Wither the ED doc? Here comes the “triple rule out” CT scan. “Chest pain represents one of the most common presenting symptoms in the emergency department, and it also represents a diagnostic challenge: Is it a pulmonary embolism? Is it an aortic dissection? Is it coronary artery disease? Or is it nothing?

Now, new CT technology promises to revolutionize this diagnosis, giving the ability to rule out all three conditions with a single 15-second scan.

In theory, this scan can replace stress testing for coronary artery disease, echocardiography or CT for aortic dissection, and CT pulmonary angiography or a ventilation-perfusion scan for pulmonary embolism.”

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  • Anonymous

    Interesting. One wonders if a negetive test would be a good enough gold standard to protect you in court when a chest pain patient with a negetive scan still ends up dropping dead.

    Of course for legal protection this type of study would become increasingly used for lower and lower risk patients. The good side is that they lawyers would have to wait 20 years to blame a radiation induced cancer on an unnecessary test.

  • Anonymous

    I wonder how many readings from the radiologist will say “cannot rule out…..clinical correlation advised”?

  • Anonymous

    “I wonder how many readings from the radiologist will say “cannot rule out…..clinical correlation advised”?”

    All of them should say “cannot rule out…..clinical correlation advised” unless the test has 100% sensitivity, which no test has. Why should the radiologist take the legal responsibility?

  • Bad Shift

    Anonymous was just being snarky–we all know that you must interpret your test results in light of your clinical suspicion. Regarding the scan, it’s about time we made some real progress in cardiac risk stratification. Think of the admissions (and difficult to interpret cardiac stress tests) this has the potential to save.

  • Henry

    OK, I detest lawyers (possibly excluding my daughter) too, but let’s not get bogged down in dissing them. What we really need here are data that show whether the tripple rule-out CT is better or worse than what we do now, and how much radiation will be given with each test–since there are some patients who show up in the ED with chest pain quite often.

    Henry Farkas, MD

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