Costly CT Scans Filling Virus Testing Void for U.S. Physicians

(Bloomberg) -- Some doctors are using expensive CT scans to check for Covid-19 infections, a sign of how a dearth of quick and reliable testing options has strained the U.S. health-care system and raised potential new risks to patients and care providers.

The scans are being used at medical facilities across the nation, from a small community hospital in rural Georgia and an emergency department in Kentucky to a large medical center in Manhattan and its satellite facilities in Brooklyn and Queens.

For patients far enough along in the progression of Covid-19, CT chest imaging can reveal distinctive hazy patterns in the lungs that may help diagnose the infection. Health workers in China turned to CT scans in February, when the outbreak in Wuhan flooded hospitals with patients and reliable tests were in short supply. That led to the reporting of thousands of new cases of Covid-19.

CT scans have emerged as an important tool at thinly resourced U.S. medical centers, where there may be few tests available or there are long lag times in results. And some doctors are using the scans as a way to gather more information about a patient’s health and evaluate treatment options.

But the use of CT scans, also called CAT scans, has generated pushback, including from the American College of Radiology. There are concerns about how effective the practice is for diagnosing Covid-19. Additionally, because the same machines are used frequently by many people, they could help spread the infection.

Even U.S. clinicians who have employed CT scans for the coronavirus say the imaging isn’t ideal. The expense can dwarf the cost of testing, and the devices present a risk of radiation exposure. But CT scans are helping to fill a pressing U.S. testing gap nonetheless.

It “is really a failure of the system to have adequate tests,” said Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston who used CT scans in the early days of the outbreak when testing wasn’t as available.

“The problem is, in a lot of small community hospitals, we’re waiting up to 12 days” for a test to come back, said Daniel Ortiz, a radiologist in Georgia, where there are roughly 10,000 cases. “And at that point, a test that’s essentially not available is worthless.”

And then there’s the expense, which providers say is usually covered by insurance companies. Chest CT scans can cost hundreds to thousands of dollars, according to the online pricing tool Healthcare Bluebook. By contrast, Medicare pays up to $51 for a Covid-19 test, although private companies typically pay more.

Caution Issued

Last month, the American College of Radiology, which represents almost 40,000 physicians, recommended against use of CT scans to screen for Covid-19 or as a primary method of diagnosis. Among the group’s concerns is that Covid-19 has an appearance similar to other infections, including the flu.

The group later acknowledged that some medical practices were using chest CT scans as part of their medical decision-making process but continued to strongly urge caution about the approach.

“A normal chest CT does not mean a person does not have Covid-19 infection and an abnormal CT is not specific for Covid-19 diagnosis,” the group said. “Clearly, locally constrained resources may be a factor in such decision making.”

Ortiz, the radiologist in Georgia, said he wished the association and other major specialty groups had taken a “more pragmatic, realistic approach” that accounted for the types of rural, small community hospitals where he works. Other groups have been more flexible in saying that CT scans can play a role in evaluating potential Covid-19 cases.

“The more resource-constrained hospitals are having a lot more of a discussion about this than ones that have access to rapid testing,” he said. “That’s a big distinction.”

Scan Questions

A point of contention in the debate over CT scans and potential Covid-19 cases is whether the imaging can accurately point to the condition.

CT scans of normal, healthy lungs appear black, representing the air within them. Disease in the organs displaces air, showing up as white abnormalities on the imaging.

“The lung only has so many ways it reacts to injury,” said Ella Kazerooni, chair of the American College of Radiology’s thoracic imaging panel, who worked on the group’s statement about CT scans and Covid-19. Patchy, white areas on CT scans -- reactions radiologists call “ground glass” consolidation -- could indicate Covid-19 or dozens of other conditions, including the flu and reactions to drugs, she said.

If Covid-19 is the most likely condition a patient has, “imaging doesn’t change that,” she said. “If you think clinically they’ve got something else, then there’s a reason to do chest X-ray or CT.”

But clinicians like Adam Bernheim, who has reviewed hundreds of CT scans of patients with Covid-19 since January, disagree.

Scans of patients with Covid-19 reveal rounded gray and white spots at the outer edge of the lung that are “very atypical,” said Bernheim, a radiologist who specializes in heart and lung imaging at Mount Sinai Health System in New York. Like a fogged-up shower door, the gray spots are “clear enough that you can see through it, but it’s kind of hazy.”

While there can be some overlap with other conditions like a drug reaction, providers can account for that by asking patients about their medical history, Bernheim and others said.

CT scans have proven a helpful tool even at Mount Sinai, where tests are available, Bernheim said.

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