Frequency of Use of Imaging Tests in the Diagnosis of Pulmonary Embolism: Effects of Physician Specialty, Patient Characteristics, and Region (original) (raw)
Related papers
Journal of Cardiovascular Disease Research, 2013
Context: Acute pulmonary embolism (PE) remains a diagnostic and therapeutic challenge to physicians. There are various non-invasive diagnostic modalities been suggested to diagnose pulmonary embolism. Aim: We tried to find the performance of various non-invasive investigations in comparison to multidetector Computerized Tomography (MDCT pulmonary angiography for the diagnosis of PE). Settings and design: A prospective cohort study was conducted in 80 hospitalized medical patients. Materials and methods: There were 80 patients with Wells score > 2 who were included. The demographic data, non-invasive investigations, and MDCT pulmonary angiography were conducted in these patients. The sensitivity (SEN), specificity (SPE), positive predictive value (PPV), and negative predictive value (NPV) were calculated for each test. Results: Out of 80 patients, 77.5% patients were with Wells score 3e6 and 22.5% patients were with Wells score more than 6. The test with highest sensitivity was D-dimer (SEN e 90%, P ¼ 0.091) followed by PAH on TTE (SEN e 83%, PPV e 86%, P ¼ 0.006). The most specific test was ECG showing S1Q3T3 (SPE e 100%, P ¼ 0.421), followed by Wells score > 6 (SPE e 91%, P ¼ 0.211). There was no test with sensitivity and specificity more than 90% Conclusion: In all patients with intermediate to high-risk probability MDCT pulmonary angiography is the most accurate test to diagnose PE and should be performed at the earliest. The combination of 2dimensional ECHO and D-dimer can be used in patients with a high clinical suspicion of PE on pre-test probability where MDCT pulmonary angiography is not possible.
Academic Radiology, 2006
Rationale and Objectives. Our aim is to document current imaging practices for diagnosing acute pulmonary embolism (PE) among physicians practicing in the United States and explore factors associated with these practices. Materials and Methods. Between September 2004 and February 2005, we surveyed by mail 855 physicians selected at random from membership lists of three professional organizations. Physicians reported their imaging practices and experiences in managing patients with suspected acute PE during the preceding 12 months. Results. Completed questionnaires were received from 240 of 806 eligible participants (29.8%) practicing in 44 states: 86.7% of respondents believed that computed tomographic pulmonary angiography (CTPA) was the most useful imaging procedure for patients with acute PE compared with 8.3% for ventilation-perfusion (V-P) scintigraphy and 2.5% for conventional pulminary angiography (PA). After chest radiography, CTPA was the first imaging test requested 71.4% of the time compared with V-P scintigraphy (19.7%) and lower-limb venous ultrasound (5.8%). Participants received indeterminate or inconclusive results 46.4% of the time for V-P scintigraphy, 10.6% of the time for CTPA, and 2.2% of the time for PA. CTPA was available around the clock to 88.3% of participants compared with 53.8% for V-P scintigraphy and 42.5% for PA. A total of 68.6% of respondents received CTPA results in 2 hours or less (vs 37.5% for V-P scintigraphy and 22.9% for PA). CTPA also provided an alternative diagnosis to PE or showed other significant abnormalities 28.5% of the time, and these findings frequently altered management. Conclusion. US clinicians unequivocally prefer CTPA in patients with suspected acute PE. Reasons for this preference include availability and timely reporting, a lower rate of inconclusive results, and the additional diagnostic capabilities that CTPA can provide.
The Role of Imaging In The Diagnosis of Pulmonary Embolism
Biomolecular and Health Science Journal, 2019
Pulmonary embolism is a common condition and sometimes can be life-threatening. A proper diagnosis can reduce mortality. Some examinations are needed to diagnose pulmonary embolism, including assessing the risk factors, clinical examination, D-dimer tests, and imaging. Imaging is necessary when the previous assessment requires further investigation. There are more imaging that can be used to diagnose and assess the severity of pulmonary embolism. However, it is still controversial regarding imaging modalities for optimizing pulmonary embolism diagnose. Chest X-Ray cannot exclude pulmonary embolism, but it is needed to guide the next examinations and to find alternative diagnoses. Pulmonary Multi-Detector CT Angiography is the gold standard to diagnose pulmonary embolism.
Controversies in Diagnosis of Pulmonary Embolism
Clinical and Applied …, 2011
The approach to the diagnosis of acute pulmonary embolism (PE) is under constant revision with advances in technology, noninvasive approaches, and increasing awareness of the risks of ionizing radiation. Optimal approaches in some categories of patients are controversial. Data are insufficient for evidence-based recommendations. Therefore, this survey of investigators in the field was undertaken. Even among experts there were marked differences of opinion regarding the approach to the diagnosis of acute PE. Although CT pulmonary angiography was usually the imaging test of choice, the respondents were keenly aware of the dangers of ionizing radiation. In view of advances in scintigraphic diagnosis since the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) trial, ventilation/perfusion (V/Q) lung scans or perfusion scans alone and single photon emission computed tomography (SPECT) V/Q lung scans are often recommended. The choice depends on the patient's age, gender, and complexity of the findings on the plain chest radiograph.
