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Adam T. Froemming - One of the best experts on this subject based on the ideXlab platform.
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High-pitch versus standard mode CT Pulmonary angiography: a comparison of indeterminate studies
Emergency Radiology, 2019Co-Authors: Derrick A. Doolittle, Adam T. FroemmingAbstract:Purpose To compare the causes of indeterminate CT Pulmonary Angiograms using standard mode and high-pitch mode, and determine at what level of the Pulmonary arterial tree studies were non-diagnostic. Methods IRB approval was obtained. A retrospeCTive review of patients at our institution who underwent a CT Pulmonary Angiogram, between November 1, 2015 and February 10, 2016 was performed. CT Pulmonary Angiograms using both high-pitch mode and standard mode were evaluated with positive and indeterminate rates calculated. Causes of indeterminate studies and the level of the Pulmonary arterial tree at which the study became non-diagnostic were determined by a board certified radiologist by looking at the images of each indeterminate study. The indeterminate rates were compared between high-pitch and standard modes using a generalized estimating equation. Results Five hundred fifty-nine CT Pulmonary Angiograms using high-pitch mode were evaluated, while 661 standard mode scans were evaluated. 69/559 (12.3%) scans with high-pitch mode were positive and 84/661 (12.7%) scans with standard mode were positive (not statistically significant, p > 0.05). There was a higher rate of indeterminate scans with standard mode compared to the high-pitch mode (80 [12.1%] standard vs. 25 [4.5%] high-pitch, p value
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High-pitch versus standard mode CT Pulmonary angiography: a comparison of indeterminate studies.
Emergency Radiology, 2018Co-Authors: Derrick A. Doolittle, Adam T. FroemmingAbstract:To compare the causes of indeterminate CT Pulmonary Angiograms using standard mode and high-pitch mode, and determine at what level of the Pulmonary arterial tree studies were non-diagnostic. IRB approval was obtained. A retrospeCTive review of patients at our institution who underwent a CT Pulmonary Angiogram, between November 1, 2015 and February 10, 2016 was performed. CT Pulmonary Angiograms using both high-pitch mode and standard mode were evaluated with positive and indeterminate rates calculated. Causes of indeterminate studies and the level of the Pulmonary arterial tree at which the study became non-diagnostic were determined by a board certified radiologist by looking at the images of each indeterminate study. The indeterminate rates were compared between high-pitch and standard modes using a generalized estimating equation. Five hundred fifty-nine CT Pulmonary Angiograms using high-pitch mode were evaluated, while 661 standard mode scans were evaluated. 69/559 (12.3%) scans with high-pitch mode were positive and 84/661 (12.7%) scans with standard mode were positive (not statistically significant, p > 0.05). There was a higher rate of indeterminate scans with standard mode compared to the high-pitch mode (80 [12.1%] standard vs. 25 [4.5%] high-pitch, p value
Derrick A. Doolittle - One of the best experts on this subject based on the ideXlab platform.
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High-pitch versus standard mode CT Pulmonary angiography: a comparison of indeterminate studies
Emergency Radiology, 2019Co-Authors: Derrick A. Doolittle, Adam T. FroemmingAbstract:Purpose To compare the causes of indeterminate CT Pulmonary Angiograms using standard mode and high-pitch mode, and determine at what level of the Pulmonary arterial tree studies were non-diagnostic. Methods IRB approval was obtained. A retrospeCTive review of patients at our institution who underwent a CT Pulmonary Angiogram, between November 1, 2015 and February 10, 2016 was performed. CT Pulmonary Angiograms using both high-pitch mode and standard mode were evaluated with positive and indeterminate rates calculated. Causes of indeterminate studies and the level of the Pulmonary arterial tree at which the study became non-diagnostic were determined by a board certified radiologist by looking at the images of each indeterminate study. The indeterminate rates were compared between high-pitch and standard modes using a generalized estimating equation. Results Five hundred fifty-nine CT Pulmonary Angiograms using high-pitch mode were evaluated, while 661 standard mode scans were evaluated. 69/559 (12.3%) scans with high-pitch mode were positive and 84/661 (12.7%) scans with standard mode were positive (not statistically significant, p > 0.05). There was a higher rate of indeterminate scans with standard mode compared to the high-pitch mode (80 [12.1%] standard vs. 25 [4.5%] high-pitch, p value
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High-pitch versus standard mode CT Pulmonary angiography: a comparison of indeterminate studies.
