Author(s): Dr Marko Berovic

Hospital: Whittington Hospital

Reference: RAD Magazine, 42, 495, 21-22

Excerpt: 

Shortness of breath and chest pain are two of the most common symptoms accounting for acute presentations to hospital. Pulmonary embolism (PE) is part of the differential diagnosis for both symptoms and due to increasing clinical concern about missing venous thromboembolic disease (VTE) and greater access to imaging, there has been a progressive year-on-year increase in imaging for PE since 2000.

With multiple testing options, development of new technologies and ongoing refinements to existing technologies, it has become a confusing and controversial area for clinicians and radiologists. CT pulmonary angiography (CTPA) has been widely adopted as the first line test of choice for PE imaging in both the USA and the UK. This diagnostic approach was endorsed by the NICE guidelines on management of VTE. The increasing use of CT for this purpose has caused concerns about resource pressures, radiation protection of patients and overdiagnosis of PE.

Optimal choice of imaging depends on the patient population studied, local access to technology, radiation dose administered and local expertise in performing and reporting the tests that are available.