Diagnosis of pulmonary embolism with various imaging modalities
Seminars in Vascular Surgery, 2004
Pulmonary embolism (PE) is a major health concern that affects approximately 600,000 new patients annually. The diagnosis of PE can be difficult to make, and several imaging studies have been developed to aid in this process. Initial evaluation involves the acquisition of a chest radiograph. Findings on radiography, however, are often non-specific. The gold-standard study historically has been pulmonary angiography,
This study was undertaken to evaluate the use of computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE) who were followed in the emergency department (ED). The files and computer records of 850 patients older than 16 years of age who were seen in the Hacettepe University Hospital ED between April 10, 2001, and December 1, 2005, and who required CTPA for PE prediagnosis and/or another diagnosis, were studied retrospectively. PE was identified by CTPA in 9.4% of 416 women and in 5.8% of 434 men. A significant difference (P<.05) was noted in the women and men in whom PE was detected. The mean age of the patients was 58.13±17.88 y (range, 16–100 y). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for clinical susceptibility to PE among patients who underwent CTPA were assessed at 95.3%, 48.2%, 13%, and 99.2%, respectively. CTPA was done for different reasons: aortic aneurysm dissection (n=1), cough distinctive diagnosis (n=1), dyspnea distinctive diagnosis (n=6), chest pain distinctive diagnosis (n=3), PE prediagnosis (n=51), and other reasons (n=2). Also, sensitivity, specificity, PPV, and NPV were found to be 95.4%, 16.2%, 14.4%, and 96%, respectively, for D-dimer. CTPA, which is accessible on a 24-h basis in the ED, is a valuable tool for the diagnosis of PE.
Lung scanning in the diagnosis of pulmonary embolism: The emperor redressed
Seminars in Nuclear Medicine, 1991
Diagnosis and management of the patient with pulmonary embolism remains a vexing clinical problem. Emboli are often unsuspected clinically. Ventilationperfusion (VQ) scintigraphy is known to miss some emboli found on pulmonary angiography. Some physicians recommend diagnostic approaches in which the lung scan plays a relatively minor role, and angiography is required for many patients. Major prospective studies recently have made available objective data for formulation and evaluation of diagnostic and therapeutic strategies. These data suggest that the lung scan is a better predictor of patient outcome than has been previously appreciated. The goal of V/Q scanning is not detection of pulmonary emboli per se, but rather the identification of patients at a high or low risk for future embolic events if they are not anticoagulated.
The Role of CT Angiography in Diagnosing Patients Suspected to Pulmonary Embolism
Journal of patient safety and quality improvement, 2015
A B S T R A C T Pulmonary embolism (PE) is a blockage of the main pulmonary artery or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism). Pulmonary embolism (PE) is the third most common cause of cardiovascular related mortality. Numerous diagnostic tools have been utilized in order to improve diagnosis and prompt appropriate treatment. Since the first introduction of Computed Tomography (CT) angiography in the setting of PE diagnosis algorithm, it has rapidly become as the first choice among imaging techniques. However, still there is long way to improve the abilities and lowering the possible hazards and problems. The purpose of this review is to evaluate and summarize the role of imaging tools in diagnosis of PE in suspected patients, with particular focus on CT angiography. We studied different areas related benefits, disagreements and challenges in utilizing CT angiography in the setting of PE diagnosis algorithm....
Iranian Journal of Radiology, 2015
The use of computed tomography pulmonary angiography (CTPA) has been increased during the last decade. Objectives: We studied the adherence to current diagnostic recommendations for evaluation of pulmonary embolism in a teaching hospital of Tehran University of Medical Sciences. Patients and Methods: The registered medical records (Wells scores and serum D-dimer level) of all patients whose CTPA was performed with suspicion of pulmonary thromboembolism (PTE) were studied retrospectively. Modified Wells score of each patient was determined without being aware of the CTPA results. The patients were categorized to those with a high (likely) clinical probability (score > 4) and low (unlikely) clinical probability (score≤ 4) of PTE. Results: During a 6-month period, 82 patients who underwent CTPA were included. The prevalence of PTE was 62.2% in the group of subjects with a likely clinical risk. In 45 (54.8%) of those patients whose CTPA was requested, the PTE was unlikely based on modified Wells criteria. In the clinically unlikely group, serum D-dimer assay was done in 15 out of 45 (33.3%), while it was inappropriately checked in 10 out of 37 (27.0%) with a clinically likely risk. General adherence rate to diagnostic algorithm of PTE was 43.9%. Conclusions: There is still excessive unjustified concern of PTE in less trained physicians leading to excessive diagnostic work-up. Loyalty to the existing guideline for management of suspected PTE in educational hospitals and supervision of attending physicians could prevent overuse of CTPA.
Blood Coagulation & Fibrinolysis, 2015
Current diagnostic strategies for pulmonary embolism rely on the sequential use of noninvasive diagnostic tests including ventilation-perfusion (V/Q) scan and computed tomography pulmonary angiography (CTPA). V/Q scan remains criticized because of a high proportion of nondiagnostic test results, especially when the chest X-ray (CXR) is abnormal. The present study assesses whether CXR results have an impact on the conclusiveness of a noninvasive diagnostic strategy of pulmonary embolism based on the combination of pretest probability, compression ultrasonography, V/Q scan, and CTPA. Patients suspected of having pulmonary embolism were managed according to a validated diagnostic strategy. All patients underwent a CXR within 24 h of the suspicion of pulmonary embolism. CXR results were correlated to strategy conclusiveness, as assessed by the rate of required CTPA as per the diagnostic algorithm. Two hundred and twenty-three patients were retrospectively analyzed. CXRs were considered as normal in 108 (48%) patients and abnormal in 115 (52%) patients. According to the diagnostic algorithm, a CTPA was required to reach a diagnostic conclusion in 11 (10%) patients of the normal CXR group, and in 14 (12%) patients of the abnormal CXR group (P > 0.05). In this study, the presence of CXR abnormalities did not have an impact on the conclusiveness of a diagnostic strategy of pulmonary embolism based on V/Q scan. CXR abnormalities should likely not be regarded as a contraindication to the use of V/Q scan in patients with suspected pulmonary embolism. Blood Coagul Fibrinolysis