ditch doctor
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AAAAA wrote:
Spiral CT scans can identify lung lesions less than one centimeter in size. ... cost of saving one life using a single CT scan could be as low as $2500.
US $2,500.00 per scan !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
My grandmother is worth *at least* 5 times as much!!!
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| ditch doctor
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AAAAA wrote:
Please make sure you read the real source before posting the correct answer which is A and not CT scan !
What is the real source? PIOPED II? Harrison's? Cecil's? eMedicine? Tintinalli? Kaplan notes? USMLE World or Qbank?
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| AAAAA
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Thank you, ditch doctor !
I am so glad someone finally responded to me after 6 months.
The answer is very simple. CTA CT angiogram are actually used to make other diagnosis but as regarded to P.E., the Board, NBME who runs the USMLE still prefers V/Q.
Once the American Thoracic Society and the National Institutes of Health decided a Natioanal Consenus and established national guidelines, then CT will be the answer !
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| AAAAA
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ditch doctor wrote:
What is the real source? PIOPED II? Harrison's? Cecil's? eMedicine? Tintinalli? Kaplan notes? USMLE World or Qbank?
The real source is national guidelines established by the AMerican Thoracic Society and the NIH.
ATS American Thoracic Society meets once a year and NIH National Lung and Heart and Blood may issue guidelines.
I am checking them out for you.
Review books are not dangerous but need a few books to compare than you get a favor !
Thank you Ditch doctor !
There are many, many, many countries use universal health care system instead of American fee-for-service. So those countries may not afford to order CT angio on every patient suspected of P.E.
This is just my point !
My family has real crisis and a liver transplantation is needed. But the Government may not want to do a transplantation on my family member because of cost ! $$$ Money is a factor in medicine, a big factor in controlling the cost of medicine.
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| AAAAA
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American Thoracic Society Develops Guidelines on Diagnosis of Venous Thromboembolism
SHARON SCOTT MOREY
The American Thoracic Society (ATS) has developed clinical practice guidelines for the diagnosis of acute venous thromboembolism. The guidelines were written by the ATS clinical practice committee and cover the diagnostic approach to acute deep venous thrombosis and to acute pulmonary embolism. The guidelines are published in the September 1999 issue of the American Journal of Respiratory and Critical Care Medicine. The document is available on the World Wide Web to subscribers of ATS journals online (http://www.atsjournals.org).
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| AAAAA
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This is the official guideline from the American Thoracic Society but they do change and modify when the new guideline should come out soon !
Standard approach to suspected pulmonary embolism. Information from the history, physical examination, chest radiographs, electrocardiogram and arterial blood gas analysis may suggest the presence of pulmonary embolism. Ventilation-perfusion scanning is an appropriate initial diagnostic test in this setting. According to the guidelines, pulmonary embolism can be reliably excluded if the lung perfusion scan is normal. When pulmonary embolism is suspected clinically, a high-probability ventilation-perfusion scan is considered diagnostic.
While pulmonary angiography is considered an appropriate study if the ventilation-perfusion scan is nondiagnostic, the guidelines also consider other possible avenues for diagnosis. Alternatives to pulmonary angiography are suggested because of the invasiveness, expense and potential inconvenience of angiography. The guidelines state that patients with nondiagnostic lung scans and adequate cardiopulmonary reserve may next undergo noninvasive lower extremity testing to exclude deep venous thrombosis. If the study is positive for thrombosis, treatment can be initiated without further investigation. MRI of the lower extremities may also be useful if the lung scan is nondiagnostic. If studies of the lower extremity are negative, then pulmonary angiography can be performed.
Use of spiral CT or MRI for the initial diagnostic approach or when ventilation-perfusion scan is nondiagnostic. Some studies have shown that spiral CT is specific for pulmonary embolism, although the guidelines recognize that no Level 1 studies have been completed to support or not support the use of spiral CT or MRI in cases of suspected pulmonary embolism. Spiral CT can demonstrate pulmonary emboli in the main, lobar or segmental vessels with a moderate to high degree of sensitivity. MRI has also demonstrated a potential in the diagnosis of pulmonary embolism. The guidelines state that precise recommendations for the use of these two techniques in the diagnosis of pulmonary embolism cannot be made until large multicenter clinical trials are completed.
Use of perfusion scan without ventilation scan. If a ventilation scan cannot be performed, perfusion scan alone is useful if the results show a high probability or a very low probability of pulmonary embolism or are normal.
Use of D-dimer assay. The guidelines note that elevated plasma D-dimer is too nonspecific for the diagnosis of deep venous thrombosis or pulmonary embolism. According to the guidelines, the wide variability among the assays and in their testing characteristics continues to limit the applicability of this test in clinical practice.
I have this question in the examination.
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| AAAAA
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ATS is a very conservative medical society , so their recommendation is less aggressive.
But once again, ATS stand on sprial CT
Use of spiral CT or MRI for the initial diagnostic approach or when ventilation-perfusion scan is nondiagnostic. Some studies have shown that spiral CT is specific for pulmonary embolism, although the guidelines recognize that no Level 1 studies have been completed to support or not support the use of spiral CT or MRI in cases of suspected pulmonary embolism. Spiral CT can demonstrate pulmonary emboli in the main, lobar or segmental vessels with a moderate to high degree of sensitivity. MRI has also demonstrated a potential in the diagnosis of pulmonary embolism. The guidelines state that precise recommendations for the use of these two techniques in the diagnosis of pulmonary embolism cannot be made until large multicenter clinical trials are completed.
Use of perfusion scan without ventilation scan. If a ventilation scan cannot be performed, perfusion scan alone is useful if the results show a high probability or a very low probability of pulmonary embolism or are normal.
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| AAAAA
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Why CTA or MRA is used but still have problems in making the diagnosis of renal artery stenosis?
What are the implications of the study?
Even trained physicians may have difficulty interpreting CTA and MRA. In this study, neither CTA nor MRA was a sensitive test for detecting renal artery stenosis.
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| AAAAA
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CONCLUSIONS: Low molecular weight heparin is at least as effective as unfractionated heparin in preventing recurrent venous thromboembolism, and significantly reduces the occurrence of major haemorrhage during initial treatment and overall mortality at the end of follow-up. It can be adopted safely as the standard therapy for deep venous thrombosis, and studies comparing individual low molecular weight heparins are merited.
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