title: Follow-up CT pulmonary angiograms in patients with acute pulmonary embolism.
abstract: Computed tomographic (CT) angiography is associated with a non-negligible lifetime attributable risk of cancer. The risk is considerably greater for women and younger patients. Recognizing that there are risks from radiation, the purpose of this investigation was to assess the frequency of follow-up CT angiograms in patients with acute pulmonary embolism. This was a retrospective cohort study of patients aged ≥18 years with acute pulmonary embolism seen in three emergency departments from January 2013 to December 2014. Records of all patients were reviewed for at least 14 months. Pulmonary embolism was diagnosed by CT angiography in 600 patients. At least one follow-up CT angiogram in 1 year was obtained in 141 of 600 (23.5 %). Two follow-ups in 1 year were obtained in 40 patients (6.7 %), 3 follow-ups were obtained in 15 patients (2.5 %), and 4 follow-ups were obtained in 3 patients (0.5 %). Among young women (aged ≤29 years) with pulmonary embolism, 10 of 21 (47.6 %) had at least 1 follow-up and 4 of 21 (19.0 %) had 2 or more follow-ups in 1 year. Among all patients, recurrent pulmonary embolism was diagnosed in 15 of 141 (10.6 %) on the first follow-up CT angiogram and in 6 of 40 (15.0 %) on the second follow-up. Follow-up CT angiograms were obtained in a significant proportion of patients with pulmonary embolism, including young women, the group with the highest risk. Alternative options might be considered to reduce the hazard of radiation-induced cancer, particularly in young women.
authors.affiliation: Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, 909 Fee Road, East Lansing, MI, 48824, USA. steinp@msu.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Stein
authors.affiliation: Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, 909 Fee Road, East Lansing, MI, 48824, USA.
authors.forename: Fadi
authors.initials: F
authors.lastname: Matta
authors.affiliation: Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, 909 Fee Road, East Lansing, MI, 48824, USA.|Department of Medical Education, Summa Akron City Hospital, Akron, OH, USA.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Hughes
authors.affiliation: Department of Medical Education, Summa Akron City Hospital, Akron, OH, USA.
authors.forename: Zak N
authors.initials: ZN
authors.lastname: Hourmouzis
authors.affiliation: Department of Medical Education, Summa Akron City Hospital, Akron, OH, USA.
authors.forename: Nina P
authors.initials: NP
authors.lastname: Hourmouzis
authors.affiliation: Department of Emergency Medicine, St. Mary Mercy Hospital, Livonia, MI, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schweiss
authors.affiliation: Department of Emergency Medicine, St. Mary Mercy Hospital, Livonia, MI, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Bach
authors.affiliation: Department of Emergency Medicine, University of Toledo Medical Center, Toledo, OH, USA.
authors.forename: Viviane M
authors.initials: VM
authors.lastname: Kazan
authors.affiliation: Department of Emergency Medicine, University of Toledo Medical Center, Toledo, OH, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Kakish
authors.affiliation: Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, 909 Fee Road, East Lansing, MI, 48824, USA.|Department of Emergency Medicine, St. Mary Mercy Hospital, Livonia, MI, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Keyes
authors.affiliation: Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, 909 Fee Road, East Lansing, MI, 48824, USA.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Hughes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012189:Retrospective Studies
keywords: CT pulmonary angiography; Pulmonary embolism; Radiation risk