CT Thorax Dosis Rendah Untuk Evaluasi Covid-19: Tinjauan Literatur Naratif Tentang Akurasi Diagnostik, Fungsi Klinis, dan Efisiensi Dosis Radiasi
DOI:
https://doi.org/10.31004/joecy.v3i1.9664Keywords:
COVID-19; CT thorax dosis rendah; low-dose CT; ultra-low-dose CT; proteksi radiasi; akurasi diagnostik.Abstract
Pandemi COVID-19 meningkatkan kebutuhan terhadap metode evaluasi yang cepat dan akurat, terutama untuk mendukung triase, stratifikasi klinis, dan pemantauan pasien dengan keterlibatan paru. Dalam konteks ini, CT thorax menjadi modalitas pencitraan yang banyak digunakan, tetapi peningkatan frekuensi pemeriksaan juga menimbulkan kekhawatiran terhadap paparan radiasi, khususnya pada pasien yang memerlukan pemeriksaan berulang. Tinjauan literatur ini bertujuan mengevaluasi peran optimalisasi CT thorax dosis rendah, meliputi low-dose CT (LDCT) dan ultra-low-dose CT (ULDCT), dalam evaluasi COVID-19 berdasarkan literatur periode 2016–2022. Metode yang digunakan adalah narrative literature review dengan sumber pustaka dari PubMed, Scopus, Web of Science, dan Google Scholar. Sintesis difokuskan pada akurasi diagnostik, parameter optimisasi protokol, serta relevansi klinis LDCT/ULDCT dibandingkan RT-PCR dan CT standar. Hasil kajian menunjukkan bahwa LDCT memiliki akurasi diagnostik yang baik untuk mendeteksi keterlibatan paru pada COVID-19, terutama pola ground-glass opacity dan konsolidasi, dengan paparan radiasi yang lebih rendah dibandingkan CT standar. Optimisasi protokol dipengaruhi oleh kombinasi pengaturan mAs, kVp, automatic exposure control, pitch, serta penggunaan iterative reconstruction atau rekonstruksi berbasis kecerdasan buatan. Meskipun ULDCT memungkinkan reduksi dosis yang lebih besar, penggunaannya tetap menghadapi keterbatasan dalam visualisasi lesi halus tertentu. Dalam praktik klinis, LDCT paling tepat diposisikan sebagai modalitas komplementer untuk triase, stratifikasi derajat keparahan, evaluasi komplikasi, dan follow-up serial pada pasien terpilih, tanpa menggantikan RT-PCR sebagai standar diagnosis etiologis utama. Dengan demikian, optimalisasi CT thorax dosis rendah merupakan strategi penting untuk menyeimbangkan manfaat diagnostik dan proteksi radiasi pada evaluasi COVID-19.
References
Agostini, Andrea, Alessandra Borgheresi, Marina Carotti, Letizia Ottaviani, Myriam Badaloni, Chiara Floridi, and Andrea Giovagnoni. 2020. “Third-Generation Iterative Reconstruction on a Dual-Source, High-Pitch, Low-Dose Chest CT Protocol With Tin Filter for Spectral Shaping at 100 kV: A Study on a Small Series of COVID-19 Patients.” La Radiologia Medica 126(3):388–98. doi:10.1007/s11547-020-01298-5.
Agostini, Andrea, Chiara Floridi, Alessandra Borgheresi, Myriam Badaloni, Paolo E. Pirani, Filippo Terilli, Letizia Ottaviani, and Andrea Giovagnoni. 2020. “Proposal of a Low-Dose, Long-Pitch, Dual-Source Chest CT Protocol on Third-Generation Dual-Source CT Using a Tin Filter for Spectral Shaping at 100 kVp for CoronaVirus Disease 2019 (COVID-19) Patients: A Feasibility Study.” La Radiologia Medica 125(4):365–73. doi:10.1007/s11547-020-01179-x.
Aljondi, Rowa, and Salem S. Alghamdi. 2020. “Diagnostic Value of Imaging Modalities for COVID-19: Scoping Review.” Journal of Medical Internet Research 22(8):e19673. doi:10.2196/19673.
Avila, Ricardo S., Sean B. Fain, C. Hatt, Samuel G. Armato, James L. Mulshine, David S. Gierada, Mario Silva, David A. Lynch, Eric A. Hoffman, Frank N. Ranallo, John R. Mayo, David F. Yankelevitz, Raúl S. J. Estépar, R. Subramaniam, Claudia I. Henschke, Alex Guimaraes, and Daniel C. Sullivan. 2021. “QIBA Guidance: Computed Tomography Imaging for COVID-19 Quantitative Imaging Applications.” Clinical Imaging 77:151–57. doi:10.1016/j.clinimag.2021.02.017.
