Comparison Between V/Q and CTPA in Pulmonary Embolism - Article Example

COMPARISON BETWEEN V/Q AND CTPA IN PULMONERY EMBOLISM Name Institution Affiliation Abstract Advancements in medicine and surgery often come with their own fair share of challenges. One particular challenge is the recent surge in Pulmonary Embolism, mostly due to recent surgery in a patient that involves the legs, hips, belly or brain (Cold, 2017). This paper aims at dissecting the most debated methods of diagnosis and subsequent treatment of Pulmonary Embolism, with an aim of suggesting the best alternative for medical practitioners. COMPARISON BETWEEN V/Q AND CTPA IN PULMONARY EMBOLISM DIAGNOSIS Pulmonary embolism in its entirety is a growing concern in the medical world, especially marginalized areas within medicine, the biggest problem hindering medical practitioners from effectively controlling the condition is the non-specific nature of the condition. The symptoms of pulmonary embolism are in close proximity to other lung related conditions (Cold, 2017). In this regard, it is highly important that professionals within the medicine fraternity come together to effectively decide upon the most appropriate way of diagnosis and subsequent treatment. Many patients, both here in Australia and all over the world suffering from this conditions are not able to obtain proper timely and adequate treatment with regards to this condition (Cold et al., 2017). This paper aims at gathering and analyzing the most recent scientific data pertaining to diagnosis of the condition with the aim of shedding more light on the condition. The most preferred methods of pulmonary embolism used in Australia are the ventilation/perfusion and the CTPA methods. The problem, however of diagnosis remains a thorn in nuclear medicine, at least, as far as pulmonary embolism is concerned (Cold, 2017). Most nuclear medicine specialists in Australia have not developed an approach towards determining the appropriate time for applying the appropriate diagnosis procedure. As stated earlier, symptoms of pulmonary embolism remain non-specific, hence diagnosis is often due to speculation, rather than concrete probable cause, this remains the biggest problem that needs to be solved by nuclear medicine specialists. Advancements in the said methods have not effectively solved this problem (Metter, Tulchinsky & Freeman, 2017). With that said, more still needs to be done in terms of research and ingenuity to improve the diagnosis methods of pulmonary embolism (Cold, 2017). It is important to note that this paper focuses more on V/Q- SPECT. This is simply because of the increasing popularity of V/Q SPECT as a method of pulmonary embolism diagnosis. V/Q SPECT has an impressive documentation of sensitivity and specificity, it is also non-invasive and the procedure can be performed on all types of patients, its radial exposure is relatively low and its acquisition time is roughly 20 minutes, if done with the right technique. In addition, it gives diagnosis to comorbid conditions and pneumonia apart from PE. It is therefore clearly evident that V/Q SPECT should be a part of the discussions involving pulmonary embolism. This is the main reason why it was prioritized in this paper. A total of six articles relating to Ventilation/perfusion, and, or, CT angiography were effectively analyzed as per the conditions of this paper. The article search engine for the same was PubMed. As will be seen in the course of this paper, the main clinical problem yet to be addressed in medicine is choosing an appropriate and effective way of diagnosis. As stated earlier, this is majorly due to the non-specific nature of the symptoms (Cold, 2017). The cost of the diagnosis, by far, is the greatest limitation. It is imminent that stake holders within the health sector, both here in Australia and the rest of the world effectively come up with improved cost effective versions of the methods described in this paper. Research Methods As stated earlier in this paper, I did a conclusive research on both V/Q and CTPA as it affects pulmonary embolism (PE). The research was done purely on already existing scientific findings by healthcare professionals. The research includes a total of six articles with conclusive scientific numerical results surrounding the two methods and pulmonary embolism in its entirety. Needless to say, analysis