Equipment availability and diagnostic strategies for suspected pulmonary embolism in Austria

Abstract

The aim of this study was to investigate equipment availability and current diagnostic strategies for suspected pulmonary embolism (PE) in Austrian hospitals. A questionnaire was sent to the medical directors of all Austrian hospitals with emergency and/or surgical, orthopedic, and medical departments. The questionnaire contained questions regarding the available equipment suitable for the imaging diagnosis of PE, the first-line and second-line imaging tests for patients with suspected PE, and additional lower extremity venous imaging and laboratory tests that complement the diagnostic armamentarium. The return rate for questionnaires was 81% (127 of 157 hospitals). There were 97% of hospitals that had the equipment to perform sonography, 59% could perform pulmonary angiography, 54% spiral CT, 19% ventilation/perfusion (V/P) scintigraphy, and 4% perfusion scintigraphy alone. Spiral-CT angiography (SCTA) was the first-line imaging study for suspected PE in 56% of hospitals, followed by echocardiography and V/P scintigraphy. Lower extremity venous imaging (47%) and, interestingly, V/P scintigraphy (43%), served as second-line imaging tests. D-dimer tests were included in the diagnostic strategy in 74% of hospitals. Spiral-CT angiography is the most commonly used primary method for suspected PE in Austrian hospitals. The V/P scintigraphy is available only in a minority of hospitals to investigate patients with suspected PE. When V/P scintigraphy is available, however, it is employed in a large number of patients per annum.

Spiral computed tomography of pulmonary embolism

“…In another survey, which examined the imaging equipment available for the diagnosis of PE in Austrian hospitals, the present authors group has demonstrated that in 1998, spiral CT was available in 54%, angiography in 46%, and V/Q scintigraphy in 22% of hospitals, respectively. It is particularly remarkable that in hospitals with v150 beds, V/Q scintigraphy was available only in 5% of institutions [38]. From these results, it can be deduced that imaging in PE cannot rely on a single methodological approach, but rather on the use of the equipment available and on exploiting the different imaging possibilities at hand.…”

“…Too many publications have reported, and too many institutions have experienced that pulmonary angiography is clinically underused because of its invasiveness and its rather low degree of acceptance by clinicians. Furthermore, as documented by studies on equipment availability [37,38] the access to pulmonary angiography is limited. Therefore, pulmonary angiography will, in the future, be kept to local or regional importance and will otherwise be completly replaced by SCTA.…”

Spiral Computed Tomography for Acute Pulmonary Embolism

“…21,22 The morbidity and mortality rates for this invasive test are reported to range from 3.5% to 6% and 0.2% to 0.5%, respectively. [23][24][25] Use of nuclear medicine imaging, once the first imaging study for suspected PE, is in decline 26,27 because of the high percentage of indeterminate studies (73% of all performed 28 ) and poor interobserver correlation. 29 Revised criteria for the interpretation of ventilation-perfusion examinations 30,31 and novel technologies in nuclear medicine such as SPECT 32 can decrease the proportion of indeterminate scintigraphic studies but cannot offset the limitations inherent to a functional imaging test.…”

Real-time MR with TrueFISP for the detection of acute pulmonary embolism: initial clinical experience

“…Among these severely ill patients in particular, reliable performance of RT-MRI ideally complemented MRA and allowed emergency diagnosis and fast therapeutic decisions. Presently, however, CTA is the most commonly used imaging modality for diagnosing PE [6]. Sensitivity of CTA reaches up to 94% for segmental PE [16] but depends on vessel size [17].…”

“…While pulmonary angiography was a long-standing gold standard, its restricted availability, the examination time required, the equipment and personnel demands, and a low percentage of major complications [4] all conspired to motivate a search for alternatives. Spiral CT, introduced for the diagnosis of PE by Remy-Jardin et al in 1992 [5], has become the most widely used imaging modality [6]. Multi-slice CT allows imaging at the subsegmental level [7,8] and visualizes simultaneous diseases such as atelectasis.…”