Abstract 16113: CT Pulmonary Angiography Yield in Patients With an Active Malignancy: Lack of Non-invasive Screening

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Olivia Lamping ◽  
Pradeep Yarra ◽  
Austin Stratton ◽  
John Pidakala ◽  
Vikas Bhalla
Keyword(s):  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
X Ray ◽  
Less Invasive ◽  
Non Invasive ◽  
Number Of Patients ◽  
Increased Risk ◽  
Chest X Ray ◽  
Revised Geneva Score ◽  
D Dimer

Patients with an active malignancy are at increased risk of venous thromboembolism due to the production of pro-coagulant factors causing a hypercoagulable state. Providers must keep their index of suspicion high for a pulmonary embolism in these patients because of the high prevalence and often vague symptoms. This is a retrospective study of 2226 patients who underwent CT pulmonary angiography (CTPA) in the emergency department. We compared the diagnosis of PE in patients with and without an active malignancy within the past 6 months. Of those patients without an active cancer, 133/1788 (7.4%) patients were diagnosed with a PE. This is not significantly different from the cohort with cancer where 37/437 (8.5%) patients were diagnosed with a PE (p=0.468). During diagnosis, patients with a history of cancer were less likely to have a chest x-ray, d-dimer or troponin performed prior to the CTPA scan (Table 1). These tests are less invasive and much cheaper than the CTPA and can help identify other pathologies that a patient may be experiencing. Not surprisingly, patients with a malignancy have a higher Wells’ score, revised Geneva score and PERC rule (Table 2), leading providers further down diagnostic algorithms towards CTPA. While many of these high-risk patients should immediately undergo CTPA, patients at low or moderate risk of PE should first be evaluated with less invasive testing such as a chest x-ray or d-dimer. In conclusion, in order to decrease the number of patients unnecessarily undergoing CTPA, patients with an active malignancy should be risk stratified in a similar manner as those patients without a malignancy, including the use of non-invasive testing where appropriate.

scholarly journals CT pulmonary angiography appropriateness in a single emergency department: does the use of revised Geneva score matter?

2021 ◽  
Author(s):  
Alessandra Mirabile ◽  
Nicola Maria Lucarelli ◽  
Enza Pia Sollazzo ◽  
Amato Antonio Stabile Ianora ◽  
Angela Sardaro ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Clinical Judgment ◽  
Pulmonary Angiography ◽  
Suspected Pulmonary Embolism ◽  
Ct Pulmonary Angiography ◽  
Computed Tomography Pulmonary Angiography ◽  
Emergency Department Patients ◽  
Revised Geneva Score ◽  
D Dimer

Abstract Purpose To assess the percentage of computed tomography pulmonary angiography (CTPA) procedures that could have been avoided by methodical application of the Revised Geneva Score (RGS) coupled with age-adjusted D-dimer cut-offs rather than only clinical judgment in Emergency Department patients with suspected pulmonary embolism (PE). Material and methods Between November 2019 and May 2020, 437 patients with suspected PE based on symptoms and D-dimer test were included in this study. All patients underwent to CTPA. For each patient, we retrospectively calculated the age-adjusted D-dimer cut-offs and the RGS in the original version. Finally, CT images were retrospectively reviewed, and the presence of PE was recorded. Results In total, 43 (9.84%) CTPA could have been avoided by use of RGS coupled with age-adjusted D-dimer cut-offs. Prevalence of PE was 14.87%. From the analysis of 43 inappropriate CTPA, 24 (55.81%) of patients did not show any thoracic signs, two (4.65%) of patients had PE, and the remaining patients had alternative thoracic findings. Conclusion The study showed good prevalence of PE diagnoses in our department using only physician assessment, although 9.84% CTPA could have been avoided by methodical application of RGS coupled with age-adjusted D-dimer cut-offs.

scholarly journals CT pulmonary angiography in COVID-19 pneumonia: relationship between pulmonary embolism and disease severity

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aya Yassin ◽  
Maryam Ali Abdelkader ◽  
Rehab M. Mohammed ◽  
Ahmed M. Osman
Keyword(s):  
Pulmonary Embolism ◽  
Disease Severity ◽  
Laboratory Data ◽  
Pulmonary Angiography ◽  
Significant Relation ◽  
Ct Pulmonary Angiography ◽  
Laboratory Results ◽  
Severity Of The Disease ◽  
The Relationship ◽  
D Dimer

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

The Use of a D-dimer Assay in Patients Undergoing CT Pulmonary Angiography for Suspected Pulmonary Embolus

2002 ◽  
Vol 57 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Guy J.C Burkill ◽  
James R.G Bell ◽  
Roger J.S Chinn ◽  
Jeremiah C Healy ◽  
Christine Costello ◽  
...  
Keyword(s):  
Pulmonary Embolus ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
D Dimer

scholarly journals Artificial Intelligence Framework for Efficient Detection and Classification of Pneumonia Using Chest Radiography Images

2021 ◽  
Author(s):  
Ali Mohammad Alqudah ◽  
Shoroq Qazan ◽  
Ihssan S. Masad
Keyword(s):  
Artificial Intelligence ◽  
Input Image ◽  
Image Size ◽  
X Ray ◽  
Softmax Classifier ◽  
Non Invasive ◽  
Efficient Detection ◽  
X Ray Imaging ◽  
Chest X Ray

Abstract BackgroundChest diseases are serious health problems that threaten the lives of people. The early and accurate diagnosis of such diseases is very crucial in the success of their treatment and cure. Pneumonia is one of the most widely occurred chest diseases responsible for a high percentage of deaths especially among children. So, detection and classification of pneumonia using the non-invasive chest x-ray imaging would have a great advantage of reducing the mortality rates.ResultsThe results showed that the best input image size in this framework was 64 64 based on comparison between different sizes. Using CNN as a deep features extractor and utilizing the 10-fold methodology the propose artificial intelligence framework achieved an accuracy of 94% for SVM and 93.9% for KNN, a sensitivity of 93.33% for SVM and 93.19% for KNN and a specificity of 96.68% for SVM and 96.60% for KNN.ConclusionsIn this study, an artificial intelligence framework has been proposed for the detection and classification of pneumonia based on chest x-ray imaging with different sizes of input images. The proposed methodology used CNN for features extraction that were fed to two different types of classifiers, namely, SVM and KNN; in addition to the SoftMax classifier which is the default CNN classifier. The proposed CNN has been trained, validated, and tested using a large dataset of chest x-ray images contains in total 5852 images.

scholarly journals Investigation of Suspected Pulmonary Embolism at Hutt Valley Hospital with CT Pulmonary Angiography: Current Practice and Opportunities for Improvement

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Nick Kennedy ◽  
Sisira Jayathissa ◽  
Paul Healy
Keyword(s):  
Pulmonary Embolism ◽  
Current Practice ◽  
Pulmonary Angiography ◽  
Pretest Probability ◽  
British Thoracic Society ◽  
Suspected Pulmonary Embolism ◽  
Ct Pulmonary Angiography ◽  
Wells Score ◽  
Positive Rate ◽  
D Dimer

Aims. To study the use of CT pulmonary angiography (CTPA) at Hutt Hospital and investigate the use of pretest probability scoring in the assessment of patients with suspected pulmonary embolism (PE).Methods. We studied patients with suspected PE that underwent CTPA between January and May 2012 and collected data on demographics, use of pretest probability scoring, and use of D Dimer and compared our practice with the British Thoracic Society (BTS) guideline.Results. 105 patients underwent CTPA and 15% of patients had PE. 13% of patients had a Wells score prior to their scan. Wells score calculated by researchers revealed 54%, 36%, and 8% patients had low, medium, and high risk pretest probabilities and 8%, 20%, and 50% of these patients had positive scans. D Dimer was performed in 58% of patients and no patients with a negative D Dimer had a PE.Conclusion. The CTPA positive rate was similar to other contemporary studies but lower than previous New Zealand studies and some international guidelines. Risk stratification of suspected PE using Wells score and D Dimer was underutilised. A number of scans could have been safely avoided by using accepted guidelines reducing resources use and improving patient safety.

Failure of the Sterile Air-Flow Component of a Protected Environment Detected by Demonstration of Chaetomium Species Colonization of Four Consecutive Immunosuppressed Occupants

1988 ◽  
Vol 9 (10) ◽  
pp. 451-456 ◽  
Author(s):  
Gail L. Woods ◽  
J. Calvin Davis ◽  
William P. Vaughan
Keyword(s):  
High Efficiency ◽  
Marrow Transplant ◽  
Fungal Colonization ◽  
Transplant Recipients ◽  
Special Care Unit ◽  
Air Filters ◽  
X Ray ◽  
Increased Risk ◽  
Chest X Ray ◽  
Protective Environment

AbstractFour bone marrow transplant recipients consecutively occupying the same room on our Oncology-Hematology Special Care Unit (OHSCU) became colonized with Chaetomium species between January and April, 1987. These patients, aged 27 to 43 years, were immunocompromised as a result of intensive chemotherapy, and were consequently at increased risk for development of invasive fungal infection. At the time of Chaetomium colonization, all patients were febrile, two had transient new infiltrates on chest x-ray, and three were receiving amphotericin B therapy. Subsequent environmental cultures revealed Chaetomium contamination of the OHSCU air-handling system, including the HEPA (high-efficiency particulate air) filters in seven of the nine rooms comprising the unit. Because fungal colonization of HEPA filters used to create a “protective environment” for immunocompromised patients can occur and can serve as a source for patient infections, guidelines concerning proper surveillance of these HEPA filters should be established. We suggest that before a new patient enters a “protected” room, the clean side of the HEPA filter should be cultured. If fungi are recovered from that culture, we would recommend changing the filter.

scholarly journals Highly Elevated Quantitative D-Dimer Assay Values Increase the Likelihood of Venous Thromboembolism

TH Open ◽  
2019 ◽  
Vol 03 (01) ◽  
pp. e2-e9 ◽  
Author(s):  
Samuel Francis ◽  
Alexander Limkakeng ◽  
Hui Zheng ◽  
Judd Hollander ◽  
Gregory Fermann ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Prospective Observational Study ◽  
Secondary Analysis ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
Vein Thrombosis ◽  
Ultrasound Computed Tomography ◽  
Deep Vein ◽  
Work Up ◽  
D Dimer

Objectives In patients with suspected venous thromboembolism (VTE), the D-dimer assay is commonly utilized as part of the workup. The assay is primarily used to determine whether to proceed with radiographic imaging. We compared D-dimer levels in patients suspected of having VTE. We hypothesized that higher D-dimer values predict a higher likelihood of subsequent VTE diagnosis. Methods We conducted a secondary analysis of a multinational, prospective observational study of low- to intermediate-risk adult patients presenting to the emergency department with suspicion of VTE. Demographic and clinical data were collected in a structured manner. Advanced imaging including ultrasound, computed tomography (CT) pulmonary angiography, and ventilation/perfusion scanning was obtained at the discretion of the treating physicians. Imaging was evaluated by board-certified radiologists in real time. D-dimer values' bins were evaluated using a logistic regression model. Results We evaluated 1,752 patients for suspected deep vein thrombosis (DVT), with 191 (10.4%) DVT positive. We evaluated 1,834 patients for suspected pulmonary embolism (PE), with 108 (5.9%) PE positive. Higher D-dimer values in both groups were associated with higher likelihood of subsequent VTE diagnosis, with D-dimer values > 3,999 ng/mL in both groups having the highest incidence of VTE. More than 50% of those patients were VTE positive. Conclusions Increasing D-dimer values predict increased likelihood of being found VTE positive in this patient population. Among those in the highest D-dimer category, > 3,999 ng/mL, over half of patients were VTE positive. Further research could determine additional nuance in D-dimer as a tool to work up suspected VTE.

scholarly journals COVID-19 Symptoms Detection Based on NasNetMobile with Explainable AI Using Various Imaging Modalities

2020 ◽  
Vol 2 (4) ◽  
pp. 490-504
Author(s):  
Md Manjurul Ahsan ◽  
Kishor Datta Gupta ◽  
Mohammad Maminur Islam ◽  
Sajib Sen ◽  
Md. Lutfar Rahman ◽  
...  
Keyword(s):  
Ct Scan ◽  
Initial Screening ◽  
X Ray ◽  
Learning Techniques ◽  
Alternative Approach ◽  
Number Of Patients ◽  
The Usa ◽  
Chest X Ray ◽  
Interpretable Model ◽  
Potential Opportunity

The outbreak of COVID-19 has caused more than 200,000 deaths so far in the USA alone, which instigates the necessity of initial screening to control the spread of the onset of COVID-19. However, screening for the disease becomes laborious with the available testing kits as the number of patients increases rapidly. Therefore, to reduce the dependency on the limited test kits, many studies suggested a computed tomography (CT) scan or chest radiograph (X-ray) based screening system as an alternative approach. Thereby, to reinforce these approaches, models using both CT scan and chest X-ray images need to develop to conduct a large number of tests simultaneously to detect patients with COVID-19 symptoms. In this work, patients with COVID-19 symptoms have been detected using eight distinct deep learning techniques, which are VGG16, InceptionResNetV2, ResNet50, DenseNet201, VGG19, MobilenetV2, NasNetMobile, and ResNet15V2, using two datasets: one dataset includes 400 CT scan and another 400 chest X-ray images. Results show that NasNetMobile outperformed all other models by achieving an accuracy of 82.94% in CT scan and 93.94% in chest X-ray datasets. Besides, Local Interpretable Model-agnostic Explanations (LIME) is used. Results demonstrate that the proposed models can identify the infectious regions and top features; ultimately, it provides a potential opportunity to distinguish between COVID-19 patients with others.

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