Azadbakht, Javid, Daryoush Khoramian, Zahra S. Lajevardi, Fateme Elikaii, Amir H. Aflatoonian, Bagher Farhood, Masoud Najafi, and Hamed Bagheri. 2021. “A Review on Chest CT Scanning Parameters Implemented in COVID-19 Patients: Bringing Low-Dose CT Protocols Into Play.” Egyptian Journal of Radiology and Nuclear Medicine 52(1). doi:10.1186/s43055-020-00400-1.
Booij, Ronald, Ricardo P. Budde, Marcel L. Dijkshoorn, and Marcel v. Straten. 2020. “Technological Developments of X-Ray Computed Tomography Over Half a Century: User’s Influence on Protocol Optimization.” European Journal of Radiology 131:109261. doi:10.1016/j.ejrad.2020.109261.
Borghesi, Andrea, Nicola Sverzellati, Roberta Polverosi, Maurizio Balbi, Elisa Baratella, Marco Busso, Lucio Calandriello, Giancarlo Cortese, Alessandra Farchione, Roberto Iezzi, Stefano Palmucci, Ilaria Pulzato, Cristiano Rampinelli, Chiara Romei, Adele Valentini, Roberto Grassi, and Anna R. Larici. 2021. “Impact of the COVID-19 Pandemic on the Selection of Chest Imaging Modalities and Reporting Systems: A Survey of Italian Radiologists.” La Radiologia Medica 126(10):1258–72. doi:10.1007/s11547-021-01385-1.
Carotti, Marina, Fausto Salaffi, Piercarlo Sarzi‐Puttini, Andrea Agostini, Alessandra Borgheresi, Davide Minorati, Massimo Galli, Daniela Marotto, and Andrea Giovagnoni. 2020. “Chest CT Features of Coronavirus Disease 2019 (COVID-19) Pneumonia: Key Points for Radiologists.” La Radiologia Medica 125(7):636–46. doi:10.1007/s11547-020-01237-4.
Coşkun, Mehmet. 2020. “Determination of Radiation Exposure With Related to the Use of Chest CT in During COVID-19 Pandemic in Pediatric Patients.” Pediatric Practice and Research 8(3):79–82. doi:10.21765/pprjournal.853934.
Dangis, Anthony, Christopher Gieraerts, Yves D. Bruecker, Lode Janssen, Hanne Valgaeren, Dagmar Obbels, Marc Gillis, Marc V. Ranst, Johan Frans, Annick Demeyere, and Rolf Symons. 2020. “Accuracy and Reproducibility of Low-Dose Submillisievert Chest CT for the Diagnosis of COVID-19.” Radiology Cardiothoracic Imaging 2(2):e200196. doi:10.1148/ryct.2020200196.
Dhillon, Permesh S., Kate Pointon, Robert Lenthall, Shalini Nair, Ganesh Subramanian, Norman McConachie, and Wazim Izzath. 2020. “Regional Mechanical Thrombectomy Imaging Protocol in Patients Presenting With Acute Ischemic Stroke During the COVID-19 Pandemic.” American Journal of Neuroradiology 41(10):1849–55. doi:10.3174/ajnr.a6754.
Foda, Haitham, and Mona Talaat. 2021. “Diagnostic Efficacy and Radiation Safety of Low Dose CT Protocol in COVID-19 Pandemic: An Alternative for Deficient RT-PCR.” Zagazig University Medical Journal 0(0):0–0. doi:10.21608/zumj.2021.86195.2283.
Gang, Yadong, Xiongfeng Chen, Huan Li, Hanlun Wang, Jianying Li, Ying Guo, Junjie Zeng, Qiang Hu, Jinxiang Hu, and Haibo Xu. 2021. “A Comparison Between Manual and Artificial Intelligence–Based Automatic Positioning in CT Imaging for COVID-19 Patients.” European Radiology 31(8):6049–58. doi:10.1007/s00330-020-07629-4.
Ghetti, C., O. Ortenzia, M. Maddalo, Luisa Altabella, and Nicola Sverzellati. 2020. “Dosimetric and Radiation Cancer Risk Evaluation of High Resolution Thorax CT During COVID-19 Outbreak.” Physica Medica 80:119–24. doi:10.1016/j.ejmp.2020.10.018.
Gieraerts, Christopher, Anthony Dangis, Lode Janssen, Annick Demeyere, Yves D. Bruecker, Nele D. Brucker, Annelies V. D. Bergh, Tine Lauwerier, A. Heremans, Eric Frans, Michaël R. Laurent, Bavo Ector, John Roosen, Annick Smismans, Johan Frans, Marc Gillis, and Rolf Symons. 2020. “Prognostic Value and Reproducibility of AI-Assisted Analysis of Lung Involvement in COVID-19 at Low-Dose Submillisievert Chest CT: Sample Size Implications for Clinical Trials.” Radiology Cardiothoracic Imaging 2(5):e200441. doi:10.1148/ryct.2020200441.
