ArticleBMC pulmonary medicine2013
Finding an alternative diagnosis does not justify increased use of CT-pulmonary angiography.
Article in BMC pulmonary medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 58 citations in OpenAlex.
- Pulmonary Embolism Detection in Unenhanced CT Exams: A Radiomic-Based Classifier as a Promising Screening-Diagnostic Tool.Journal of personalized medicine · 2025Article
- Beyond pulmonary embolism: Alternative diagnosis and incidental findings on CT pulmonary angiography in sickle cell disease.Emergency radiology · 2024Article
- Cardiovascular Computed Tomography in the Diagnosis of Cardiovascular Disease: Beyond Lumen Assessment.Journal of cardiovascular development and disease · 2024Review
- Deep Learning-Based Algorithm for Automatic Detection of Pulmonary Embolism in Chest CT Angiograms.Diagnostics (Basel, Switzerland) · 2023Article
- CTPA ordering trends in local emergency departments: are they increasing and did they increase as a result of COVID-19?Emergency radiology · 2023Article
- Comparing 'clinical hunch' against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism.BMC pulmonary medicine · 2022Article
- A deep learning approach for automated diagnosis of pulmonary embolism on computed tomographic pulmonary angiography.BMC medical imaging · 2022Article
- Diagnosing pulmonary thromboembolism: Concerns and controversies.Medical journal, Armed Forces India · 2022Review
- CT pulmonary angiography findings in HIV-infected patients referred for suspected pulmonary thrombo-embolic disease.SA journal of radiology · 2022Article
- Applications of artificial intelligence in the thorax: a narrative review focusing on thoracic radiology.Journal of thoracic disease · 2021Review
- Multimodal fusion with deep neural networks for leveraging CT imaging and electronic health record: a case-study in pulmonary embolism detection.Scientific reports · 2020Article
- The use of computed tomography pulmonary angiography in the diagnosis of heart failure in the acute setting.Irish journal of medical science · 2020Article
- The use of clinical decision rules for pulmonary embolism in the emergency department: a retrospective study.International journal of emergency medicine · 2020Article
- Higher Imaging Yield When Clinical Decision Support Is Used.Journal of the American College of Radiology : JACR · 2020Article
- PENet-a scalable deep-learning model for automated diagnosis of pulmonary embolism using volumetric CT imaging.NPJ digital medicine · 2020Article
- Computed tomography for suspected pulmonary embolism results in a large number of non-significant incidental findings and follow-up investigations.Emergency radiology · 2019Article
- Assessing the Prevalence of Incidental Findings Identified by CTPA in Women of Reproductive Age.Emergency medicine international · 2018Article
- Observational
- Variation in the utilization and positivity rates of CT pulmonary angiography among emergency physicians at a tertiary academic emergency department.Emergency radiology · 2015Article
- Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e TisilogiaArticle
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe increased use of computed tomography pulmonary angiography (CTPA) is often justified by finding alternative diagnoses explaining patients' symptoms. However, this has not been rigorously examined.
methodsWe retrospectively reviewed CTPA done at our center over an eleven year period (2000 - 2010) in patients with suspected pulmonary embolus (PE). We then reviewed in detail the medical records of a representative sample of patients in three index years - 2000, 2005 and 2008. We determined whether CTPA revealed pulmonary pathology other than PE that was not readily identifiable from the patient's history, physical examination and prior chest X-ray. We also assessed whether the use of pre-test probability guided diagnostic strategy for PE.
resultsA total of 12,640 CTPA were performed at our center from year 2000 to 2010. The number of CTPA performed increased from 84 in 2000 to 2287 in 2010, a 27 fold increase. Only 7.6 percent of all CTPA and 3.2 percent of avoidable CTPAs (low or intermediate pre-test probability and negative D-dimer) revealed previously unknown findings of any clinical significance. When we compared 2008 to 2000 and 2005, more CTPAs were performed in younger patients (mean age (years) for 2000: 67, 2005: 63, and 2008: 60, (p=0.004, one-way ANOVA)). Patients were less acutely ill with fewer risk factors for PE. Assessment of pre-test probability of PE and D-dimer measurement were rarely used to select appropriate patients for CTPA (pre-test probability of PE documented in chart (% total) in year 2000: 4.1%, 2005: 1.6%, 2008: 3.1%).
conclusionsOur data do not support the argument that increased CTPA use is justified by finding an alternative pulmonary pathology that could explain patients' symptoms. CTPA is being increasingly used as the first and only test for suspected PE.
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