Society of Nuclear Medicine and Molecular Imaging

View all recommendations from this society

Released February 21, 2013

Avoid using a computed tomography angiogram to diagnose pulmonary embolism in young women with a normal chest radiograph; consider a radionuclide lung study (“V/Q study”) instead.

  • When the clinical question is whether or not pulmonary emboli are present, a V/Q study can provide the answer with lower overall radiation dose to the breast than can CTA, even when performed with a breast shield.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The president of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) appointed a Steering Committee, led by the president-elect, to develop the “Top 5” list. This committee solicited input from five SNMMI clinical specialty councils (cardiovascular, brain, nuclear oncology, general nuclear medicine, pediatric) and our PET Center of Excellence. A task force made up of the Steering Committee and specialty council/center leadership convened, and its members also provided recommendations. The Steering Committee reviewed and ranked the submissions and presented the five highest-ranked statements to the SNMMI Board of Directors and House of Delegates.

SNMMI’s disclosure and conflict of interest policy can be obtained by contacting the organization (email@snmmi.org).

Sources

International Commission on Radiological Protection. Radiation dose to patients from radiopharmaceuticals (Addendum to ICRP Publication 53). ICRP Publication 80. 1998. Ann. ICRP 28 (3). McCollough CH, Primak AN, Braun N, Kofler J, Yu L, Christner J. Strategies for reducing radiation dose in CT. Radiol Clin North Am [Internet]. 2009 Jan [cited 2012 Oct 19];47:27-40.

McCollough CH, Primak AH, Braun N, Kofler J, Yu L, Christner J. Strategies for reducing radiation dose in CT. Radiol Clin North Am. 2009;47:27-40.

Hurwitz LM, Yoshizumi TT, Goodman PC, Nelson RC, Toncheva G, Nguyen GB, Lowry C, Anderson-Evans C. Radiation dose savings for adult pulmonary embolus 64-MDCT using bismuth breast shields, lower peak kilovoltage, and automatic tube current modulation. AJR Am J Roentgenol [Internet]. 2009 Jan [cited 2012 Oct 19];192(1):244-53.

Stein EG, Haramati LB, Chamarthy M, Sprayregen S, Davitt MM, Freeman LM. Success of a safe and simple algorithm to reduce use of CT pulmonary angiography in the emergency department. AJR Am J Roentgenol [Internet]. 2010 Feb [cited 2012 Oct 19];194:392-397.

Parker MS, Hui FK, Camacho MA, Chung JK, Broga DW, Sethi NN. Female breast radiation exposure during CT pulmonary angiography. AJR Am J Roentgenol [Internet]. 2005 Nov [cited 2012 Oct 19];185:1228-1233.

Niemann T, Nicolas G, Roser HW, Müller-Brand J, Bongartz G.. Imaging for suspected pulmonary embolism in pregnancy-what about the fetal dose? A comprehensive review of the literature. Insights Imaging [Internet]. 2010 Nov [cited 2012 Oct 19];1:361-372.

Freeman LM, Haramati LB. V/Q scintigraphy: alive, well and equal to the challenge of CT angiography. Eur J Nucl Med Mol [Internet]. Imaging. 2009 Mar [cited 2012 Oct 19];36:499-504.

Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med [Internet]. 2007 Nov 29 [cited 2012 Oct 19];357:2277-2284.

Freeman LM, Stein EG, Spraregen S, Chamarthy M, Haramati LB. The current and continuing role of ventilation-perfusion scintigraphy in evaluating patients with suspected pulmonary embolism. Semin Nucl Med [Internet]. 2008 Nov [cited 2012 Oct 19]. 38(6):432-440.

Burns SK, Haramati LB. Diagnostic imaging and risk stratification of patients with acute pulmonary embolism. Cardiol Rev [Internet]. 2012 Jan-Feb [cited 2012 Oct 19];20(1):15-24.