Success of a safe and simple algorithm to reduce use of CT pulmonary angiography in the emergency department

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Abstract

OBJECTIVE. The purpose of our study was to determine whether the radiation exposure to patients with suspected pulmonary embolism (PE) could be decreased by safely increasing the use of ventilation-perfusion (V/Q) scanning and decreasing the use of CT pulmonary angiography (CTPA) through an educational intervention. MATERIALS AND METHODS. Collaborative educational seminars were held among the radiology, nuclear medicine, and emergency medicine departments in December 2006 and January 2007 regarding the radiation dose and accuracies of V/Q scanning and CTPA for diagnosing PE. To reduce radiation exposure, an imaging algorithm was introduced in which emergency department patients with a clinical suspicion of PE underwent chest radiography. If the chest radiograph was normal, V/Q scanning was recommended, otherwise CTPA was recommended. We retrospectively tallied the number and results of CTPA and V/Q scanning and calculated mean radiation effective dose before and after the intervention. False-negative findings were defined as subsequent thromboembolism within 90 days. RESULTS. The number of CTPA examinations performed decreased from 1,234 in 2006 to 920 in 2007, and the number of V/Q scans increased from 745 in 2006 to 1,216 in 2007. The mean effective dose was reduced by 20%, from 8.0 mSv in 2006 to 6.4 mSv in 2007 (p < 0.0001). The patients who underwent CTPA and V/Q scanning in 2006 were of similar age. In 2007, the patients who underwent V/Q scanning were significantly younger. There was no significant difference in the false-negative rate (range, 0.8-1.2%) between CTPA and V/Q scanning in 2006 and 2007. CONCLUSION. The practice patterns of physicians changed in response to an educational intervention, resulting in a reduction in radiation exposure to emergency department patients with suspected PE without compromising patient safety.

Original languageEnglish (US)
Pages (from-to)392-397
Number of pages6
JournalAmerican Journal of Roentgenology
Volume194
Issue number2
DOIs
StatePublished - Feb 2010

Fingerprint

Hospital Emergency Service
Lung
Pulmonary Embolism
Thorax
Physicians' Practice Patterns
Radiation
Emergency Medicine
Thromboembolism
Nuclear Medicine
Patient Safety
Computed Tomography Angiography
Radiology
Radiography
Ventilation
Perfusion
Radiation Exposure

Keywords

  • CT
  • Lung scan
  • Practice pattern
  • Pulmonary angiography
  • Pulmonary embolism
  • Radiation exposure
  • Ventilation-perfusion scanning

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{d6e91f91a7ef48e2a4cf1fdf83c664bd,
title = "Success of a safe and simple algorithm to reduce use of CT pulmonary angiography in the emergency department",
abstract = "OBJECTIVE. The purpose of our study was to determine whether the radiation exposure to patients with suspected pulmonary embolism (PE) could be decreased by safely increasing the use of ventilation-perfusion (V/Q) scanning and decreasing the use of CT pulmonary angiography (CTPA) through an educational intervention. MATERIALS AND METHODS. Collaborative educational seminars were held among the radiology, nuclear medicine, and emergency medicine departments in December 2006 and January 2007 regarding the radiation dose and accuracies of V/Q scanning and CTPA for diagnosing PE. To reduce radiation exposure, an imaging algorithm was introduced in which emergency department patients with a clinical suspicion of PE underwent chest radiography. If the chest radiograph was normal, V/Q scanning was recommended, otherwise CTPA was recommended. We retrospectively tallied the number and results of CTPA and V/Q scanning and calculated mean radiation effective dose before and after the intervention. False-negative findings were defined as subsequent thromboembolism within 90 days. RESULTS. The number of CTPA examinations performed decreased from 1,234 in 2006 to 920 in 2007, and the number of V/Q scans increased from 745 in 2006 to 1,216 in 2007. The mean effective dose was reduced by 20{\%}, from 8.0 mSv in 2006 to 6.4 mSv in 2007 (p < 0.0001). The patients who underwent CTPA and V/Q scanning in 2006 were of similar age. In 2007, the patients who underwent V/Q scanning were significantly younger. There was no significant difference in the false-negative rate (range, 0.8-1.2{\%}) between CTPA and V/Q scanning in 2006 and 2007. CONCLUSION. The practice patterns of physicians changed in response to an educational intervention, resulting in a reduction in radiation exposure to emergency department patients with suspected PE without compromising patient safety.",
keywords = "CT, Lung scan, Practice pattern, Pulmonary angiography, Pulmonary embolism, Radiation exposure, Ventilation-perfusion scanning",
author = "Stein, {Evan G.} and Haramati, {Linda B.} and Murthy Chamarthy and Seymour Sprayregen and Davitt, {Michelle M.} and Freeman, {Leonard M.}",
year = "2010",
month = "2",
doi = "10.2214/AJR.09.2499",
language = "English (US)",
volume = "194",
pages = "392--397",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
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T1 - Success of a safe and simple algorithm to reduce use of CT pulmonary angiography in the emergency department

AU - Stein, Evan G.

