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After a five-minute CT scan, the 62-year-old St. George woman had an answer — a blood clot in her lung, also called a pulmonary embolism. The problem strikes 600,000 Americans each year and is the third-leading cause of cardiovascular death, after heart attack and stroke. The scanners have been used to diagnose pulmonary embolisms since they came to market in the early 1990s, but doctors sometimes worried about the possibility of clots that didn't show up on the pictures. They often ordered extra, more invasive tests to be sure. Research published today in the Journal of the American Medical Association is expected to put those fears to rest. The study's authors found that single-slice spiral CT scanners — the machine used in at least 50 percent of U.S. hospitals — are just as effective at ruling out pulmonary embolisms as catheterization tests using radioactive dye. Plus, the scans are quicker and safer. " Despite the CT test being negative, patients often went on and had other invasive tests," said U. Joseph Schoepf, lead author of the study and an associate professor of radiology at the Medical University. "That's expensive and obviously adds to chance that they're getting sicker along the way." Catheterizations, for instance, sometimes dislodge clots or damage veins, and treating patients with blood thinners without a definitive diagnosis can lead to bleeding in the brain. Schoepf's study found that among 3,500 patients from across the world whose CT scans seemed to rule out a pulmonary embolism and were given no further tests or treatment, nearly all were still healthy a year later. That means that even small clots the CT might have missed usually weren't significant enough to cause problems, Schoepf said. Pulmonary embolisms often result from long periods of inactivity or after surgery, and they're more likely to strike in young women who take birth control pills and smoke. They frequently begin in the legs, where they're hard to detect, and then snake their way through the bloodstream to block an artery in the lungs. The new study makes CT scanning the most thoroughly studied diagnostic tool for pulmonary embolisms, since even pulmonary catheterization was never studied in more than 1,000 patients. MUSC and other research hospitals have installed next-generation "64-slice" CT scanners, which take three-dimensional, lifelike pictures of the body in less than half the time of spiral CT machines. The images they produce leave little doubt in the minds of doctors about what diagnosis they're looking at. Insurance companies reimburse hospitals the same amount for all types of CT testing, however, so there's little incentive for facilities to upgrade to the newest technology. Schoepf hopes his research will reassure emergency room physicians and private practice doctors that they can trust the older scanners — now close to 15 years old — when they suspect a pulmonary embolism. " We feel that this particular topic has a chance of being pivotal in changing patient care," Schoepf said. "We're at the threshold of changing practice patterns throughout the country." |
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