Trends and Sex Differences in the Usage and Yield of Computed Tomography Angiography in the Diagnostics of Pulmonary Embolism
This population-based study of over 187,000 CT pulmonary angiography examinations in Stockholm from 2010 to 2023 reveals a 137% increase in usage accompanied by a declining diagnostic yield, particularly among young women, highlighting an urgent need to refine patient selection criteria to minimize unnecessary radiation exposure.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a blood clot forms in the legs and travels to the lungs, it creates a condition known as a pulmonary embolism. This is a medical emergency that can be fatal if not treated quickly. To find these clots, doctors often use a specialized X-ray scan called a computed tomography pulmonary angiography, or CTPA. This test takes detailed pictures of the blood vessels in the chest to see if a blockage is present. While the test is highly effective at finding the problem, it involves exposure to radiation, which carries a small risk of causing cancer later in life. Because of this, medical experts have long worried that the test might be used too often, perhaps on patients who are unlikely to have a clot, simply because the technology is available and easy to order.
A team of researchers in Stockholm, Sweden, set out to understand exactly how often this test has been used over the last decade and whether the results have changed. They looked at a massive collection of medical records covering more than two million people in the region. By using advanced computer programs trained to read thousands of radiology reports, they identified every CTPA scan performed between 2010 and 2023. Their goal was to see if the number of scans was rising, if the scans were still finding clots as often as before, and if there were differences in how men and women were being tested.
The researchers found that the use of this test has grown dramatically. Between 2010 and 2023, the number of CTPA scans performed increased by 137 percent. The rise was steady for several years, but it spiked sharply in 2020 and 2021 during the global pandemic, before dipping slightly in the following years. Even with this dip, the total number of scans in 2023 remained nearly 30 percent higher than it was in 2019. However, while more people were getting scanned, the test was finding fewer clots. In the early years of the study, about 16 percent of the scans came back positive for a pulmonary embolism. By the end of the study period, that number had dropped to 12 percent. This means that for every hundred people scanned, fewer were actually found to have the dangerous condition they were suspected of having.
The data also revealed a striking difference between men and women, particularly among younger adults. For women between the ages of 20 and 39, the number of scans performed was nearly double the number performed on men of the same age. Yet, the number of actual clots found in these young women was only about 10 percent higher than in young men. This suggests that young women are being scanned at a much higher rate relative to how often they actually have the disease. In contrast, for people in their 40s and 50s, men were found to have clots more often than women, even though women in this age group still underwent slightly more scans. In older age groups, the rates of scanning and finding clots were much more similar between the sexes.
These findings point to a clear need to refine how doctors decide who should receive this scan. The study suggests that the current approach is leading to many examinations that provide little clinical value, exposing patients to radiation without a high likelihood of finding a serious problem. This is especially true for young women, who are being scanned at a rate that far outpaces the actual presence of clots in their population. The authors conclude that improving the selection of patients for this test could reduce unnecessary radiation exposure while ensuring that those who truly need the scan continue to receive it.
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