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AJR Am J Roentgenol. 2010 Feb;194(2):392-7. doi: 10.2214/AJR.09.2499.

Success of a safe and simple algorithm to reduce use of CT pulmonary angiography in the emergency department.

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1
Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.

Erratum in

  • AJR Am J Roentgenol. 2010 Mar;194(3):554.

Abstract

OBJECTIVE:

The purpose of our study was to determine whether the radiation exposure to patients with suspected pulmonary embolism (PE) could be decreased by safely increasing the use of ventilation-perfusion (V/Q) scanning and decreasing the use of CT pulmonary angiography (CTPA) through an educational intervention.

MATERIALS AND METHODS:

Collaborative educational seminars were held among the radiology, nuclear medicine, and emergency medicine departments in December 2006 and January 2007 regarding the radiation dose and accuracies of V/Q scanning and CTPA for diagnosing PE. To reduce radiation exposure, an imaging algorithm was introduced in which emergency department patients with a clinical suspicion of PE underwent chest radiography. If the chest radiograph was normal, V/Q scanning was recommended, otherwise CTPA was recommended. We retrospectively tallied the number and results of CTPA and V/Q scanning and calculated mean radiation effective dose before and after the intervention. False-negative findings were defined as subsequent thromboembolism within 90 days.

RESULTS:

The number of CTPA examinations performed decreased from 1,234 in 2006 to 920 in 2007, and the number of V/Q scans increased from 745 in 2006 to 1,216 in 2007. The mean effective dose was reduced by 20%, from 8.0 mSv in 2006 to 6.4 mSv in 2007 (p < 0.0001). The patients who underwent CTPA and V/Q scanning in 2006 were of similar age. In 2007, the patients who underwent V/Q scanning were significantly younger. There was no significant difference in the false-negative rate (range, 0.8-1.2%) between CTPA and V/Q scanning in 2006 and 2007.

CONCLUSION:

The practice patterns of physicians changed in response to an educational intervention, resulting in a reduction in radiation exposure to emergency department patients with suspected PE without compromising patient safety.

PMID:
20093601
DOI:
10.2214/AJR.09.2499
[Indexed for MEDLINE]
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