Radiologists back judicious use of CT pulmonary angio in women because of radiation dose to breast


There are a number of ways to reduce the radiation exposure, Dr. Parker said. "First, we need to reduce the number of female patients scanned by better selecting those patients who truly warrant the CT pulmonary angiogram. Arterial blood gases, D-dimer assays, Doppler studies and chest radiography are tools that can be appropriately used to triage patients with suspected acute pulmonary thromboembolic disease, especially in out-patient and emergency department settings." Radiologists often manipulate scan parameters (e.g., reduce tube current, reduce tube voltage, increase pitch) to reduce the radiation exposure. However, each manipulation has a trade-off with respect to image quality and potential loss of diagnostic information. "Radiologists and clinicians both must come to an agreement as to whether the detection of distal segmental or subsegmental emboli truly impact patient management and are worth the radiation dose to the patient," Dr. Parker said. Thin-layered bismuth breast shields may reduce breast radiation exposure by 57% without greatly affecting diagnostic interpretation and should be routinely used in reproductive age and perimenopausal women. Alternative, lower-dose examinations utilizing ionizing radiation (e.g., ventilation-perfusion lung scan in the setting of a normal chest radiograph) and nonionizing radiation exams (e.g., MR angiography) may be considered in stable female patients, he said.

CT is an excellent tool for diagnosing pulmonary embolism, a disease that if undetected, has a high morbidity and mortality rate, said Dr. Parker. "We just need to carefully weigh the benefits of the examination with the potential long-term risks before determining if it is the right examination for each patient," he added.

The study will be presented on May 4 at the American Roentgen Ray Society Annual Meeting in Miami Beach, FL


Contact: Keri Sperry
American Roentgen Ray Society

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