Edward Y. Lee MD, MPH, Presenter: Nothing to Disclose

David Zurakowski PhD, Abstract Co-Author: Nothing to Disclose

Phillip M. Boiselle MD, Abstract Co-Author: Nothing to Disclose

To determine the current policies and practices of Society for Pediatric Radiology (SPR) members regarding the use of computed tomography pulmonary angiography (CTPA) for evaluating pediatric patients with suspected pulmonary embolism (PE).

Surveys were mailed electronically to a total of 416 institutions. Information gathered included the existence of written policies, the imaging study of choice for suspected PE, routine acquisition of chest radiographs prior to CTPA, currently used CTPA techniques, modifications of standard protocols for radiation dose reduction, typical DLP for CTPA, and estimated annual frequency of performing CTPA for evaluating PE in children. Survey items pertaining to policies and practices were compared between practice settings and populations using chi-square analysis.

118 institutions responded, which resulted in a response rate of 28% (118 / 416). Of these 118 respondents, 104 (88%) perform CTPA in children with clinical suspicion of PE. Of the 104 respondents who perform CTPA, 26 (25%) have a written policy for CTPA, 93 (89%) perform CTPA as the first study choice, and 67 (64%) routinely obtain chest radiographs prior to CTPA. The most commonly used CTPA techniques include 2.0 ml/kg of contrast amount in 68 (65%), mechanical injection of contrast in 58 (56%), and initiation of CTPA scanning based on bolus tacking technique in 80 (77%), with a mean Hounsfield Unit of 140. Sixty respondents (58%) modify standard CTPA imaging protocols for evaluating PE in children in order to decrease radiation dose. The two most common modifications for radiation dose reduction were reduced mAs in 41 (68%) and automatic exposure control in 38 (63%). Ninety-one (88%) respondents did not know the typical DLP for CTPA performed in their institutions. A significantly greater percentage of radiation dose reduction techniques are performed within academic institutions compared to private institutions (P = .03).

Most survey respondents perform CTPA as the study of choice for evaluating PE in children, but there is considerable variability in their policies and practices. Although a slight majority of respondents employ radiation dose reduction techniques, most are unaware of the typical radiation dose associated with CTPA.

Our survey data suggest the need for formal practice guidelines for performing CTPA evaluation in children with suspected PE.

Lee, E, Zurakowski, D, Boiselle, P, Pulmonary Embolism in Pediatric Patients: Survey of CT Pulmonary Angiography Practices and Policies.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9012254.html