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CT pulmonary angiography: refer with caution.

MIAMI BEACH -- CT pulmonary angiography can deliver considerable radiation to sensitive breast tissue--an important consideration when referring women for diagnosis of pulmonary emboli, Dr. Mark S. Parker said at the annual meeting of the American Roentgen Ray Society.

CT pulmonary angiography aids diagnosis and management of patients with complex thoracic and cardiopulmonary disease. Dr. Parker of Virginia Commonwealth University, Richmond, and his colleagues studied 1,325 patients who had CT pulmonary angiograms; 60% were women. The women had a mean age of 52 years. Younger patients may be at particular risk for developing cancer given the estimated 10- to 30-year latency period at the typical dosages of ionizing radiation delivered by CT pulmonary angiography.

A dose of at least 2.0 rads per breast is typically delivered during CT pulmonary angiography. This is equivalent to 100-400 chest radiographs or 10-25 two-view mammograms. Exposure is two to three times greater with CT scans that overlap regions of interest, and a 30%-50% increased dose is possible with multidetector CT imaging, Dr. Parker said.

Methods that can be used to triage women with suspected acute pulmonary thromboembolic disease include arterial blood gas measurements, D-dimer assays, Doppler studies, and chest radiography.

Thin-layer bismuth breast shields, which can reduce exposure by 57%, should be routinely worn by women of reproductive age and by perimenopausal patients, Dr. Parker said. Lower-dose examinations may be considered for some women with stable disease. These techniques include a ventilation-perfusion lung scan in the setting of a normal chest radiograph, and magnetic resonance angiography.

BY DAMIAN McNAMARA

Miami Bureau
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Title Annotation:Pulmonary Medicine
Author:McNamara, Damian
Publication:Internal Medicine News
Article Type:Brief Article
Geographic Code:1USA
Date:Oct 15, 2004
Words:259
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