A retrospective medical record review was performed to study the differences in clinical risk profiles and the relationships between test results versus management for suspected pulmonary thromboembolism (TE) in patients undergoing either radionuclide ventilation perfusion (V/Q) scans or pulmonary computed tomographic angiography (CTA), as the initial test. Data of 138 consecutive V/Q patients were compared with that of 149 consecutive CTA patients during equivalent 6-month intervals before and after the introduction of CTA. Information on risk factors, signs and symptoms, all diagnostic test results, and the relationships between the test results and ultimate physician management were collected and analyzed. V/Q results predicted physician management in all patients with high probability scans and 91% with normal to low probability scans. There were 35 patients with indeterminate V/Q scans--43% of these patients were managed without any other diagnostic test. CTA results predicted management in all patients with positive studies and 99% of patients with negative studies. In contrast to the V/Q cohort, only seven CTA studies were inconclusive--additional diagnostic tests determined management in all but one case. Compared with V/Q, CTA has fewer indeterminate results, is more directly reflective of management, and reduces the number of patients managed with inconclusive data.
Many radiologists are not familiar with the names of various instruments, surgical sponges, and needles that may be seen on intraoperative and postoperative radiographs. These devices may be intentionally placed for localization or therapeutic intervention, discovered on radiographs obtained to evaluate incorrect sponge or needle counts, or incidentally encountered on postoperative radiographs. These paraphernalia are usually described in vague nonspecific terms in radiology reports. In this article, photographs and radiographs of several instruments commonly used for intraoperative localization or therapy are presented, as well as examples of sponges, needles, and other devices that should not be found on postoperative radiographs. Familiarity with their appearances will allow a more precise and knowledgeable description in radiology reports.
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