The Use of Computed Tomography of Pulmonary Angiogram in a District Hospital

Background . Computed tomography of pulmonary angiogram (CTPA) is a widely used investigation in patients with suspected pulmonary embolism (PE). It is not without adverse effects either through contrast injection or radiation exposure. International guidelines suggest that patients with a low/intermediate clinical probability and negative D-dimer do not require CTPA to exclude PE. Method . A retrospective audit of 100 consecutive CTPA scans was performed at a district general hospital from January to May 2012 to assess adherence to the current guidelines for diagnosis of acute PE and utilisation of CTPA. Result . Of the total 88 CTPA scans that were included in the study, 14% were positive for PE. At least 6%, potentially up to 30% of all the scans, could have been avoided by adherence to current guidelines, thereby improving the positive yield to as high as 19%. Clinical probability scores were documented in only 3%. Orthopaedics requested 3% of all scans and the Assessment Treatment and Rehabilitation (ATR) unit had the highest number of CTPA requests per 100 departmental inpatient admissions. Conclusion . Adherence to the current guidelines can reduce the number of CTPA scans required and may reduce cost, contrast exposure, and radiation burden.