Are CT Angiograms Overused?
“The number of CT angiograms (CTAs) has gone up substantially, but the number of pulmonary emboli found has not, leading some researchers to question the utilization of this procedure.
Researchers reviewed 1,384 records of patient who underwent a CTA for suspected pulmonary embolism during a seven-month period (March-September) in 2002, 2003 and 2004. ‘The total number of CTAs performed during the study interval in 2004 was 43% higher than in 2002 and 47% higher than in 2003,’ said Tom Reed, a medical student at Albert Einstein College of Medicine in Bronx, NY, and lead author of the study.”
I have no doubt it’s overused. CTAs take about 15 minutes to perform. The other major modality to rule out PE, the V/Q scan, takes about 60 minutes, cannot be used with an abnormal plain chest x-ray, and the results are less conclusive (i.e. many more “indeterminate” results).
Thus, CTAs are faster, more convenient, and give a more conclusive result. A pulmonary embolism is something that a physician can be sued for missing. As defensive medicine rises, the use of CTA as a CYA test certainly contributes to its overuse.
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- Does your patient really need another chest CT?
- 10 overused tests and treatments
- P4P: You need bigger carrots
- When specialists provide primary care, and why patients aren’t complaining
- Screening chest CTs don’t save lives
- Charlie Weis’ malpractice trial
- The Weis trial continues
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For those of us who work at night, there are a couple more advantages to CTA over VQ. First, we don’t keep the VQ material at our hospital and have to send out for it. This adds about 2 hours to the time. The other is that the radiologist has to come in for a VQ scan, as opposed to reading a CT from home, or letting NightHawk read it.
I agree. We are not allowed to miss anything and a jury will not accept any excuse for not doing the CTA.
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