title: Computed Tomography Pulmonary Angiography for Evaluation of Patients With Suspected Pulmonary Embolism: Use or Overuse.
abstract: BACKGROUND
  The use of computed tomography pulmonary angiography (CTPA) has been increased during the last decade.
  
  
  OBJECTIVE
  We studied the adherence to current diagnostic recommendations for evaluation of pulmonary embolism in a teaching hospital of Tehran University of Medical Sciences.
  
  
  METHODS
  The registered medical records (Wells scores and serum D-dimer level) of all patients whose CTPA was performed with suspicion of pulmonary thromboembolism (PTE) were studied retrospectively. Modified Wells score of each patient was determined without being aware of the CTPA results. The patients were categorized to those with a high (likely) clinical probability (score > 4) and low (unlikely) clinical probability (score≤ 4) of PTE.
  
  
  RESULTS
  During a 6-month period, 82 patients who underwent CTPA were included. The prevalence of PTE was 62.2% in the group of subjects with a likely clinical risk. In 45 (54.8%) of those patients whose CTPA was requested, the PTE was unlikely based on modified Wells criteria. In the clinically unlikely group, serum D-dimer assay was done in 15 out of 45 (33.3%), while it was inappropriately checked in 10 out of 37 (27.0%) with a clinically likely risk. General adherence rate to diagnostic algorithm of PTE was 43.9%.
  
  
  CONCLUSIONS
  There is still excessive unjustified concern of PTE in less trained physicians leading to excessive diagnostic work-up. Loyalty to the existing guideline for management of suspected PTE in educational hospitals and supervision of attending physicians could prevent overuse of CTPA.
authors.affiliation: Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shima
authors.initials: S
authors.lastname: Molaee
authors.affiliation: Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran ; Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Ghanaati
authors.affiliation: Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Enayat
authors.initials: E
authors.lastname: Safavi
authors.affiliation: Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Morteza
authors.initials: M
authors.lastname: Foroumandi
authors.affiliation: Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran ; Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Soheil
authors.initials: S
authors.lastname: Peiman
keywords: Computed Tomography; Emergencies; Pulmonary Embolism