Written by Physician’s Weekly blogger, Skeptical Scalpel

In a June 3rd Washington Post article about recent changes in airport screening practices, risk management expert Bruce McIndoe discussed disinfecting baggage, fever checks, and possible on-site virus testing. The article goes on to say, “McIndoe sees a not-too-distant future in which health screeners might even administer CT lung scans before allowing passengers to board.”

Although a number of papers have reported that chest CT scan can identify some patients with COVID-19 before they are symptomatic, screening CT scans at airports would not be practical for the following reasons:

  1. Cost. The cheapest machine suitable for lung CT scans would cost in the neighborhood of $250,000. Every one of the more than 500 commercial airports in the United States would need one or more CT scanners.
  2. Facilities. The airports would have to build Lead-lined rooms for each scanner.
  3. Personnel. Each scanner would require radiology technicians and cleaners.
  4. Time. The scan itself does not take long, but cleanup of the room and the scanner would take at least 15 minutes.
  5. Interpretation. Artificial intelligence has been trained to read COVID-19 CT scans, but is AI ready for prime time? If a radiologist is deemed necessary, it could be done remotely, but the turnaround time for the reading would probably be at least another 15 or 20 minutes. Who is going to pay for the reading, and how much would it cost?
  6. What if a scan shows an incidental finding like a lung or adrenal mass? Who notifies the patient/passenger? How would they follow up? Who is liable if follow-up is not done?
  7. How would passengers be selected for CT scan? If they are symptomatic, they should be rejected without the need for exposure to unnecessary radiation. If not symptomatic, what would be the criteria?

However, screening CT scans at airports might be a boon for people without health insurance. The out-of-pocket cost of a CT scan in a hospital or outpatient imaging center can range from $400 to more than $2,000. If a patient needed a chest CT scan, it would be cheaper to buy a plane ticket, go to the airport, have the CT scan, and not bother to get on the plane.

I thank my Twitter radiologist colleagues Rich Duszal (@RichDuszak) and Saurabh Jha (@RogueRad) for their valuable input.

 

Skeptical Scalpel is a retired surgeon and was a surgical department chair and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times.For the last 9 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,700,000 page views, and he has over 21,000 followers on Twitter.