Pelvic CT Unneeded with CT Pulmonary Angiography

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Digital radiography CT imaging of the pelvis is unnecessary in patients undergoing CT imaging for a suspected pulmonary embolism and concomitant evaluation for venous thromboembolism a new study shows. The result could cut radiation exposure in people undergoing CT pulmonary angiography.

The single institution study led by Dr. Charbel Ishak of the Nassau University Medical Center in East Meadow, New York, showed that pelvic CT during pulmonary angiography did not improve the detection of venous thromboembolism. The researchers presented their findings at this week’s annual meeting of the American Roentgen Ray Society in Chicago.

“Using CT venography in the lower extremities without including the pelvis can decrease the population’s radiation dose generated by CT usage,” Ishak said in a prepared statement. "Radiologists and technologists can eliminate pelvic imaging while acquiring only images of the lower extremities with CT venography, starting from groin to below the knee. Authors believe that by stopping the imaging of the pelvis, we can decrease patient radiation dose without significantly affecting the diagnosis of venous thromboembolism."

CT scans of the lower extremities including the pelvis are commonly carried out in order to detect potentially dangerous clots elsewhere in the body when diagnosing suspected pulmonary embolus. According to, the typical radiation exposure for a pelvic CT is around 15 millisievert (mSv). That is approximately 10 times higher than the typical low-dose CT scan of the chest.

Ishak and colleagues conducted a retrospective review of 1,527 consecutive patients who had visited the large community medical center during the years 2006, 2007 and 2008. There were 652 men and 875 women with an average age of 54 years who underwent CT pulmonary angiography together with CT lower extremity venography, including the pelvis, to assess pulmonary embolisms and venous thromboembolism in the legs.

Two attending radiologists reviewed the radiologic reports and analyzed them for the presence and location of embolisms. They found that thromboembolisms isolated in the pelvis vessels in 5 of 1,527 patients (0.3 percent) of those who underwent pulmonary angiography and CT scans of the lower extremities, and found pelvic embolisms in 5 of 151 (3.3 percent) of those who showed evidence of embolisms in the lower extremities. They found there was no statistical difference in the detection of lower extremity embolisms whether the pelvis was included or not.

Based on that result, the researchers concluded that the benefit of pelvic CT imaging during CT pulmonary angiography does not warrant the added radiation exposure required for CT imaging of the pelvic region.

By Michael O’Leary, contributing writer, Health Imaging Hub

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