‘Ultra-low-dose’ CT versus X-thorax op de SEH

OBJECTIVE: The enhanced diagnostic accuracy of ultra-low-dose chest CT (ULDCT) compared to chest X-ray (CXR) at a comparable radiation dose, makes ULDCT an appealing alternative at the emergency department (ED). Design We assessed the impact on health outcomes of replacing CXR with ULDCT in patients with suspected non-traumatic pulmonary disease at the ED. Results ULDCT is non-inferior in short-term functional health with minimal differences in hospital admissions, length of stay, mortality, and economic impact compared to CXR. There were more incidental findings, but less additional imaging procedures after 28 days with ULDCT. Pneumonia was more often correctly diagnosed with ULDCT. In patients with an atypical presentation of pneumonia ULDCT performed better than CXR. Conclusion The results of our trial do not support the unconditional use of ULDCT in the work-up of patients presenting with non-traumatic pulmonary disease at the ED. It is recommended to consider the use of ULDCT instead of CXR in vulnerable patients.