<b>Pulmonary Embolism in Pregnant Patients:</b> A Survey of Practices and Policies for CT Pulmonary Angiography

Schuster, Michael; Fishman, Joel E.; Copeland, Julie; Hatabu, Hiroto; Boiselle, Phillip M.

doi:10.2214/ajr.181.6.1811495

Cited by 66 publications

(37 citation statements)

References 11 publications

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“…Concerning third generation DSCT scanners, there is currently only one study by Sabel et al demonstrating that high-pitch CTPA in single-energy mode is feasible with this scanner generation, even though no distinct decrease in radiation dose was observed compared to standard pitch cohorts [18]. Independent of the vendor, scanner generation, and protocol used, several basic strategies have been proposed for effectively decreasing radiation exposure in chest examinations, for example limiting the scan volume from the aortic arch to the right diaphragm [31,32].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Pulmonary Artery Embolism: Comparison of Single-Source CT and 3rd Generation Dual-Source CT using a Dual-Energy Protocol Regarding Image Quality and Radiation Dose

Petritsch¹,

Kosmala²,

Gassenmaier³

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNGZiel Das Potential der Dritt-Generation Dual-Source CT (DSCT) in der Lungenemboliediagnostik wurde bis dato noch nicht ausführlich untersucht. Ziel dieser Studie war es, Strahlendosisparameter sowie subjektive und objektive Bildqualität des aktuellsten DSCT Scanners im Single-Energy und Dual-Energy (DE) Modus mit einem herkömmlichen pulmonalen Standard CTA Protokoll am 64-Zeilen CT (SSCT) zu vergleichen. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. Material und Methoden▪ Die Dual-Energy CT bietet potentiell zusätzliche Informationen durch die Erstellung von farbcodierten Jod-Karten. ABSTR AC TPurpose To compare radiation dose, subjective and objective image quality of 3 rd generation dual-source CT (DSCT) and dual-energy CT (DECT) with conventional 64-slice singlesource CT (SSCT) for pulmonary CTA.Materials and Methods 180 pulmonary CTA studies were performed in three patient cohorts of 60 patients each. Group 1: conventional SSCT 120 kV (ref.); group 2: single-energy DSCT 100 kV (ref.); group 3: DECT 90/Sn150 kV. CTDIvol, DLP, effective radiation dose were reported, and CT attenuation (HU) was measured on three central and peripheral levels. The signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR) were calculated. Two readers assessed subjective image quality according to a five-point scale.Results Mean CTDIvol and DLP were significantly lower in the dual-energy group compared to the SSCT group (p < 0.001 [CTDIvol]; p < 0.001 [DLP]) and the DSCT group (p = 0.003 [CTDIvol]; p = 0.003 [DLP]), respectively. The effective dose in the DECT group was 2.79 ± 0.95 mSv and significantly smaller than in the SSCT group (4.60 ± 1.68 mSv, p < 0.001) and the DSCT group (4.24 ± 2.69 mSv, p = 0.003). The SNR and CNR were significantly higher in the DSCT group (p < 0.001).Subjective image quality did not differ significantly among the three protocols and was rated good to excellent in 75 % (135/180) of cases with an inter-observer agreement of 80 %.Conclusion Dual-energy pulmonary CTA protocols of 3 rd generation dual-source scanners allow for significant reduction of radiation dose while providing excellent image quality and potential additional information by means of perfusion maps. Key Points:▪ Dual-energy CT with 90/Sn150 kV configuration allows for significant dose reduction in pulmonary CTA. ▪ Subjective image quality was similar among the three evaluated CT-protocols (64-slice SSCT, single-energy DSCT, 90/Sn150 kV DECT) and was rated good to excellent in 75% of cases.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of Pulmonary Artery Embolism: Comparison of Single-Source CT and 3rd Generation Dual-Source CT using a Dual-Energy Protocol Regarding Image Quality and Radiation Dose

Petritsch¹,

Kosmala²,

Gassenmaier³

et al. 2017

Fortschr Röntgenstr

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“…32 A survey of American radiological practice in 2002 revealed CTPA to be the initial imaging technique of choice in pregnant patients with suspected PE; however, there was great variation in the standard of practice. 33 In spite of concerns about the potential risks to the fetus, only 60 per cent of radiologists obtained informed consent before imaging, only 40 per cent altered imaging parameters in order to reduce radiation dose, and only 17 per cent had a written departmental policy in place. Recent analysis of UK practice revealed similar lack of knowledge of fetal dosimetry in the imaging of pregnant women suspected of having PE.…”

