Diagnostic accuracy of ultra-low-dose chest computed tomography in an emergency department
Maria Tækker, Björg Kristjánsdóttir, Michael Brun Andersen, Maja Lynge Fransen, Pernille Wied Greisen, Christian B. Laursen, Bo Redder Mussmann, Stefan Posth, Ole Graumann
Abstract
Background This study examined whether ultra-low-dose chest computed tomography (ULD-CT) could improve detection of acute chest conditions. Purpose To determine (i) whether diagnostic accuracy of ULD-CT is superior to supine chest X-ray (sCXR) for acute chest conditions and (ii) the feasibility of ULD-CT in an emergency department. Material and Methods From 1 February to 31 July 2019, 91 non-traumatic patients from the Emergency Department were prospectively enrolled in the study if they received an sCXR. An ULD-CT and a non-contrast chest CT (NCCT) scan were then performed. Three radiologists assessed the sCXR and ULD-CT examinations for cardiogenic pulmonary edema, pneumonia, pneumothorax, and pleural effusion. Resources and effort were compared for sCXR and ULD-CT to evaluate feasibility. Diagnostic accuracy was calculated for sCXR and ULD-CT using NCCT as the reference standard. Results The mean effective dose of ULD-CT was 0.05±0.01 mSv. For pleural effusion and cardiogenic pulmonary edema, no difference in diagnostic accuracy between ULD-CT and sCXR was observed. For pneumonia and pneumothorax, sensitivities were 100% (95% confidence interval [CI] 69–100) and 50% (95% CI 7–93) for ULD-CT and 60% (95% CI 26–88) and 0% (95% CI 0–0) for sCXR, respectively. Median examination time was 10 min for ULD-CT vs. 5 min for sCXR ( P<0.001). For ULD-CT 1–2 more staff members were needed compared to sCXR ( P<0.001). ULD-CT was rated more challenging to perform than sCXR ( P<0.001). Conclusion ULD-CT seems equal or better in detecting acute chest conditions compared to sCXR. However, ULD-CT examinations demand more effort and resources.