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In many institutions, computed tomography (CT) angiography has virtually replaced ventilation/perfusion (V/Q) scanning for diagnosing pulmonary embolism (PE) in patients with good renal function. However, CT exposes patients to more radiation than does V/Q scanning, especially patients who are scanned repeatedly. In a study from a single French hospital, researchers evaluated a diagnostic strategy that relied heavily on V/Q scanning in 321 adults with suspected PE. Those with normal d-dimer and low or intermediate clinical probability (according to Wells criteria) were excluded, because PE was considered to be ruled out in those patients.
All patients underwent leg ultrasound initially; results were positive in 43 patients. The remaining 278…