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.