CT pulmonary angiography is the first-line imaging test for acute pulmonary embolism: a survey of US clinicians.
OBJECTIVE
Our aim is to document current imaging practices for diagnosing acute pulmonary embolism (PE) among physicians practicing in the United States and explore factors associated with these practices.


METHODS
Between September 2004 and February 2005, we surveyed by mail 855 physicians selected at random from membership lists of three professional organizations. Physicians reported their imaging practices and experiences in managing patients with suspected acute PE during the preceding 12 months.


RESULTS
Completed questionnaires were received from 240 of 806 eligible participants (29.8%) practicing in 44 states: 86.7% of respondents believed that computed tomographic pulmonary angiography (CTPA) was the most useful imaging procedure for patients with acute PE compared with 8.3% for ventilation-perfusion (V-P) scintigraphy and 2.5% for conventional pulminary angiography (PA). After chest radiography, CTPA was the first imaging test requested 71.4% of the time compared with V-P scintigraphy (19.7%) and lower-limb venous ultrasound (5.8%). Participants received indeterminate or inconclusive results 46.4% of the time for V-P scintigraphy, 10.6% of the time for CTPA, and 2.2% of the time for PA. CTPA was available around the clock to 88.3% of participants compared with 53.8% for V-P scintigraphy and 42.5% for PA. A total of 68.6% of respondents received CTPA results in 2 hours or less (vs 37.5% for V-P scintigraphy and 22.9% for PA). CTPA also provided an alternative diagnosis to PE or showed other significant abnormalities 28.5% of the time, and these findings frequently altered management.


CONCLUSIONS
US clinicians unequivocally prefer CTPA in patients with suspected acute PE. Reasons for this preference include availability and timely reporting, a lower rate of inconclusive results, and the additional diagnostic capabilities that CTPA can provide.
Russell H. Morgan Department of Radiology and Radiological Sciences, 601 N. Caroline Street, Room 3254, The Johns Hopkins University School of Medicine, Baltimore, MD 21287-0801, USA. cweiss@jhmi.edu
Clifford R
CR
Weiss
John C
JC
Scatarige
Gregory B
GB
Diette
Edward F
EF
Haponik
Barry
B
Merriman
Elliot K
EK
Fishman
D000792:Angiography / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology