Congress:
EuroSafe Imaging 2021
Keywords:
Management, Oncology, Radioprotection / Radiation dose, CT, Audit and standards, Cost-effectiveness, Health policy and practice, Cancer, Outcomes, Patterns of Care
Authors:
I. RAJENDRAN, L. Tandon
DOI:
10.26044/esi2021/ESI-11271
Results or findings
The total number of positive cases for pulmonary embolism over the study period was 166. The mean age was 66 (median 68, age range 22 to 101 years). Majority of the positive cases had provoking factors, of which, 31(19%) had known malignancy, 65(39%) had other provoking factors. Rest of them, 70(42%) were identified as unprovoked PE
.
Most of the patients with unprovoked PE, 54(76%) had additional CT AP to look for occult cancer and 5(7%) had ultrasound for the same reason. However, 4 patients(6%) had CT abdomen and pelvis done along with CT PA where there was signs and symptoms of cancer. Only 3 patients(4%) had CT abdomen and pelvis done prior to the CT PA and 5(7%) had no further CT abdomen pelvis or ultrasound subsequently. The clinical signs and symptoms of cancer were present in only 11(20%) patients which had CT AP.
Total number of new cancer detected overall in the included patients was 9(12.8%). Majority of them were identified on CT PA examination, 5 (55%) patients had cancer detected on the CT PA examination. Also, 2 patients (22%) had cancer diagnosed on concurrent CT AP scans and 2 patients had it diagnosed through blood investigations (raised PSA). Essentially, no cancer was detected in the CT AP scan done following unprovoked PE which was requested to look for occult cancer. Interestingly, one patient had colon cancer detected in CT AP done after 8 months, when patient presented with another episode of unprovoked PE and anaemia.
In terms of further investigations, one patient had MRI and three patients had invasive examinations such as colonoscopy, UGI endoscopy, hysteroscopy and cystoscopy.
We also did a pilot study to check if the practice has changed post new NICE guidelines with a sample from June 2020. Once again we noticed similar outcome. There were a total of 208 scans done in the month, 21 were identified as unprovoked PE. Allowing for one patient who had cancer detected on the CT PA examination, no new cancer identified in the CT AP done following unprovoked PE.