of scientific methods provides an evidence-based method of drawing medical conclusions, rather than intuition or prejudice which affect the other methods of acquiring knowledge (Reference, 2017). The search methods were purely search engine inspired. The database for the search included PubMed publications for the in depth scientific analysis of the two diagnosis methods, although there were other websites, through the google scholar and google search engines, that covered general knowledge on PE as well as scientific analysis of data, as seen in the reference section. The main terms used in sieving through PubMed publications was ‘comparison between V/Q and CTPA in pulmonary embolism diagnosis’. For the other website searches used during this research was ‘importance of scientific analysis of data’ and ‘challenges in medicine with regards to pulmonary embolism. The research was done on purely PubMed publications. Majority of the analyzed publications focused on the numerical analysis of the patients using both methods and the predeceasing cause and effect of the method with regards to pulmonary embolism. The research process, as will be shown, proved highly effective and conclusive with respect to the merits and demerits of both methods. The Research Findings 1- Accuracy The very first article was chosen on the aspect of accuracy. The article was chosen for the specific purpose of comparing the diagnosis accuracy of Ventilation/Perfusion (V/P) single-photon emission tomography (SPECT) combined with full-dose CT with a hybrid SPECT/CT scanner simultaneously (Milla’, 2017). Out of 315 patients who were analyzed during the study period of this analysis, 22.27% were effectively diagnosed with pulmonary embolism. The sensitivity and specificity of the patient population was found to be 95.53% and 97.1% for V/P SPECT/ CT (Milla’, 2017). 2- Recent Advancements in V/Q scintigraphy The second article chosen aimed at studying the recent development of V/Q within diagnosis of pulmonary embolism. The most recent imaging techniques used within V/Q scintigraphy offer different state of the art approaches that can be selected according to the requirements of the medical environment as well as the patient in question (Metter, Tulchinsky & Freeman, 2017). The overall effect of these advancements is over diagnosis. These methods are highly sensitive and may reveal clinically insignificant pulmonary embolisms (Metter, Tulchinsky & Freeman, 2017). 3- Concurrence of V/Q-SPECT and CTPA on patients suffering from pulmonary fibrosis and suspected pulmonary embolism This article presented a case study of 22 patients with pulmonary fibrosis who went through both V/Q-SPECT and CTPA (Leuschner , 2016). Out of the 22 patients who underwent the diagnosis process using both procedures, nine had a confirmation of pulmonary embolism with V/Q-SPECT in their diagnosis as compared to only two of these matches confirmed through CTPA (Leuschner, 2016). 4- Other frames of references within the remaining articles. The other chosen articles within the pulmonary diagnosis spectrum included the preferred method for a follow up diagnosis of pulmonary thromboembolism. In this case, the V/Q-SPECT planar proved very useful for the PTE follow up diagnosis (Frary, Gerke, Madsen & Hess, 2016). V/Q-SPEC also proved to provide higher capabilities of discovering perfusion defects diagnosis (Frary, Gerke, Madsen & Hess, 2016). Review of the Evidence Review of the evidence Number Abstracts matching the items search 52 Articles identified through alternate means 17 Articles rejected based on title 25 Articles rejected based on the abstract 14 Articles retrieved and copied for review 30 Articles rejected at first reading 11 Articles scored 19 Article meeting cut offs 6 DIFFERENCES BETWEEN V/Q AND CTPA A COMPARISON OF V/Q AND CTPA BASED ON THE EVALUATION CRITERIA DESCRIBED IN THE PAPER. V/Q BETTER THAN CTPA CTPA IS THE SAME AS V/Q CTPA IS BETTER THAN V/Q Accuracy YES Concordance on patients with pulmonary embolism YES Advancements in the method YES Availability YES Cost YES Findings Throughout the course of my research, all the articles I came across had an affinity for V/Q at the expense of CTPA. By comparison, CTPA seems to carry more weight, in almost every article I went through, as far as advantages are concerned. The radionuclide used in V/Q is inhaled in small