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April 9, 2008

Evaluation of Suspected Pulmonary Embolism During Pregnancy—Reply

JAMA. 2008;299(14):1665-1666. doi:10.1001/jama.299.14.1665-b

In Reply: Dr Siegel raises an interesting point about which consensus does not yet seem to have been reached. Although some studies have calculated less fetal radiation exposure using helical CT scanning than scintigraphic lung scanning,1 other studies indicate little difference between the 2 modalities or somewhat less radiation with scintigraphy when only a perfusion scan is done.2 Moreover, CT estimates used very specific parameters for scanning time, collimation, and cranial-caudal scan extent, which might not strictly apply in all clinical situations. Some experts, such as a majority of PIOPED II (Prospective Investigation of Pulmonary Embolism Diagnosis II) investigators, recommend pulmonary scintigraphy for diagnosis of pulmonary embolism in the setting of pregnancy3 while others now recommend CTPA.4

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