“CT imaging is strongly recommended as the main basis for the current 2019nCoV pneumonia (diagnosis).” On February 3, Zhang Xiaochun, deputy director of the imaging department at Zhongnan Hospital of Wuhan University, who is on the front line of the fight against the epidemic, published an appeal in his circle of friends, which triggered widespread discussion. As of 24:00 on Feb. 7, the number of people diagnosed as infected with XKP has exceeded 34,000, with more than 27,000 suspected to be infected. Is it necessary to use CT imaging as an important basis for screening, clinical diagnosis and efficacy monitoring of nucleic acid-negative suspected patients in the current situation? What are the advantages of CT imaging compared with nucleic acid testing, and what challenges does it pose? February 6, with these questions, surging news reporter interviewed Dr. Zhang Xiaochun. Previously Zhang Xiaochun through WeChat circle of friends article said: in the key infected areas of Hubei Province or Wuhan, should be suspected patients or with a history of close contact with the diagnosed patients for lung CT imaging exclusion, as the main basis of the current 2019nCoV pneumonia screening; at the same time, call for giving asymptomatic or nucleic acid test negative but CT imaging positive people to be isolated and treated in order to prevent the cause of the family aggregation of infections, so that the epidemic is further spread. Spread. In an interview, she told the surging news reporter that she has been subjected to a lot of misunderstandings since posting the circle of friends. “I mean don’t wait for the results of nucleic acid test, while doing nucleic acid test, CT imaging of the lungs, the CT of the lungs showing signs of acute inflammation of the patient, according to the “suspected disease from there” principle of early admission. Nucleic acid testing is still the gold standard for final pathogenetic diagnosis, and its pathogenetic evidence is irreplaceable and indisputable.” “Nucleic acid testing still has some limitations as of now, such as the problem of false negatives.” Zhang Xiaochun pointed out that this is mainly caused by several reasons, one is the current nucleic acid kit development time is particularly short, product stability is not high; second, different manufacturers, nucleic acid test kit quality levels, will also affect the test results; third, the accuracy of sampling there is a personal dependence on the operator, many sampling personnel are drafted from various medical positions, not all of them are professional, the operation of each person sampling is not the same. Third, the accuracy of sampling is dependent on the operator. Many sampling personnel are recruited from various medical positions, and not all of them are specialized in sampling. Zhang Xiaochun’s suggestion is supported by many medical colleagues. Zhang Yujiao, director of clinical radiotherapy for thoracic oncology at MD Anderson Cancer Center in the United States, also wrote an article saying, “It is urgent to use CT as a new diagnostic standard for pneumonia.” According to the above article, the nucleic acid test has the following limitations: when the viral load is not high, its detection rate is relatively low, and thus false-negative; it can only make a pathogenetic diagnosis, but it cannot judge the severity of the pneumonia condition and its progression (CT imaging can); the number of kits is insufficient, coupled with the fact that the quality of new products from the major companies is yet to be researched and improved; and it takes a day or more to get the results after sampling. Zhang Xiaochun told the surging news reporter, the reason why she made such an appeal is based on the actual needs of the clinical front line of the key infected areas, “the key infected areas in the very period of time to take the very initiative, as a last resort. This situation is difficult to contain the epidemic if you don’t focus on tightening your fist with a heavy punch.” On Feb. 5, Wang Chen, an expert in respiratory and critical care medicine, vice president of the Chinese Academy of Engineering and president of the Chinese Academy of Medical Sciences, said in a guest appearance on News 1+1 that “not all people who are sick can test positive for nucleic acid, and the detection rate of nucleic acid for real cases is only 30 to 50 percent.” “Where does the remaining 50 percent go? If missed, he returns to his family and community, and wandering outside of society creates a potential infection.” Zhang Xiaochun said. Zhang Xiaochun pointed out that CT test results are intuitive, fast and highly accessible to the public, “so I propose not to wait for the nucleic acid test results, and at the same time carry out the two-pronged approach of checking CT imaging of the lungs. But not waiting is not the same as not doing it, which is that CT is not a substitute for pathogenetic testing of nucleic acids and can only be used as an objective means of responding to inflammation in the lungs.” Since CT imaging does not identify whether it is another pneumonia or a new crown pneumonia, will admitting patients together who have not obtained the results of the kit test lead to incorrect treatment? In this regard, Zhang Xiaochun believes that as long as the pneumonia is new, whether it is new crown pneumonia or other viral or bacterial infections or other microorganisms triggering the pneumonia, the current treatment is largely the same. There is no specific drug for new crown pneumonia, just anti-viral, anti-bacterial, anti-fungal, supportive nutritional symptomatic, oxygen desaturation oxygen and so on. Since the treatment is the same, a positive image of the lungs on CT should be treated first, so that at least it will not be missed. However, Zhang Xiaochun also emphasized that after the admission of such patients, to do single-room isolation treatment to reduce the probability of cross-infection, “if there are no conditions, create conditions also on.” For areas outside of Hubei Province, Zhang Xiaochun said that this initiative is not suitable for only distributed cases of the province. Zhang Xiaochun is pleased that the value of diagnostic imaging has been updated not long ago in the fifth edition of the “new coronavirus infection of pneumonia diagnosis and treatment program” has been reflected. The program mentioned, “suspected cases with pneumonia imaging characteristics” as the Hubei Province, clinical diagnosis of case criteria, which suggests that the new coronavirus clinical diagnosis in Hubei region no longer wait for the nucleic acid test results, this criterion is conducive to the early and early treatment of patients with pneumonia in Hubei Province. At the same time, Wuhan overnight to build three “square cabin hospital”, will provide a total of 3400 beds, for the new coronavirus infection of pneumonia patients with mild disease. In addition to Hubei, the means of prevention and control are also being upgraded, and the degree of severity is unprecedented. Zhang Xiaochun pointed out that the pressure on Wuhan and Hubei to prevent the epidemic is still huge. The use of CT images as a basis for clinical diagnosis will also face great challenges, not only testing the resource reserves in Hubei province, but also placing higher demands on the professionalism of healthcare workers, as well as putting forward new requirements for cross-infection control. “There are two major challenges to putting CT into practice as one of the screening criteria for new-onset pneumonia. The first is that a large number of suspected patients will be introduced into hospitals, and the carrying capacity is still greatly challenged by the insufficient number of CT machines and technicians in many places. This requires unified deployment and support from the state.” Zhang Xiaochun said. The second challenge is reflected in the prevention and control of intra-hospital cross-infection. “Not only the cross-infection between patients, but also the risk of occupational exposure of doctors, we need to do a good job of one person, one machine, one disinfection, patients and doctors at the same time to disinfect, protective materials would have been insufficient, the implementation of this situation is also more difficult. Wuhan, Hubei is the focus of the key infected areas in the focus, need to focus more efforts to solve.” A few days ago, Zhang Xiaochun also put forward the proposal of mobile CT or square cabin CT stationed in Wuhan to meet the demand for lung CT examination in square cabin hospitals and isolation sites. Content source: surging news