amounts, which translates to fewer side effects as compared to CTPA. V/Q (Hogg, 2006), as proved through the documented experimentation results is more accurate and other pulmonary related conditions , case in question, pulmonary fibrosis (Leuschner, 2016). The recent advancements in V/Q has tremendously increase its sensitivity, to a point of over or under diagnosis (Metter, Tulchinsky & Freeman, 2017). Although this may be considered a limitation to some, it clearly shows the potential of V/Q to transform nuclear medicine and diagnosis of pulmonary embolism as we know it. Conclusion While it was quite unorthodox to focus on V/Q SPECT throughout the course of this paper, it is, by virtue of the views expressed in the first paragraph that the future of pulmonary embolism diagnosis lies with V/Q-SPECT. The ‘head starts’ it has over other methods should put it at the top of the research list, at least, as far as pulmonary embolism is concerned. It is quite evident in this paper that V/Q-SPECT has far much more benefits as compared to CTPA. The most deciding factor should however be accuracy. In as much as there are other benefits associated with CTPA, V/Q-SPECT should be the most preferred method by virtue of its accuracy, as presented by the article data received. It is therefore the collective responsibility of all stake holders within the nuclear medicine fraternity to effectively come up with ways of improving V/Q SPECT and make it the most preferred method of pulmonary embolism diagnosis. It is my opinion and conclusion through the scientific evidence presented in this paper that the future of pulmonary embolism lies with V/Q-SPECT. Nuclear medicine specialists should strive to improve the current versions of V/Q in a way that is cheaper to patients, more effective and perfectly sensitive (not the extreme). If there is anything medicine has taught me, anything is possible. References Cold, F., Health, E., Disease, H., Management, p., Conditions, S., Problems, S., Disorders, S., Checker, S., Interviews, E., Boards, M., Guide I., Doctor, P., Medications, M., Identifier P., Interactions, C., Drugs, C., Pregnant, T., Management, D., Obesity, W., Recipes, F., Exercise, F., Beauty, H., Balance, H., Relationships, S., Care, O., Health, W., Health, M., Well, A., Teens, H., Kids, F., Pregnant, G., Trimester, T., Baby, N., Health, C., Vacancies, C., Kids, r., Cats, h., Dogs, H., Diets, S., Heart, Y., Age, G., cancer, D., Attack, V., Boards, M., Blogs, E., Center, N., and Health, L. (2017). Pulmonary Embolism- Topic Overview. [online] WebMD. Available at: http://www.webmd.com/lung/tc/pulmonary-embolism-topic-overview [Accessed 7 Apr 2017]. Frary, E., Gerke, O., Madsen, P., & Hess, S. (2016). State-of-the-Art Imaging in Pulmonary Embolism: Ventilation/Perfusion Single-Photon Emission Computed Tomography versus Computed Tomography Angiography-Controversies, Results and Recommendations from a Systematic Review. Seminars In Thrombosis And Hemostasis, 42(08), 833-845. Doi: 10.1055/S-0036-1593376 G. Santos, J., Carmona, S., A. Sequeria, J., Prata, A., & Santos, A. (2016). Pulmonary ventilation/perfusion single photon emission tomography – Initial experience of a Nuclear Medicine Department. Revista Portuguesa De Pneumologia (English Edition), 22(1), 27-33. Doi: 10.1016/j.rppnen.2015.06.011 Hogg, K. (2006). Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study. Emergency Medicine Journal, 23(2), 123-127. Doi:10.1136/emj.2005.027110 Leuchner, G., Wenter, V., Milger, K., Zimmerman, G., Matthes, S., & Meinel, F. et al. (2016). Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography. Respirology, 21(6), 1081-1087. Doi:10.1111/resp.12797 Metter, D., Tulchinsky, M., & Freeman, L. (2017). Current Status of Ventilation-Perfusion Scintigraphy for Suspected Pulmonary Embolism. American Journal Of Roentgenology, 208(3), 489-494. Doi:10.2214/ajr.16.17195 Milla’, M., Bechini, J., Vazquez, A., Vallegos, V., Tenesa, M., & Espinal, A. et al. (2017). Acute pulmonary embolism detection with ventilation/perfusion SPECT combined with full dose CT: What is the best option?. Revista Espan’ola De Medicine Nuclear E Imagen Molecular. Doi:10.1016/j.remn.2016.11.06 Reference. (2017). Why is the scientific method important?. [online] Available at: https://www.reference.com/science/scientific-method-important-e1ac2c0d5b696f1 [Accessed 7 April. 2017]. Read More