Department of Radiology, Children's Hospital Boston and Harvard Medical School, MA 02115, USA.
Acad Radiol. 2010 Dec;17(12):1543-9. doi: 10.1016/j.acra.2010.08.012. Epub 2010 Oct 8.
To determine the current policies and practices of Society for Pediatric Radiology (SPR) members regarding the evaluation of pediatric patients with suspected pulmonary embolism (PE) with an emphasis on use of computed tomography pulmonary angiography (CTPA).
Institutional review board exemption was granted for this study. Surveys were mailed electronically to the 1575 members of the SPR representing 416 institutions. Information gathered included the existence of written policies, the imaging study of choice for suspected PE, routine acquisition of chest radiographs before CTPA, currently used CTPA techniques, modifications of protocols for radiation dose reduction, typical DLP (dose-length-product) for CTPA, and estimated annual frequency of performing CTPA for evaluating PE in children. Survey items pertaining to policies and practices were compared between practice settings and populations using chi-square analysis.
One hundred and sixty members representing 118 institutions responded, which resulted in a response rate of 28% (118/416), on an institutional basis. Of these 118 respondents, 104 (88%) perform CTPA in children with clinical suspicion of PE. Of the 104 respondents who perform CTPA, 26 (25%) have a written policy for CTPA, 93 (89%) perform CTPA as the first study choice, and 67 (64%) routinely obtain chest radiographs before CTPA. The most commonly used CTPA techniques in children with clinical suspicion of PE include intravenous contrast amount of 2 mL/kg, mechanical injection of intravenous contrast, and tailored bolus tracking method for CTPA scan initiation by observing the Hounsfield units of contrast in the central pulmonary artery on the monitoring scan. Sixty respondents (58%) modify CTPA imaging protocols for evaluating PE in children in order to decrease radiation dose. The two most common modifications for radiation dose reduction were reduced mAs in 41 (68%) and automatic exposure control in 38 (63%). The majority of respondents (88%) did not know the typical DLP for a 20-kg child during CTPA study performed to evaluate for PE. A significantly greater percentage of radiation dose-reduction techniques are performed within academic institutions compared with private institutions (P = .03).
Most survey respondents perform CTPA as the study of choice for evaluating PE in children, but there is considerable variability in their policies and practices. Respondents from academic medical centers are more likely to employ radiation dose-reduction techniques for CTPA than those in private practice settings.
旨在确定美国儿科放射学会（SPR）成员在评估疑似肺栓塞（PE）的儿科患者时的现行政策和实践，重点关注使用计算机断层肺动脉造影（CTPA）。
本研究获得机构审查委员会豁免。向 SPR 的 1575 名成员（代表 416 个机构）以电子方式邮寄了调查。收集的信息包括书面政策的存在、疑似 PE 的首选影像学研究、CTPA 前常规进行胸部 X 线检查、目前使用的 CTPA 技术、用于降低辐射剂量的协议修改、CTPA 的典型剂量长度乘积（DLP）以及评估儿童 PE 的 CTPA 年频率。使用卡方分析比较实践环境和人群之间与政策和实践相关的调查项目。
在机构层面上，118 个机构中有 16 名成员（代表 118 名）做出回应，回应率为 28%（118/416）。在这 118 名应答者中，有 104 名（88%）对有临床疑似 PE 的儿童进行 CTPA。在进行 CTPA 的 104 名应答者中，26 名（25%）有 CTPA 书面政策，93 名（89%）将 CTPA 作为首选研究，67 名（64%）在进行 CTPA 前常规进行胸部 X 线检查。在有临床疑似 PE 的儿童中，最常用的 CTPA 技术包括静脉内造影剂用量 2 毫升/公斤、静脉内造影剂机械注射和通过观察监测扫描中央肺动脉中的造影剂 Hounsfield 单位来启动 CTPA 扫描的定制团注追踪方法。60 名应答者（58%）为了降低辐射剂量而修改了 CTPA 成像协议。最常见的两种降低辐射剂量的方法是 41 名应答者（68%）降低毫安和 38 名应答者（63%）自动曝光控制。大多数应答者（88%）不知道在为评估 PE 而进行的 20 公斤儿童 CTPA 研究中典型的 DLP。与私立机构相比，在学术医疗机构中进行的辐射剂量降低技术的比例明显更高（P =.03）。
大多数调查应答者将 CTPA 作为评估儿童 PE 的首选研究，但他们的政策和实践存在相当大的差异。来自学术医疗中心的应答者比私人执业环境中的应答者更有可能采用 CTPA 辐射剂量降低技术。
