Why are doctors overriding CT guidelines for PE patients?

As much as 37% of CT pulmonary angiography exams for patients with a pulmonary...Read more on AuntMinnie.comRelated Reading: Clinical rules reduce need for CTPA during pregnancy MRA tops CTA for pulmonary embolism evaluation French find no need for CT to rule out PE CT use for pulmonary embolism rises despite low yield Doctors who order fewer CTPA scans detect more PE
Source: AuntMinnie.com Headlines - Category: Radiology Source Type: news

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(Abstracted from N Engl J Med 2019;380:1139–1149) Acute pulmonary embolism is one of the leading causes of maternal death, with the overall incidence reported to be 1.72 cases per 1000 deliveries, accounting for approximately 1 death in every 100,000 deliveries. Since the D-dimer test has low specificity and sensitivity, it is common for pregnant women with suspected pulmonary embolism to undergo computed tomography (CT) pulmonary angiography or ventilation-perfusion (V/Q) scanning, both of which involve radiation exposure to the mother and fetus.
Source: Obstetrical and Gynecological Survey - Category: OBGYN Tags: OBSTETRICS: MEDICAL COMPLICATIONS OF PREGNANCY Source Type: research
AbstractPurpose of ReviewThe purpose of this article is to review the imaging findings and current imaging techniques of acute pulmonary embolism (PE) and chronic thromboembolic disease. Special considerations are also discussed, including pregnancy, congenital heart disease, lower extremity computed tomography (CT), and the isolated subsegmental PE.Recent FindingsCT pulmonary angiography and planar ventilation/perfusion (V/Q) lung scintigraphy are the primary means of evaluating pulmonary embolic disease. Magnetic resonance angiography avoids ionizing radiation and iodinated contrast in select patients. V/Q SPECT/CT provi...
Source: Current Respiratory Care Reports - Category: Respiratory Medicine Source Type: research
Authors: Kruger PC, Eikelboom JW, Douketis JD, Hankey GJ Abstract Pulmonary embolism (PE) is a potentially life-threatening condition, mandating urgent diagnosis and treatment. The symptoms of PE may be non-specific; diagnosis therefore relies on a clinical assessment and objective diagnostic testing. A clinical decision rule can determine the pre-test probability of PE. If PE is "unlikely", refer for a D-dimer test. If the D-dimer result is normal, PE can be excluded. If D-dimer levels are increased, refer for chest imaging. If PE is "likely", refer for chest imaging. Imaging with computed tomo...
Source: Medical Journal of Australia - Category: General Medicine Tags: Med J Aust Source Type: research
In conclusion, pulmonary embolism is an important complication of pregnancy. Understanding the recommendations from various specialty groups allows us to be better consultants and assist in the management of these patients. References 1. Righini M, Robert-Ebadi H, Elias A, et al. Diagnosis of pulmonary embolism during pregnancy. Ann Intern Med. 2018; 169:766-773 2. Kirsch J, Brown RKJ, Henry TS, et al. ACR Appropriateness Criteria ® Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/. American College of Radiology. Accessed January 2019. 3. Parker JA, Coleman RE, Grady E, et al. SN...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Educational Exhibit Posters Source Type: research
Conclusion: High-pitch dual-source CT with free-breathing yields better image quality, reduces image acquisition time and radiation doses. PMID: 30834417 [PubMed - in process]
Source: Saudi Medical Journal - Category: Middle East Health Tags: Saudi Med J Source Type: research
CONCLUSION: Careful CTPA scan protocol selection and additional optimization of scan length may result in significant radiation dose reduction for a pregnant patient and her fetus, whilst maintaining diagnostic confidence. PMID: 30672171 [PubMed - in process]
Source: Korean J Radiol - Category: Radiology Authors: Tags: Korean J Radiol Source Type: research
​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; &AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and it...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Use of CT in the investigation of pulmonary embolism in radiosensitive patients such as pregnant and young female patients entails the need for protocol optimization. The aim of this study was to analyze the dose reduction and image quality achieved by using 80  kV instead of 100 kV in CT pulmonary angiography protocols.
Source: Radiography - Category: Radiology Authors: Source Type: research
Conclusion: A diagnostic strategy based on assessment of clinical probability, D-dimer measurement, CUS, and CTPA can safely rule out PE in pregnant women. Primary Funding Source: Swiss National Foundation for Scientific Research, Groupe d'Etude de la Thrombose de Bretagne Occidentale, and International Society on Thrombosis and Haemostasis. PMID: 30357273 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - Category: Internal Medicine Authors: Tags: Ann Intern Med Source Type: research
Abstract Differences of computed tomography pulmonary angiography versus ventilation-perfusion lung scan in pregnant patients with suspected acute pulmonary embolism are not well-known, leading to ongoing debate on which test to choose. We searched in PUBMED, EMBASE, Web of science and Cochrane library databases and identified all relevant articles and abstracts published up to October1st 2017. We assessed diagnostic efficiency, frequency of non-diagnostic results and radiation exposure for patient and fetus. We included 13 studies for the diagnostic efficiency analysis, 30 for non-diagnostic results analysis and ...
Source: Haematologica - Category: Hematology Authors: Tags: Haematologica Source Type: research
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