Gombolevskiy, Victor А., С. П. Морозов, Valeria Chernina, Ivan A. Blokhin, and J. Vassileva. 2021. “A Phantom Study to Optimise the Automatic Tube Current Modulation for Chest CT in COVID-19.” European Radiology Experimental 5(1). doi:10.1186/s41747-021-00218-0.
Greffier, Joël, Adel Hoballah, Alexandre Sadate, Fabien d. Oliveira, Pierre‐Géraud Claret, Hélène d. Forges, Paul Loubet, Jean‐Marc Mauboussin, Aymeric Hamard, Jean-Paul Bérégi, and Julien Frandon. 2021. “Ultra-Low-Dose Chest CT Performance for the Detection of Viral Pneumonia Patterns During the COVID-19 Outbreak Period: A Monocentric Experience.” Quantitative Imaging in Medicine and Surgery 11(7):3190–99. doi:10.21037/qims-20-1176.
He, Jianlong, Lin Luo, Zhendong Luo, Jianxun Lyu, Ming‐Yen Ng, Xinping Shen, and Zhibo Wen. 2020. “Diagnostic Performance Between CT and Initial Real-Time RT-PCR for Clinically Suspected 2019 Coronavirus Disease (COVID-19) Patients Outside Wuhan, China.” Respiratory Medicine 168:105980. doi:10.1016/j.rmed.2020.105980.
Homayounieh, Fatemeh, Ola Holmberg, Rashid A. Umairi, Sallam Aly, Algidas Basevičius, Paulo R. Costa, Adham Darweesh, Vesna Gershan, Pilvi Ilves, D. Kostova-Lefterova, Simone K. Renha, Iman Mohseni, Osvaldo Rampado, Natalia Rotaru, Issahaku Shirazu, В. Е. Синицын, Tajana Turk, Claire V. N. Ty, Mannudeep K. Kalra, and J. Vassileva. 2021. “Variations in CT Utilization, Protocols, and Radiation Doses in COVID-19 Pneumonia: Results From 28 Countries in the IAEA Study.” Radiology 298(3):E141–51. doi:10.1148/radiol.2020203453.
Joyce, Stella, Owen J. O’Connor, M. Maher, and Mark F. McEntee. 2020. “Strategies for Dose Reduction With Specific Clinical Indications During Computed Tomography.” Radiography 26:S62–68. doi:10.1016/j.radi.2020.06.012.
Kalra, Mannudeep K., Fatemeh Homayounieh, Chiara D. Arru, Ola Holmberg, and J. Vassileva. 2020. “Chest CT Practice and Protocols for COVID-19 From Radiation Dose Management Perspective.” European Radiology 30(12):6554–60. doi:10.1007/s00330-020-07034-x.
Kovács, Anita, Péter Palásti, Dániel Veréb, Bence Bozsik, András Palkó, and Zsigmond T. Kincses. 2020. “The Sensitivity and Specificity of Chest CT in the Diagnosis of COVID-19.” European Radiology 31(5):2819–24. doi:10.1007/s00330-020-07347-x.
Lee, Jong H., Hyunsook Hong, Hyungjin Kim, Chang H. Lee, Jin M. Goo, and Soon H. Yoon. 2021. “CT Examinations for COVID-19: A Systematic Review of Protocols, Radiation Dose, and Numbers Needed to Diagnose and Predict.” Journal of the Korean Society of Radiology 82(6):1505. doi:10.3348/jksr.2021.0096.
May, Matthias, Rafael Heiß, Julia Koehnen, Matthias Wetzl, Sarina K. Mueller, Christoph Treutlein, Lars Bräeuer, Michael Uder, and Markus Kopp. 2021. “Personalized Chest Computed Tomography.” Investigative Radiology 57(3):148–56. doi:10.1097/rli.0000000000000822.
Ohana, Mickaël, J. Müller, François Séverac, Pascal Bilbault, Martin Behr, M. Oberlin, Pierre Leyendecker, and Catherine Roy. 2021. “Temporal Variations in the Diagnostic Performance of Chest CT for Covid-19 Depending on Disease Prevalence: Experience From North-Eastern France.” European Journal of Radiology 134:109425. doi:10.1016/j.ejrad.2020.109425.