Emergency Radiology, 2018Co-Authors: Derrick A. Doolittle, Adam T. FroemmingAbstract:To compare the causes of indeterminate CT Pulmonary Angiograms using standard mode and high-pitch mode, and determine at what level of the Pulmonary arterial tree studies were non-diagnostic. IRB approval was obtained. A retrospeCTive review of patients at our institution who underwent a CT Pulmonary Angiogram, between November 1, 2015 and February 10, 2016 was performed. CT Pulmonary Angiograms using both high-pitch mode and standard mode were evaluated with positive and indeterminate rates calculated. Causes of indeterminate studies and the level of the Pulmonary arterial tree at which the study became non-diagnostic were determined by a board certified radiologist by looking at the images of each indeterminate study. The indeterminate rates were compared between high-pitch and standard modes using a generalized estimating equation. Five hundred fifty-nine CT Pulmonary Angiograms using high-pitch mode were evaluated, while 661 standard mode scans were evaluated. 69/559 (12.3%) scans with high-pitch mode were positive and 84/661 (12.7%) scans with standard mode were positive (not statistically significant, p > 0.05). There was a higher rate of indeterminate scans with standard mode compared to the high-pitch mode (80 [12.1%] standard vs. 25 [4.5%] high-pitch, p value
Ramin Khorasani - One of the best experts on this subject based on the ideXlab platform.
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does clinical decision support reduce unwarranted variation in yield of CT Pulmonary Angiogram
The American Journal of Medicine, 2013Co-Authors: Luciano M Prevedello, Ali S Raja, Ivan K Ip, Aaron D Sodickson, Ramin KhorasaniAbstract:OBJECTIVE: The study objeCTive was to determine whether previously documented effeCTs of clinical decision support on computed tomography for Pulmonary embolism in the emergency department (ie, decreased use and increased yield) are due to a decrease in unwarranted variation. We evaluated clinical decision support effeCT on intra- and inter-physician variability in the yield of Pulmonary embolism computed tomography (PE-CT) in this setting. METHODS: The study was performed in an academic adult medical center emergency department with 60,000 annual visits. We enrolled all patients who had PE-CT performed 18 months pre- and post-clinical decision support implementation. Intra- and inter-physician variability in yield (% PE-CT positive for acute Pulmonary embolism) were assessed. Yield variability was measured using logistic regression accounting for patient charaCTeristics. RESULTS: A total of 1542 PE-CT scans were performed before clinical decision support, and 1349 PE-CT scans were performed after clinical decision support. Use of PE-CT decreased from 26.5 to 24.3 computed tomography scans/1000 patient visits after clinical decision support (P < .02); yield increased from 9.2% to 12.6% (P < .01). Crude inter-physician variability in yield ranged from 2.6% to 20.5% before clinical decision support and from 0% to 38.1% after clinical decision support. After controlling for patient charaCTeristics, the post-clinical decision support period showed significant inter-physician variability (P < .04). Intra-physician variability was significant in 3 of the 25 physicians (P < .04), all with increased yield post-clinical decision support. CONCLUSIONS: Overall PE-CT yield increased after clinical decision support implementation despite significant heterogeneity among physicians. Increased inter-physician variability in yield after clinical decision support was not explained by patient charaCTeristics alone and may be due to variable physician acceptance of clinical decision support. Clinical decision support alone is unlikely to eliminate unwarranted variability, and additional strategies and interventions may be needed to help optimize acceptance of clinical decision support to maximize returns on national investments in health information technology.
James D Birchall - One of the best experts on this subject based on the ideXlab platform.
