Choosing Wisely:

Avoid using a CT angiogram to diagnose pulmonary embolism (PE) in young women with a normal chest radiograph; consider a radionuclide lung study (“V/Q study”) instead.

Rationale and Comments: When the clinical question is whether or not pulmonary emboli are present, a V/Q study can provide the answer with lower overall radiation dose to the breast than can CT angiography, even when performed with a breast shield.
Sponsoring Organizations:
  • Society of Nuclear Medicine and Molecular Imaging
  • Sources:
  • Expert consensus
  • Disciplines:
  • Pulmonary medicine
  • References: • International Commission on Radiological Protection report 53 ( and 80 ( ICRP%20Publication%2080).
    • McCollough, et al. Strategies for reducing radiation dose in CT. Radiol Clin North Am. 2009;47:27-40.
    • Hurwitz, et al. Radiation dose savings for adult pulmonary embolus 64-MDCT using bismuth breast shields, lower peak kilovoltage, and automatic tube current modulation. AJR Am J Roentgenol. 2009;192:244-53.
    • Stein EG, et al. Success of a safe and simple algorithm to reduce use of CT pulmonary angiography in the emergency department. AJR Am J Roentgenol. 2010;194:392-7.
    • Parker MS, et al. Female breast radiation exposure during CT pulmonary angiography. AJR Am J Roentgenol. 2005;185: 1228-33.
    • Niemann T, et al. Imaging for suspected pulmonary embolism in pregnancy-what about the fetal dose? A comprehensive review of the literature. Insights Imaging. 2010;1:361-72.
    • Freeman LM, et al. V/Q scintigraphy: alive, well and equal to the challenge of CT angiography. Eur J Nucl Med Mol Imaging. 2009;36:499-504.
    • Brenner DJ, et al. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277-84.
    • Freeman LM, et al. The current and continuing role of ventilation-perfusion scintigraphy in evaluating patients with suspected pulmonary embolism. Semin Nucl Med. 2008;38(6): 432-40.
    • Burns SK, et al. Diagnostic imaging and risk stratification of patients with acute pulmonary embolism. Cardiol Rev. 2012;20(1):15-24.

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