Role of Clinical Decision Tools in the Diagnosis of Pulmonary Embolism

Sherk, William M.; Stojanovska, Jadranka

doi:10.2214/ajr.16.17206

Cited by 28 publications

(24 citation statements)

References 126 publications

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“…Clinical decision rules such as Wells, Geneva, and PERC were created and designed to help clinicians risk‐stratify patients undergoing workup for possible PE. In particular, the PERC were designed to eliminate the need for PE testing if a patient scored zero out of eight criteria . We found that, even in an academic center, adherence to PERC did not seem consistent and a significant percentage of PERC‐negative patients had PE testing performed.…”

Section: Discussionmentioning

confidence: 93%

See 1 more Smart Citation

Pulmonary Embolism Testing Among Emergency Department Patients Who Are Pulmonary Embolism Rule‐out Criteria Negative

Buchanan

Teeples

Carlson

et al. 2017

Academic Emergency Medicine

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Section: Discussionmentioning

confidence: 93%

“…Multiple clinical decision rules exist to aid the clinician in the risk stratification of patients with signs and symptoms that may be consistent with PE . One of the most utilized clinical decision rules is the Pulmonary Embolism Rule‐out Criteria (PERC) .…”

mentioning

confidence: 99%

Pulmonary Embolism Testing Among Emergency Department Patients Who Are Pulmonary Embolism Rule‐out Criteria Negative

Buchanan

Teeples

Carlson

et al. 2017

Academic Emergency Medicine

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“…In the cases where a PE is highly suspected or likely, it is preferred to proceed directly to imaging such as a computed tomography pulmonary arteriography (CTPA). The ease of obtaining it, combined with the high predictive value (92-96%), has placed CTPA as the dominant imaging modality for suspected PE [40]. In patients unable to receive iodinated contrast, a ventilation-perfusion (V-Q ) scan or a contrast-enhanced magnetic resonance angiography (MRA) may represent a valid alternative.…”

Section: Pulmonary Embolismmentioning

confidence: 99%

“…MRA has a sensitivity of 78% and specificity of 99%. This imaging study, however, relies on patient participation and compliance, and therefore a nontrivial proportion of studies will be inadequate to obtain sufficient level of diagnostic accuracy [40]. Once diagnosed, the treatment of PE involves systemic anticoagulation, with more invasive measures such as thrombolysis or embolectomy performed in patients with significant hemodynamic instability, respiratory decompensation, or acute right ventricular dysfunction [37].…”

Section: Pulmonary Embolismmentioning

confidence: 99%

Introductory Chapter: Defining the True Global Impact of Embolic Phenomena

Wolfe¹,

Stawicki²,

Swaroop³

et al. 2020

Embolic Diseases - Evolving Diagnostic and Management Approaches

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“…Computed tomography pulmonary angiography (CTPA) is currently the preferred imaging modality for diagnosis of suspected pulmonary embolism (PE). With improved spatial and temporal resolution available with modern CT scanners, CTPA has high diagnostic accuracy in the detection of segmental and subsegmental PE (1)(2)(3). However, the high radiation dose associated with CTPA is still a concern, given the high prevalence of PE and widespread use of less-invasive imaging for clinical diagnosis (1)(2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Optimization of computed tomography pulmonary angiography protocols using 3D printed model with simulation of pulmonary embolism

Aldosari¹,

Jansen²,

Sun³

2019

Quant. Imaging Med. Surg

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Background: Three-dimensional (3D) printing has been shown to accurately replicate anatomical structures and pathologies in complex cardiovascular disease. Application of 3D printed models to simulate pulmonary arteries and pulmonary embolism (PE) could assist development of computed tomography pulmonary angiography (CTPA) protocols with low radiation dose, however, this has not been studied in the literature. The aim of this study was to investigate optimal CTPA protocols for detection of PE based on a 3D printed pulmonary model. Methods: A patient-specific 3D printed pulmonary artery model was generated with thrombus placed in both main pulmonary arteries to represent PE. The model was scanned with 128-slice dual-source CT with slice thickness of 1 and 0.5 mm reconstruction interval. The tube voltage was selected to range from 70, 80, 100 to 120 kVp, and pitch value from 0.9 to 2.2 and 3.2. Quantitative assessment of image quality in terms of signal-to-noise ratio (SNR) was measured in the main pulmonary arteries and within the thrombus regions to determine the relationship between image quality and scanning protocols. Both two-dimensional (2D) and 3D virtual intravascular endoscopy (VIE) images were generated to demonstrate pulmonary artery and thrombus appearances. Results: PE was successfully simulated in the 3D printed pulmonary artery model. There were no significant differences in SNR measured in the main pulmonary arteries with 100 and 120 kVp CTPA protocols (P>0.05), regardless of pitch value used. SNR was significantly lower in the high-pitch 3.2 protocols when compared to other protocols using 70 and 80 kVp (P<0.05). There were no significant differences in SNR measured within the thrombus among the 100 and 120 kVp protocols (P>0.05). For low dose 70 and 80 kVp protocols, SNR was significantly lower in the high-pitch of 3.2 protocols than that in other protocols with different pitch values (P<0.01). 2D images showed the pulmonary arteries and thrombus clearly, while 3D VIE demonstrated intraluminal appearances of pulmonary wall and thrombus in all protocols, except for the 70 kVp and pitch 3.2 protocol, with visualization of thrombus and pulmonary artery wall affected by artifact associated with high image noise. Radiation dose was reduced by up to 80% when lowering kVp from 120 to 100 and 80 kVp with use of 3.2 high-pitch protocol, without significantly affecting image quality. Conclusions: Low-dose CT pulmonary angiography can be achieved with use of low kVp (80 and 100) and high-pitch protocol with significant reduction in radiation dose while maintaining diagnostic images of PE. Use of high pitch, 3.2 in 70 kVp protocol should be avoided due to high image noise and poorer quality.

show abstract

Role of Clinical Decision Tools in the Diagnosis of Pulmonary Embolism

Cited by 28 publications

References 126 publications

Pulmonary Embolism Testing Among Emergency Department Patients Who Are Pulmonary Embolism Rule‐out Criteria Negative

Pulmonary Embolism Testing Among Emergency Department Patients Who Are Pulmonary Embolism Rule‐out Criteria Negative

Introductory Chapter: Defining the True Global Impact of Embolic Phenomena

Optimization of computed tomography pulmonary angiography protocols using 3D printed model with simulation of pulmonary embolism

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