title: [Improvement of pulmonary angiography in the framework of a maintenance of certification].
abstract: OBJECTIVE
  This evaluation of clinical practices (pulmonary embolus) was performed to evaluate the quality of CT pulmonary angiograms for suspected acute pulmonary embolus.
  
  
  METHODS
  Five validated criteria evaluating both the acquisition technique and the quality of image interpretation were selected: slice thickness, pulmonary arterial enhancement over 250 HU, caudocranial acquisition, visualization of fifth order pulmonary arterial branches, and right-left ventricular ratio in the presence of pulmonary embolus. Forty CT pulmonary angiograms were reviewed before and after implementation of a practice quality improvement program: modification of acquisition protocol, training of medical and paramedical staff, and implementation of a standardized radiology report.
  
  
  RESULTS
  Thin collimation was already implemented. The implementation of two other technical parameters significantly improved the technical quality of the examinations. The detection of findings with adverse clinical outcome was also significantly improved. Only the accuracy of detection of embolus involving fifth order pulmonary arterial branches could not be improved, a criteria allowing formal exclusion of pulmonary embolus.
  
  
  CONCLUSIONS
  This study resulted in an improvement in the quality of CT pulmonary angiograms and increased awareness of radiologists for the prognostic value of right ventricular dilatation. It has also underscored the need for quality control of a CT pulmonary angiogram prior to interpretation.
authors.affiliation: Service d'imagerie médicale, hôpital de La Timone, CHU de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France. marianne jolibert@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Jolibert
authors.forename: V
authors.initials: V
authors.lastname: Vidal
authors.forename: F
authors.initials: F
authors.lastname: Cohen
authors.forename: J-M
authors.initials: JM
authors.lastname: Bartoli
authors.forename: G
authors.initials: G
authors.lastname: Moulin
authors.forename: A
authors.initials: A
authors.lastname: Jacquier
authors.forename: J-Y
authors.initials: JY
authors.lastname: Gaubert
mesh_terms: D000792:Angiography / Q000379:methods / Q000592:standards; D002983:Clinical Competence; D006801:Humans; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000592:standards