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p260 managing the indeterminate CT Pulmonary Angiogram do we get it right
Thorax, 2010Co-Authors: E L Odowd, James D Birchall, Robert J BergAbstract:IntroduCTion Around 5% of CT Pulmonary Angiograms (CTPA) are indeterminate, usually due to incomplete contrast enhancement of Pulmonary arteries, motion artefaCT or difficulty interpreting small peripheral filling defeCTs. While BTS guidelines propose good quality negative CTPA as sufficient grounds to not treat for Pulmonary embolism (PE), response to indeterminate CTPA is not addressed. No previous study has investigated variation in radiologists′ reporting and clinicians′ response to indeterminate CTPA′s. Methods Records of 51 patients with indeterminate CTPA were retrospeCTively reviewed for radiologist′s reporting, clinicians′ documentation of such, and clinical outcomes. Results Reports included “no large central PE” (n=25), “no obvious PE within the limitations of the study” (n=14), “unable to exclude segmental/subsegmental PE” (n=5), and “equivocal filling defeCTs of uncertain significance” (n=4). 17/51 (33%) stated: “PE cannot be excluded.” Further imaging was suggested in only 2 cases. Clinicians documented recognition of technical shortcomings, reported by radiologists, in only 16/51 cases (31%), and recorded “no PE” in 29/51 (57%). Clinicians assessed pre-test probability in 8/51 (8%). 36 patients had the diagnosis of PE dismissed without further tests, of whom 26 were treated for other acute cardio-respiratory conditions revealed on CTPA. 0 had one or more additional tests (repeat CTPA, V/Q scan or Doppler u/s), confirming thrombo-embolic disease in 2. Further investigation was significantly more likely following scans stating “PE cannot be excluded” than all other reports; both overall (47% vs 6%, p Conclusion There is a lack of clear guidance, and considerable variation in radiological reporting of, and clinicians′ response to indeterminate CTPA. Un-ambiguous reporting, repeat clinical assessment, appropriate consideration of alternative diagnoses, and further investigation where appropriate may reduce the risks of missed diagnosis or unwarranted anti-coagulation.
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vq scintigram in the CT Pulmonary Angiogram era
European Radiology, 2006Co-Authors: James D BirchallAbstract:Sir, The recent review by Wildberger et al. entitled ‘CT imaging in acute Pulmonary embolism; diagnostic strategies’ is timely and provides a good historical review of the difficulties of investigating for acute Pulmonary embolus. In particular they outline the great utility of CT Pulmonary Angiogram in this area [1]. The major challenge is in determining the presence or absence of acute Pulmonary embolus confidently by imaging, which is dependent on an accurate clinical assessment of the risk of Pulmonary embolus. Standardised guidance for the assessment of Pulmonary embolus and its subsequent management is vital, and indeed they outline the current British Thoracic society guidelines for the management of acute Pulmonary embolus from the perspeCTive of CT accurately [2]. However, these same guidelines also add that where an established nuclear medicine department exists, VQ scintigraphy still has a valuable role in patientswith a normal chest radiograph. Indeed these guidelines, in addition to the obvious determinate results, normal study and high probability by PIOPED [3], state that a low probability VQ scan result in a patient with a low clinical risk excludes a recent acute Pulmonary embolus, which is highlighted in the summary guidance for the junior clinician. Studies reviewing 6-month mortality following a low probability VQ scintigram have shown no death attributed to acute Pulmonary embolus either clinically or at postmortem [4, 5]. If the VQ scan is intermediate by PIOPED or the clinical risk and VQ probability are incongruent then further imaging with CT Pulmonary Angiogram assists greatly. On refleCTion this is a very difficult area for the clinician and if you consider your patient to have an acute Pulmonary embolus with a high clinical risk or elevated D-dimer, first line diagnostic imaging with either CT Pulmonary Angiogram or VQ scintigraphy is effeCTive in the context of robust guidelines.
M J Janicek - One of the best experts on this subject based on the ideXlab platform.
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incidental finding of Pulmonary nodule on CT Pulmonary Angiogram CTpa in view of current surveillance recommendations is any lung cancer screening protocol applicable
Journal of Clinical Oncology, 2010Co-Authors: O C Enrizo, T Baykaner, M J JanicekAbstract:1597 Background: Incidental finding of Pulmonary nodules on CT is frequent and application of cancer screening derived follow up (f/u) algorithms could produce multiple repeated scans with low yiel...