AU - Haramati, Linda B.

AU - Chamarthy, Murthy

AU - Sprayregen, Seymour

AU - Davitt, Michelle M.

AU - Freeman, Leonard M.

PY - 2010/2

Y1 - 2010/2

N2 - OBJECTIVE. The purpose of our study was to determine whether the radiation exposure to patients with suspected pulmonary embolism (PE) could be decreased by safely increasing the use of ventilation-perfusion (V/Q) scanning and decreasing the use of CT pulmonary angiography (CTPA) through an educational intervention. MATERIALS AND METHODS. Collaborative educational seminars were held among the radiology, nuclear medicine, and emergency medicine departments in December 2006 and January 2007 regarding the radiation dose and accuracies of V/Q scanning and CTPA for diagnosing PE. To reduce radiation exposure, an imaging algorithm was introduced in which emergency department patients with a clinical suspicion of PE underwent chest radiography. If the chest radiograph was normal, V/Q scanning was recommended, otherwise CTPA was recommended. We retrospectively tallied the number and results of CTPA and V/Q scanning and calculated mean radiation effective dose before and after the intervention. False-negative findings were defined as subsequent thromboembolism within 90 days. RESULTS. The number of CTPA examinations performed decreased from 1,234 in 2006 to 920 in 2007, and the number of V/Q scans increased from 745 in 2006 to 1,216 in 2007. The mean effective dose was reduced by 20%, from 8.0 mSv in 2006 to 6.4 mSv in 2007 (p < 0.0001). The patients who underwent CTPA and V/Q scanning in 2006 were of similar age. In 2007, the patients who underwent V/Q scanning were significantly younger. There was no significant difference in the false-negative rate (range, 0.8-1.2%) between CTPA and V/Q scanning in 2006 and 2007. CONCLUSION. The practice patterns of physicians changed in response to an educational intervention, resulting in a reduction in radiation exposure to emergency department patients with suspected PE without compromising patient safety.

AB - OBJECTIVE. The purpose of our study was to determine whether the radiation exposure to patients with suspected pulmonary embolism (PE) could be decreased by safely increasing the use of ventilation-perfusion (V/Q) scanning and decreasing the use of CT pulmonary angiography (CTPA) through an educational intervention. MATERIALS AND METHODS. Collaborative educational seminars were held among the radiology, nuclear medicine, and emergency medicine departments in December 2006 and January 2007 regarding the radiation dose and accuracies of V/Q scanning and CTPA for diagnosing PE. To reduce radiation exposure, an imaging algorithm was introduced in which emergency department patients with a clinical suspicion of PE underwent chest radiography. If the chest radiograph was normal, V/Q scanning was recommended, otherwise CTPA was recommended. We retrospectively tallied the number and results of CTPA and V/Q scanning and calculated mean radiation effective dose before and after the intervention. False-negative findings were defined as subsequent thromboembolism within 90 days. RESULTS. The number of CTPA examinations performed decreased from 1,234 in 2006 to 920 in 2007, and the number of V/Q scans increased from 745 in 2006 to 1,216 in 2007. The mean effective dose was reduced by 20%, from 8.0 mSv in 2006 to 6.4 mSv in 2007 (p < 0.0001). The patients who underwent CTPA and V/Q scanning in 2006 were of similar age. In 2007, the patients who underwent V/Q scanning were significantly younger. There was no significant difference in the false-negative rate (range, 0.8-1.2%) between CTPA and V/Q scanning in 2006 and 2007. CONCLUSION. The practice patterns of physicians changed in response to an educational intervention, resulting in a reduction in radiation exposure to emergency department patients with suspected PE without compromising patient safety.

KW - CT

KW - Lung scan

KW - Practice pattern

KW - Pulmonary angiography

KW - Pulmonary embolism

KW - Radiation exposure

KW - Ventilation-perfusion scanning

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