Management of Suspected Acute Pulmonary Embolism in the Era of CT Angiography: A Statement from the Fleischner Society

Rémy‐Jardin, Martine; Pistolesi, Massimo; Goodman, Lawrence R.; Gefter, Warren B.; Gottschalk, Alexander; Mayo, John R.; Sostman, Henry Dirk

doi:10.1148/radiol.2452070397

Cited by 513 publications

(372 citation statements)

References 170 publications

(187 reference statements)

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“…Among them, multidetector CT (MDCT) has definitely influenced the evaluation of airways and lung diseases, allowing examination of the entire thorax without gaps, providing simultaneous availability of several series of images from a single data set with a dramatic reduction in breathing artefacts inherent to the high speed of data acquisitions [1][2][3]. This technology has also become the gold standard for diagnosing pulmonary vascular diseases, combining high spatial resolution and an optimal enhancement of thoracic circulations, exemplified in the diagnosis of acute pulmonary embolism [4]. More recently, it has become possible to integrate cardiac and coronary artery imaging into chest CT examinations, a concept applicable to numerous thoracic diseases [5].…”

Section: Introductionmentioning

confidence: 99%

Chest computed tomography using iterative reconstruction vs filtered back projection (Part 1): evaluation of image noise reduction in 32 patients

et al. 2010

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Section: Introductionmentioning

confidence: 99%

Chest computed tomography using iterative reconstruction vs filtered back projection (Part 1): evaluation of image noise reduction in 32 patients

et al. 2010

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“…Some guidelines recommend planar imaging as an alternative for patients contraindicated for CTPA due to severe renal insufficiency, multiple myeloma, or allergy to intravenous contrast agents or those with an inconclusive CT scan 28. Yet the relatively high rate of indeterminate (low and intermediate probability) planar scan results limit their clinical and economic utility.…”

Section: Discussionmentioning

confidence: 99%

The Economic Value of Hybrid Single‐photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis

Toney

Kim

Palli

2017

Academic Emergency Medicine

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ObjectiveThe objective was to quantify the potential economic value of single‐photon emission computed tomography (SPECT) with computed tomography (CT; SPECT/CT) versus CT pulmonary angiography (CTPA), ventilation–perfusion (V/Q) planar scintigraphy, and V/Q SPECT imaging modalities for diagnosing suspected pulmonary embolism (PE) patients in an emergency setting.MethodsAn Excel‐based simulation model was developed to compare SPECT/CT versus the alternate scanning technologies from a payer's perspective. Clinical endpoints (diagnosis, treatment, complications, and mortality) and their corresponding cost data (2016 USD) were obtained by performing a best evidence review of the published literature. Studies were pooled and parameters were weighted by sample size. Outcomes measured included differences in 1) excess costs, 2) total costs, and 3) lives lost per annum between SPECT/CT and the other imaging modalities. One‐way (±25%) sensitivity and three scenario analyses were performed to gauge the robustness of the results.ResultsFor every 1,000 suspected PE patients undergoing imaging, expected annual economic burden by modality was found to be 3.2 million (SPECT/CT), 3.8 million (CTPA), 5.8 million (planar), and 3.6 million (SPECT) USD, with a switch to SPECT/CT technology yielding per‐patient‐per‐month cost savings of $51.80 (vs. CTPA), $213.80 (vs. planar), and $36.30 (vs. SPECT), respectively. The model calculated that the incremental number of lives saved with SPECT/CT was six (vs. CTPA) and three (vs. planar). Utilizing SPECT/CT as the initial imaging modality for workup of acute PE was also expected to save $994,777 (vs. CTPA), $2,852,014 (vs. planar), and $435,038 (vs. SPECT) in “potentially avoidable”’ excess costs per annum for a payer or health plan.ConclusionCompared to the currently available scanning technologies for diagnosing suspected PE, SPECT/CT appears to confer superior economic value, primarily via improved sensitivity and specificity and low nondiagnostic rates. In turn, the improved diagnostic accuracy accords this modality the lowest ratio of expenses attributable to potentially avoidable complications, misdiagnosis, and underdiagnosis.

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“…[3] In 2006, results from the landmark PIOPED II trial established CTPA as the first choice diagnostic imaging modality, with sensitivity over 90% for patients with high clinical suspicion of PE and specificity of 96%. [4,5] Over the next five years, there was a four-fold increase in CTPA use and a 33% decrease in V/Q imaging. [6] However, CTPA carries significant risk of adverse effects compared to less invasive methods for diagnosis of PE.…”

Section: Introductionmentioning

confidence: 99%

A Computerized Method for Measuring Computed Tomography Pulmonary Angiography Yield in the Emergency Department: Validation Study (Preprint)

Richardson¹,

Solomon²,

O'Connell³

et al. 2018

Preprint

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Background: Use of computed tomography pulmonary angiography (CTPA) in the assessment for pulmonary embolism (PE) has significantly increased over the past two decades. While this technology has improved the accuracy of radiologic testing for PE, CTPA also carries the risk of significant iatrogenic harm. Each CTPA carries a 14% risk of contrast induced nephropathy and a lifetime malignancy risk that can be as high as 2.76%. Appropriate use of CTPA can be estimated by monitoring CTPA yield, the percentage of tests positive for PE. This is the first study to propose and validate a computerized method for measuring CTPA yield in the ED.

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Management of Suspected Acute Pulmonary Embolism in the Era of CT Angiography: A Statement from the Fleischner Society

Cited by 513 publications

References 170 publications

Chest computed tomography using iterative reconstruction vs filtered back projection (Part 1): evaluation of image noise reduction in 32 patients

Chest computed tomography using iterative reconstruction vs filtered back projection (Part 1): evaluation of image noise reduction in 32 patients

The Economic Value of Hybrid Single‐photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis

A Computerized Method for Measuring Computed Tomography Pulmonary Angiography Yield in the Emergency Department: Validation Study (Preprint)

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