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AIM: to determine the effectiveness of a new imaging algorithm in the investigation of suspected pulmonary embolism (PE). MATERIALS AND METHODS: A new imaging algorithm for suspected PE was introduced following the installation of a multisection computed tomography (CT) machine at our institution. Before its installation, patients with suspected PE were evaluated with ventilation/perfusion (V/Q) scintigraphy. Subsequently, patients were triaged according to chest radiography (CR) and respiratory history to either lung scintigraphy or CT pulmonary angiography (CTPA). Patients with a normal CR and no history of lung disease were evaluated using perfusion (Q) scintigraphy [ventilation (V) scintigraphy was no longer performed]. Patients with an abnormal CR, asthma or chronic lung disease were evaluated using CTPA. All V/Q images in a continuous 3-year period before the introduction of the new imaging algorithm and all Q images performed in a 3-year period after its introduction were retrospectively reviewed. Imaging reports were categorized into normal, non-diagnostic (low or intermediate probability) or high probability for PE. Patients in the later group who subsequently underwent CTPA, were also reviewed. RESULTS: After the policy change the percentage of normal scintigrams significantly increased (39 to 60%; p<0.001). There was a non-significant increase in the percentage of high probability scintigrams (15 to 18%; p=0.716). Overall the diagnostic yield of lung scintigraphy improved significantly (54 to 78%; p<0.001). CONCLUSION: the diagnostic performance of lung scintigraphy can be improved by careful triage of patients to either Q scintigraphy or CTPA based on clinical history and CR findings. Q scintigraphy remains a valuable diagnostic test in the investigation of suspected PE in carefully selected patients.

Original publication

DOI

10.1016/j.crad.2006.05.017

Type

Journal article

Journal

Clin Radiol

Publication Date

12/2006

Volume

61

Pages

1010 - 1015

Keywords

Adolescent, Adult, Aged, Aged, 80 and over, Algorithms, Clinical Protocols, Female, Humans, Lung, Male, Middle Aged, Pulmonary Embolism, Radionuclide Imaging, Retrospective Studies, Tomography, X-Ray Computed