CLINICAL UTILIZATION OF THE NONDIAGNOSTIC LUNG SCINTIGRAM

By virtue of the poor specificity of ventilation perfusion lung scinti graphy, a significant number of examinations for suspected pulmonary e mbolism (PE) result in a report which is neither normal nor high proba bility. These are unhelpful in establishing a firm clinical diagnosis. Patients with an indeterminate report should therefore undergo furthe r investigation to establish the diagnosis particularly when treatment with anticoagulants is proposed. All lung scintigram reports issued o ver a 2-year period mere reviewed and 102 indeterminate lung scintigra m reports were identified. The case notes of 94 of these patients were examined and details of further investigation and management recorded . Fifty-one patients (55%) had no further radiological investigations and 19 (37%) of these were unequivocally categorized as having had pul monary embolism by the referring clinician. Eighteen of these were tre ated with anticoagulation therapy. When patients proceeded to further radiological investigation then the result usually influenced the fina l clinical diagnosis. Clinicians frequently treat an intermediate repo rt as the end point in investigation of suspected PE and consequently some patients may receive suboptimal management. By implementing a hos pital wide policy of further investigation of non-diagnostic lung scin tigrams, using a standard protocol, patient management could be improv ed.