Samir, Ahmed, Reham M. El-Husseiny, Rania A. Sweed, Nermeen Abd El-Monsef Abd El-Maaboud, and Mohamed Masoud. 2021. “Ultra-Low-Dose Chest CT Protocol During the Second Wave of COVID-19 Pandemic: A Double-Observer Prospective Study on 250 Patients to Evaluate Its Detection Accuracy.” Egyptian Journal of Radiology and Nuclear Medicine 52(1). doi:10.1186/s43055-021-00512-2.
Seyed Mohammad Bagher Hosseini Nasab, Mohammad R. Deevband, Roghaye Rahimi, Saeed Nasiri, Mohammad R. Ahangaran, and Mina Morshedi. 2021. “Optimization of Lung Ct Protocol for the Diagnostic Evaluation of Covid-19 Lung Disease.” Radiation Protection Dosimetry 196(1–2):120–27. doi:10.1093/rpd/ncab140.
Shiri, Isaac, Azadeh Akhavanallaf, Amirhossein Sanaat, Yazdan Salimi, Dariush Askari, Zahra Mansouri, Sajad P. Shayesteh, Mohammad Hasanian, Kiara Rezaei‐Kalantari, Ali Salahshour, Saleh Sandoughdaran, Hamid Abdollahi, Hossein Arabi, and Habib Zaidi. 2020. “Ultra-Low-Dose Chest CT Imaging of COVID-19 Patients Using a Deep Residual Neural Network.” European Radiology 31(3):1420–31. doi:10.1007/s00330-020-07225-6.
Singh, Ramandeep, Weiwen Wu, Ge Wang, and Mannudeep K. Kalra. 2020. “Artificial Intelligence in Image Reconstruction: The Change Is Here.” Physica Medica 79:113–25. doi:10.1016/j.ejmp.2020.11.012.
Skalidis, Ioannis, Vinh K. Nguyen, Hugo Bothorel, Lauriane Poli, Rui R. D. Costa, Alain B. Younossian, Nicole Petriccioli, and Omar Kherad. 2021. “Unenhanced Computed Tomography (CT) Utility for Triage at the Emergency Department During COVID-19 Pandemic.” The American Journal of Emergency Medicine 46:260–65. doi:10.1016/j.ajem.2020.07.058.
Stoleriu, Mircea G., Michael Gerckens, Florian Obereisenbuchner, Iva Zaimova, Justin Hetrodt, Sarah-Christin Mavi, Felicitas Schmidt, Anna A. Schoenlebe, Katharina Heinig-Menhard, Ina Koch, Rudolf A. Jörres, Judith Spiro, Lorenz Nowak, Rudolf Hatz, Jürgen Behr, Wolfgang Gesierich, Marion Heiß-Neumann, and Julien Dinkel. 2021. “Automated Quantitative Thin Slice Volumetric Low Dose CT Analysis Predicts Disease Severity in COVID-19 Patients.” Clinical Imaging 79:96–101. doi:10.1016/j.clinimag.2021.04.008.
Tabatabaei, Seyed M. H., Hamid R. Talari, Ali Gholamrezanezhad, Bagher Farhood, Habibollah Rahimi, Reza Razzaghi, Narges Mehri, and Hamid Rajebi. 2020. “A Low-Dose Chest CT Protocol for the Diagnosis of COVID-19 Pneumonia: A Prospective Study.” Emergency Radiology 27(6):607–15. doi:10.1007/s10140-020-01838-6.
Teichgräber, Ulf, Amer Malouhi, Maja Ingwersen, Rotraud Neumann, Marina Reljic, Stefanie Deinhardt‐Emmer, Bettina Löffler, Wilhelm Behringer, Jan-Christoph Lewejohann, Andreas Stallmach, and Philipp A. Reuken. 2021. “Ruling Out COVID-19 by Chest CT at Emergency Admission When Prevalence Is Low: The Prospective, Observational SCOUT Study.” Respiratory Research 22(1). doi:10.1186/s12931-020-01611-w.
Xu, Buyun, Yangbo Xing, Jiahao Peng, Zhaohai Zheng, Weiliang Tang, Yong Sun, Chao Xu, and Fang Peng. 2020. “Chest CT for Detecting COVID-19: A Systematic Review and Meta-Analysis of Diagnostic Accuracy.” European Radiology 30(10):5720–27. doi:10.1007/s00330-020-06934-2.
Zhou, Yang, Yineng Zheng, Yun Wen, Xin Dai, Wengang Liu, Qihui Gong, Chaoqiong Huang, Fajin Lv, and Jiahui Wu. 2021. “Radiation Dose Levels in Chest Computed Tomography Scans of Coronavirus Disease 2019 Pneumonia.” Medicine 100(31):e26692. doi:10.1097/md.0000000000026692.
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