Clifford Raabe Weiss MD, Presenter: Nothing to Disclose

John Charles Scatarige MD, Abstract Co-Author: Nothing to Disclose

Gregory B. Diette, Abstract Co-Author: Nothing to Disclose

Barry Merriman MA, Abstract Co-Author: Nothing to Disclose

Edward Francis Haponik MD, Abstract Co-Author: Nothing to Disclose

Elliot Keith Fishman MD, Abstract Co-Author: Nothing to Disclose

Published evidence and practice guidelines suggest that the preferred option in non-invasive imaging for acute pulmonary embolism (PE) has shifted from ventilation-perfusion scanning (V-Q) to CT pulmonary angiography (CTPA). The purpose of this study was to document current imaging practices for acute PE among physicians practicing in the United States.

Between September 2004 and February 2005, we surveyed 855 physicians, including 350 general internists (GIM), 255 pulmonologists (PM), and 250 emergency medicine specialists (EM), selected at random from membership lists of three professional organizations. We questioned the clinicians concerning their imaging beliefs, practices, and experiences in suspected acute PE during the preceding 12 months.

Completed questionnaires were received from 240 (30%) of 806 eligible physicians. Forty-four states were represented and 66% of respondents were in private practice. Although 76% of respondents felt that conventional pulmonary angiography (CPA) represented the imaging “gold standard” for acute PE, 87% (EM 89%, PM 88%, GIM 82%) believed that CTPA was the most useful imaging procedure in that condition, compared with 8% for V-Q and 3% for CPA. Excluding chest radiography, CTPA was the first imaging test requested by 71 % of respondents (EM 79%, GIM 68%, PM 67%), compared to V-Q (20%) and lower extremity venous ultrasound (6%). 82% of the clinicians agreed that the utility of CTPA in acute PE had been validated in clinical studies, compared to 71% for V-Q. Around-the-clock availability of CTPA was reported by 88 % of participants, compared to 54 % for V-Q and 43% for CPA. Sixty-nine percent of respondents received CTPA results in 2 hours or less, compared to 38% for V-Q, and 23% for CPA. Participants reported indeterminate or inconclusive results 46% of the time for V-Q, 11% for CTPA, and 2% for CPA.

Clinicians from all three groups expressed a clear preference for CTPA in suspected acute PE. The reasons for this preference included availability, rapidity of reporting, perceived clinical utility, and a comparatively low rate of inconclusive results.

Weiss, C, Scatarige, J, Diette, G, Merriman, B, Haponik, E, Fishman, E, Imaging Preferences in the Diagnosis of Acute Pulmonary Embolism: Results of a 2005 Nationwide Survey of Physicians.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4415571.html