnostic Imaging’s Weekly Scan. I’m senior editor, Whitney Palmer.

Before we get to our featured interview with Dr. Cynthia McCullough about recommendations for the use of lead shielding during imaging in light of last week’s research on the impact diagnostic scans can have on the risk of testicular cancer, here are the top stories of the week.

With now more than 250,000 COVID-19 deaths and a multitude of states hitting daily highs for newly diagnosed cases, providers are going to need a better way to diagnose patients who are suspected of being infected with the virus. According to a study published in Radiology this week, that rapid test might already be here. Researchers from The Netherlands have found that pairing a chest CT with the CO-RADS scoring system can provide a quick, accurate diagnosis for patients who have exhibited symptoms of the virus for more than 48 hours. The team scored 1,070 chest CT scans and compared those assessments to RT-PCR results. For CO-RADS scores of 4 or higher, the team determined the CT/CO-RADS sensitivity for a correct diagnosis was 86 percent, and specificity was 81 percent for an odd ratio of 25.9. When compared to the clinical reference standard, sensitivity was 77 percent, and specificity was 90 percent for an odd ratio of 30.6. Having this combined test could make it easier to identify other causes of pulmonary symptoms, as well as more quickly identify which patients should be put into isolation while lessening any crowding in emergency departments.

Despite being over a week away, news is already being released from this year’s RSNA annual meeting. Researchers from the Emory University School of Medicine published their findings this week that a new interventional radiology treatment, called cooled radiofrequency ablation, can provide relief for shoulder and hip joint pain in patients for whom anesthetic or corticosteroid injections are no longer effective. It could be a way to avoid both surgery and opioids, they said. This technique uses needles to deliver radiofrequency to the shoulder and hip joints, stunning the nerves, and slowing down pain transmissions to the brain. In a study with 23 patients with advanced degenerative arthritis, between 70 percent to 85 percent of patients reported pain reduction. The team says they plan to investigate how well the method works on pain associated with oncology and sick cell anemia.

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Even though a good number of patients are descending upon the emergency department these days with worries about COVID-19, there are still a huge number of patients that present every year with complaints of abdominal pain. CT scans and ultrasounds are the first-line imaging studies ordered to diagnose what’s behind these problems, but a new study published in Current Problems in Diagnostic Radiology shows that the overwhelming majority of those studies do not comply with the ACR’s Appropriateness Criteria. In fact, according to researchers from Brazil, 36 percent of CTs and 84 percent of ultrasounds were considered inappropriate. Based on their analysis of abdominal scans ordered between January 2019 and March 2019, they found that 85 percent of emergency providers recognize they order too many scans, and they point to fears of malpractice as the main reason why. But, the team determined a lack of education about the appropriateness guidelines is still a significant contributing factor. Most incorrectly ordered studies were requested for pancreatitis, renal failure, biliary disease, diverticulitis, appendicitis, and abdominal pain. They were considered inappropriate because they were ordered for the wrong modality, they were not the recommended test of first-use, or the results would not affect treatment or management.

And, finally, this week, Diagnostic Imaging spoke with Dr. Cynthia McCullough, chair of the board of the American Association of Physicists in Medicine about the guidance around using lead shielding in diagnostic imaging. Recently, the recommendations on shielding have shifted away from using this protective measure because it can distort the image without providing any benefit. In light of research published last week on how diagnostic imaging scans can potentially increase a man’s risk of testicular cancer by 60 percent, McCullough offered some perspective not only on the official guidance but on how radiologists and radiologic technologists should proceed in daily practice. Here’s what she had to say.

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