V/Q Scanning Better Choice for Detecting PE

Over the past 10 years, CT angiography (CTA) has been replacing ventilation/perfusion (VQ) imaging as “the gold standard” for imaging pulmonary embolism (PE). Some would say that’s with good reason: CT is faster, produces sharper images, and is usually readily available in most hospitals. However, using CT for diagnosing PE is a big concern for some doctors, who say the test causes excessive radiation to the chest and breasts and poses a particular danger for younger women of child-bearing age. Because of the potential increase in the risk for breast cancer, Leonard M. Freeman, MD, director of nuclear medicine at Montiofore Medical Center in New York, and his colleagues have been arguing for the use of V/Q for diagnosing PE when possible. Freeman estimates that the radiation exposure to breasts in women of childbearing age is somewhere between 65 to 250 times greater than that from V/Q scintigraphy.

“The case certainly seems compelling for use of lung scintigraphy to diagnose PE in patients with clear chest X-rays, especially in women of childbearing age,” wrote C. Richard Goldfarb, MD, in a review of an article in Radiology Today.

Related seminar: Diagnostic Imaging Review: For Residents, Fellows, and Radiologists