title: Controversies in diagnosis of pulmonary embolism.
abstract: The approach to the diagnosis of acute pulmonary embolism (PE) is under constant revision with advances in technology, noninvasive approaches, and increasing awareness of the risks of ionizing radiation. Optimal approaches in some categories of patients are controversial. Data are insufficient for evidence-based recommendations. Therefore, this survey of investigators in the field was undertaken. Even among experts there were marked differences of opinion regarding the approach to the diagnosis of acute PE. Although CT pulmonary angiography was usually the imaging test of choice, the respondents were keenly aware of the dangers of ionizing radiation. In view of advances in scintigraphic diagnosis since the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) trial, ventilation/perfusion (V/Q) lung scans or perfusion scans alone and single photon emission computed tomography (SPECT) V/Q lung scans are often recommended. The choice depends on the patient's age, gender, and complexity of the findings on the plain chest radiograph.
authors.affiliation: Department of Internal Medicine and Research and Advanced Studies Program, Michigan State University College of Osteopathic Medicine, East Lansing, MI 48341, USA. steinp@trinity-health.org
authors.forename: Paul D
authors.initials: PD
authors.lastname: Stein
authors.forename: H Dirk
authors.initials: HD
authors.lastname: Sostman
authors.forename: James E
authors.initials: JE
authors.lastname: Dalen
authors.forename: Dale L
authors.initials: DL
authors.lastname: Bailey
authors.forename: Marika
authors.initials: M
authors.lastname: Bajc
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Goodman
authors.forename: Alexander
authors.initials: A
authors.lastname: Gottschalk
authors.forename: Russell D
authors.initials: RD
authors.lastname: Hull
authors.forename: Fadi
authors.initials: F
authors.lastname: Matta
authors.forename: Massimo
authors.initials: M
authors.lastname: Pistolesi
authors.forename: Victor F
authors.initials: VF
authors.lastname: Tapson
authors.forename: John G
authors.initials: JG
authors.lastname: Weg
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Woodard
mesh_terms: D000208:Acute Disease; D000792:Angiography / Q000379:methods; D003625:Data Collection; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods