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Pulmonary Embolism Imaging Protocol Selection

Pulmonary Embolism Imaging Protocol Selection: Suspected Pulmonary Embolism → Calculate Pretest Probability → D-dimer Result → PE Excluded.

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. Start

    Suspected Pulmonary Embolism

    1. Action

      Calculate Pretest Probability

      Wells Score or YEARS criteria

      1. Decision

        D-dimer Result

        • Negative
        • Positive
        • High pretest - skip
        1. End

          PE Excluded

          Negative D-dimer + low pretest

        2. Decision

          CTPA Contraindications?

          • None
          • Renal/contrast
          • Pregnancy
          1. End

            CTPA

            First-line for most patients

          2. End

            V/Q Scan

            Preferred for pregnancy, renal failure

          3. Action

            LE Doppler First

            If positive, can treat without CTPA

Guideline Source

ACR Appropriateness Criteria: Suspected Pulmonary Embolism

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • CTPA sensitivity lower for subsegmental PE
  • V/Q often nondiagnostic with underlying lung disease
  • Clinical judgment required for borderline cases

Applicable Regions

USAUUKEU

EU: ESC guidelines; emphasis on YEARS algorithm

US: CTPA standard first-line; PIOPED for V/Q

Version 1Next review: 2028-01-01

Frequently Asked Questions

What is the Pulmonary Embolism Imaging Protocol Selection?

The Pulmonary Embolism Imaging Protocol Selection is a diagnostic clinical algorithm for Radiology. It provides a structured decision tree to guide clinical decision-making, based on ACR Appropriateness Criteria: Suspected Pulmonary Embolism.

What guideline is the Pulmonary Embolism Imaging Protocol Selection based on?

This algorithm is based on ACR Appropriateness Criteria: Suspected Pulmonary Embolism (DOI: 10.1016/j.jacr.2021.04.013).

What are the limitations of the Pulmonary Embolism Imaging Protocol Selection?

Known limitations include: CTPA sensitivity lower for subsegmental PE; V/Q often nondiagnostic with underlying lung disease; Clinical judgment required for borderline cases. Individual patient factors may require deviation from these recommendations.

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