CT Pulmonary Angiogram (CTPA) is the gold standard investigation for Pulmonary Embolism (PE). European Society of Radiology (ESR) reporting guidelines state that reports should include "specific positive or negative features...which affect intetrpretation".1 For investigation of PE, we think thisshould include specific CT radiographic evidence of right heart strain (RHS) as presence of these features alters prognosisand acute management.2,3

A retrospective audit of 50 consecutive 'positive' CTPAs was performed. Scan reports were audited for an overall comment on evidence of RHS, and mention of specific features of RHS - ratio of right ventricular/left ventricular diameters (RV:LV ratio); ventricular septal flattening or bowing; contrast reflux into the inferior vena cava (IVC); and pulmonary artery dilatation.

19/50 reports had mention of RHS (10 with evidence for, 9 without). Scan reports with "no evidence of RHS" or equivalent wording were not investigated further as it was surmised that none of the previously described radiological features were present. Of the remaining 41 scans, reports were audited for comment (either presence or absence) on the specifical radiological features of RHS: RV size or RV:LV ratio (n=7; 17.1%); septal bowing or flattening (n=5; 12.2%); contrast reflux into IVC (n=10; 24.4%); pulmonary artery size (n=15; 36.6%)....

In our single hospital audit, the majority of CTPA reports did not meet ESR recommendations in providing "specific positive or negative" findings. In the context of PE, this should include evidence of RHS. It is important that presence or absence of RHS is documented in CTPA reports, specifically RV:LV ratio, which is independently related to mortality,and can be used to risk-stratify those patients needing more aggressive therapy or suitable for early discharge.2,3 Physicians are not trained to interpret CT scans, so it is essential for...

1. European Society of Radiology. Good practice for radiological reporting. Guidelines from the European Society of Radiology. Insights Imaging. 2011; 2(1): 93-96. 2. Kang DK, Ramos-Duran L, Schoepf UJ, Armstrong AM, Abro JA, Ravenel JG, et al. Reproducibility of CT signs of right ventricular dysfunction in acute pulmonary embolism. American Journal of Radiology. 2010; 194: 1500-1506. 3. Dogan H, de Roos A, Geleijins J, Huisman MV, Kroft LJM. The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism. Diagnostic Interventional Radiology....