Section: Clinical Situation Suggested Managementmentioning

confidence: 99%

Management of venous thrombosis in pregnancy

Nelson

Greer

2008

Trends Urology, Gynecol. Sexual Health

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The management of venous thromboembolism in pregnancy is challenging, as many diagnostic tests are less accurate in pregnant than in non‐pregnant patients, and some of the radiological procedures are potentially hazardous to the fetus. In addition, anticoagulant treatment with coumarins can cause embryopathy. The authors recommend strategies for women at risk of deep venous thrombosis or pulmonary thromboembolism during pregnancy and outline appropriate investigations and treatment. Copyright © 2008 Wiley Interface Ltd

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“…25 Toraks Radyoloji Derneği'nin üyeleri arasında 2003 yılında yapılan bir taramada radyologların %53'ünün gebelerdeki PTE tanısında birinci basamak yöntem olarak BTPA'yı kullandığı, bunların sadece %60'ının işlem için onay formu aldığı ve sadece %40'ının radyasyon dozunu azaltmak için görüntüleme protokolünü modifiye ettiği bildirilmiştir. 26 İyonize kontrast maddenin fetüs üzerinde yarattığı risk tam olarak araştırılmamıştır. Çoğu gebede renal kolik gibi bazı problemler nedeniyle intravenöz kontrast madde kullanılmaktadır.…”

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The Management of Pulmonary Thromboembolism in Pregnancy

Kıvanç¹

2011

Solunum

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ÖZETPulmoner tromboemboli (PTE) gebelik ve loğusalık dönemindeki maternal ölümlerin en önemli nedenlerindendir. Aynı yaştaki gebe olmayan kadınlara göre gebelerde PTE'ye, beş kat daha fazla rastlanılır. PTE'nin bazı semptomları gebeliğin beklenen normal semptomlarıyla karıştığından, gebelikte PTE tanısı koymak oldukça zordur. Gebelerde PTE tanısı, tedavinin hem anne hem de fetüs için yaratabileceği zararlı etkilerinden dolayı hayati önem taşır. Tanısal işlemler sırasında oluşacak fetal radyasyon maruziyeti nedeniyle doğru görüntüleme yönteminin uygulanması önemlidir. Gebelik sırasında gelişen PTE'nin tedavisinde hem anne hem de bebek güvenliği açısından tercih edilen ilaç düşük moleküler ağırlıklı heparindir. Genel olarak postpartum en az altı hafta devam edecek şekilde altı aylık antikoagülan tedavi önerilmektedir.Anah tar söz cük ler: antikoagülan tedavi, gebelik, pulmoner tromboemboli ABST RACTPulmonary thromboembolism (PTE) is the leading cause of maternal death during pregnancy and puerperium. The rate of PTE in pregnancy is five times greater than that for non-pregnant women of the same age. The clinical diagnosis of PTE is difficult as some of the clinical symptoms of PTE can be normal and expected symptoms of pregnancy. Precise PTE diagnosis in pregnancy is vital as treatment is associated with side effects for both the mother and fetus. Accurate imaging is essential, but there are anxieties relating to fetal radiation exposure during diagnostic procedures. Based on the safety data for both mother and fetus, low-molecular weight heparin is the preferred drug for the treatment of PTE during pregnancy. In general, at least six months of anticoagulant therapy with treatment continued until at least six weeks postpartum is recommended.

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Pulmonary Embolism in Pregnant Patients: A Survey of Practices and Policies for CT Pulmonary Angiography

Abstract: Most respondents perform CT angiography in pregnant patients suspected of having pulmonary embolism, but their policies and practices vary considerably.

Cited by 66 publications

References 11 publications

Diagnosis of Pulmonary Artery Embolism: Comparison of Single-Source CT and 3rd Generation Dual-Source CT using a Dual-Energy Protocol Regarding Image Quality and Radiation Dose

Diagnosis of Pulmonary Artery Embolism: Comparison of Single-Source CT and 3rd Generation Dual-Source CT using a Dual-Energy Protocol Regarding Image Quality and Radiation Dose

Management of venous thrombosis in pregnancy

The Management of Pulmonary Thromboembolism in Pregnancy

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