AJR: ER docs name CT as ideal technique for pulmonary embolism diagnosis

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In the diagnosis of pulmonary embolism, CT scanning is the preferred technique of emergency room (ER) physicians and advised by radiologists by an overwhelming majority, according to a study in the January issue of the American Journal of Roentgenology.

Saurabh Jha, MD, of the department of radiology at the Hospital of the University of Pennsylvania in Philadelphia, and colleagues found that in addition to CT leading the way in diagnosing pulmonary embolisms, ventilation–perfusion scintigraphy may play an increasing role when the use of iodinated contrast material is contraindicated. MRI technology, while still emerging, was used infrequently.

"CT is the nearly universal first-line imaging choice for the diagnosis of pulmonary embolism. This is not surprising considering its accuracy is well established," said Jha.

The study, which sought to determine the most practiced diagnostic approach to pulmonary embolism by ER clinicians and radiologists, included the opinions of 62 radiologists and 52 ER physicians throughout Pennsylvania.

The online questionnaire asked radiologists about their recommendations in terms of diagnosing pulmonary embolism, and the questions for emergency department physicians focused on their practice with respect to the diagnosis strategies for the detection of pulmonary embolism within typical situations as well as clinical circumstances in which the primary imaging technique is considered less desirable.

The authors found that 96 percent of ER physicians and 90 percent of all radiologists considered CT scanning to be their first choice for diagnosing pulmonary embolism. The desire to utilize ventilation–perfusion scintigraphy screening increased for the treatment of patients with renal failure and allergy to iodinated contrast material, and MRI was chosen infrequently, said the authors.

The authors also made a correlation to heavy CT usage, especially among ER physicians, with the additional advantages of the technology, including the capability of making alternative diagnoses, its rapid performance time and the availability of 24-hour interpretation of a study.

"The results of our study indicate that by a large margin, both emergency physicians and radiologists prefer CT in the diagnosis of pulmonary embolism,” said Jha.