Medically Imaging COVID-19 | G34: COVID-19 Project

What to Expect as a Patient

Mon, 01 Jan 0001 00:00:00 +0000

So the doctor has recommended you for a scan, what now? We will go through the process of what happens before you meet the ladies and gentlemen at the radiography department for the scan.

Do I Have to Change My Clothes?

Before undergoing the examination, you, the patient, should remove all artefacts such as jewellery, bras, and belts. You will be given a hospital gown and asked to change into it.

Do I Have to Sign Any Forms?

You will be asked several safety questions which you are expected the answer honestly. For example, “do you have any metal objects like an artificial hip replacement?”. For female patients, you may be asked questions to determine if you are pregnant; this is because the staff in the CT department don’t want to expose the foetus to the ionising radiation coming from the scan. You may be asked about other CT and other x-ray procedures you have had in the past to determine if it is safe to expose the body to more radiation. Don’t worry, the examination would not be recommended unless the benefits of having it done are greater than the risks of not having it done.

How will the Procedure Take Place?

The exam will take place in a clean room with a machine that look similar to a doughnut in it. You will be told in simple terms what is going to be done and will be informed of the benefits of having it done and the consequences of not having it done as well as the risks patients may attract themselves due to their behaviour whilst undergoing the procedure.

A non-contrast, single phase, low radiation dose chest CT is usually what is used to evaluate patients with COVID-19. During the examination you will be expected to lie on the table with your arms over your head. Some people may feel uncomfortable lying on the table so it’s important you are comfortable before the procedure begins.

The radiographer will position the patient and they must stay in that position unless told to move. The table that the patient is lying on will move through the gantry (technical term for the big doughnut) to the x-ray tube and detector. The x-ray tube rotates around the patient and the detector gathers the requires information and transports it to the computer which will form the images. The examination will be completed when all the necessary images are got. The scans will then be analysed and reported by the radiologist and the results will then be sent to your doctor.

How Long Will It Take?

It is a quick procedure that lasts about 10 minutes. The patient should practise with the radiographer holding their breath for short periods of time before they have to do this during the examination.

What Happens to Patients Who Get Acute Symptoms?

For treatment of COVID-19, some patients stay in ICU for about 2 weeks and others with milder cases stay for 3-4 days. Some patients have even longer stays and the recovery period can be extremely long.

During the hospital stay you will have many routine observations by nursing staff and healthcare assistants. Your blood pressure, heart rate, temperature and oxygen levels will be checked, how frequently this occurs depends on how serious your condition is. Blood tests will also be performed to help monitor the condition.

The staff will be wearing personal equipment such as gloves, a mask, and an apron to help stop the spread of infection. They will help you with self-care, cleaning and eating if you need assistance and your meals will be provided.

As part of routine ward rounds, doctors will visit daily. They will ask you simple questions and will examine you further if they need to and just check up on you and how you are holding up.

Mental health is just as important, now more than ever.

How Will the Virus be Treated?

Oxygen is the main treatment for this virus. The amount of care and observation you receive will be mainly determined by your oxygen levels. Medication is not the primary mode of fighting this virus but rather keeping you in good health with a strong immune system. There has been recommendations made by the National Institutes of Health (NIH) of certain viral medications for antiviral therapy but these methods are saved for the more severe cases of coronavirus where the patient has been diagnosed with respiratory tract infections. Click here to read the article about Remdesivir and antiviral therapy, however, it may have very technical medical language.

References Used:

Computational Tomography - What is it, Why Use It and How Do I Prepare for It?

Mon, 01 Jan 0001 00:00:00 +0000

What on EARTH is a CT Scan?

CT Staff with Patient
(Image taken from Amber Diagnostics Website, Published 2013/02/04, Accessed 2020/11/08)

A CT scan is a medical imaging technique that uses many different X-Ray images to create one image of the body. During a CT scan, you will lie on a bed that moves through an arc, called a gantry. As you move through the gantry, the scanner will emit a series of narrow beams. This is quite different from an X-Ray, which only sends one radiation beam. We do this so that we can obtain a much clearer image of the lungs. An image can then be projected onto the computer screen for examination. This is a quick and painless procedure which will be over in a matter of minutes.

How does COVID-19 present on a CT Scan?

We use CT scans in order to detect abnormalities in the lungs. The scans can detect hazy, patchy, white spots in the lungs - which are an indicator of COVID-19. The CT scan can create a 3D image of the lungs. In severe cases of COVID-19, as the pneumonia progresses, air sacs can become filled with fluid leaking from the blood vessels in the lungs. This is what we are looking for on a CT scan which can detect the presence as well as the severity of COVID-19.

Why do we use CT scans in relation to COVID-19?

Though, in theory, COVID-19 can be detected on a CT scan, it is currently diagnosed through a swab test – imaging is not recommended for patients with suspected COVID-19. However, CT imaging plays an important role in the disease for hospitalised patients who have further complications. In COVID-19 patients, CT imaging is used in extreme cases, most commonly to diagnose secondary infections such as pneumonia.

What are you even looking for?

Pneumonia, including COVID-19 pneumonia, increases density in areas of the lungs, which is what the chest CT is trying to detect. These are visible as areas of whiteness around the lungs as seen below.

CT Scans of Lungs with Pneumonia
(Image taken from News Medical Life Sciences Website, Published 2020/03/15, Accessed 2020/11/08)

What to Expect as a Patient Going into a CT Exam?

In preparing for the CT exam all artefacts are removed. You may be asked to change into a hospital gown and rehearse breath holds. The scan will take no longer than 10 minutes. As a patient, you must remain still throughout the scan and may be asked to hold your breath at various intervals. The CT exam will produce an excellent 3D projection with good visualisation of the lung tissue and any potential damage done to it as a result of coronavirus.

Radiation Dose to the Patient During a CT Examination

There’s no need to be afraid

Although the radiation dose for CT is classified as a high dose technique, it is relatively low in comparison to some everyday tasks and is equivalent to smoking 140 cigarettes, driving 6,000km in a car or flying 40,000km in a plane.

References Used:

Lung Ultrasounds - An Alternative Modality

Mon, 01 Jan 0001 00:00:00 +0000

CT may not always be the best mode of imaging a patient. We present a different type of medical imaging, one that doesn’t use ionising radiation.

How Can Lung Ultrasounds be Used as an Alternative Modality for Detecting COVID-19?

Lung ultrasounds can be used as an alternative modality for patients who are too critically ill to receive a CT scan to detect diseases such as COVID-19 pneumonia and other complications. Although a CT Scan has been the gold standard in diagnosing lung infections, however, given the limitations of not being readily available and the intense radiation exposure, lung ultrasounds have been used widely in many countries in early detection of pneumonia. It also decreases the spread of cross infection as the imaging technique is available bedside for patients in intensive care units.

SARS-CoV-2 related pneumonia is shown to involve periphery and subpleural lung areas which are better imaged by a lung ultrasound than the standard X-ray. Another advantage of a new lung ultrasound machine is its compatibility with smartphones and tablets which allows its results to be read remotely making it a great source for rural communities.

What Do Ultrasound Scan Show and How Do They Work?

References Used:

Magnetic Resonance Imaging

Mon, 01 Jan 0001 00:00:00 +0000

MRI is an imaging modality which uses extremely strong magnets and radio waves to generate images of parts of the body which can’t be seen as well with CT, x-ray, or ultrasound. It does not involve ionising radiation.

Before the Scan

Before an MRI scan, the patient will be required to answer a safety screening questionnaire to ensure they understand the safety concerns and assess their past medical history. As the magnets used in MRI are extremely strong, any objects with ferrous material will be attracted to the scanner. This means any bodily implants or pacemakers will have to be assessed to ensure they will not cause damage to the patient when placed inside the scanner. The patient will also be required to remove all metal from their person and change into a hospital gown.

During the Scan

During an MRI scan, the patient will lie on a table which moves into the scanner. The scanner can be very loud, but there is a call bell which can be pressed to get the radiographer’s attention if needed. Music may be played through headphones to calm the patient if they find the noise very disruptive. The scanner is open at each end and cool air can be blown through to make the process more comfortable. In total, the scan will take 30-50 mins.

What is MRI looking for in COVID-19 Patients?

MRI can be used to look at patients with pneumonia should the doctor not want to expose the patient to ionising radiation from CT or general x-rays. It can also be used to scan for any abnormalities, or neurological damage, caused by the side effects of COVID-19.

References Used:

Nuclear Medicine and What to Expect as a Patient

Mon, 01 Jan 0001 00:00:00 +0000

Nuclear medicine can also be used in evaluating the causes of endocrine hypertension when MRI and CT cannot detect a mass in the glands of patients with high suspicion of the condition.

Do I Have to Take Any Medication?

Nuclear medicine uses a radioactive material called a radiopharmaceutical. This material is provided for the patient most commonly as an injection into the bloodstream. It can also be swallowed or inhaled as a gas.

How Will the Procedure Go?

If nuclear medicine imaging is recommended, the patient is asked to lie down on the examination table once the radiopharmaceutical has been administered and has accumulated in the body. From there, a scanner or a camera will take a series of images as it rotates around the patient. The length of time for nuclear medicine procedures vary, depending on the type of exam. Scanning time can take from 20 minutes to several hours and can even be conducted over several days.

Will It Hurt?

Nuclear medicine imaging itself causes no pain but it is highly essential that the patient must remain still during the process, and this may cause slight discomfort for the patient. Nuclear medicine imaging is considered a non-invasive and relatively safe procedure as the level of radiation dose received by the patient is about the same as the dose given during a routine chest x-ray or CT scan which is not a lot as explained here.

What Do I Do After the Exam?

The patient is advised for the next couple of hours or days after the procedure to drink plenty of water so that the material inserted into the body loses its radioactivity over time, and flushes out of the body through the urinary tract.

References Used:

Radiological Imaging in Endocrine Hypertension