Clinicians' interpretation of ventilation/perfusion (V/Q) lung scan reports

Ismail, Ayesha
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The survey of clinicians’ interpretation of Ventilation/Perfusion (V/Q) scan reports will determine which further decisions are taken for the management of patients with suspected pulmonary embolism (PE). This study assessed the referring clinicians’ interpretation of terminology used in V/Q scan reports and how this affected clinical management. Methods: A questionnaire was sent out to 300 clinicians with varying experience levels and working in various different clinical departments. Questions related to terminology used, further management of patients, clinicians’ preferences and areas where imaging reports can be improved. Results: 162 responses were received. Most clinicians (87-94%) understood the terminology recommended by guidelines as intended. A negative V/Q scan despite a high clinical pre-test probability led 33% of clinicians to consider an alternative diagnosis and 59% of clinicians to refer the patient for Computed Tomography Pulmonary Angiography (CTPA). The remaining 8% of respondents would trust their clinical judgement and treat as PE despite a negative V/Q scan. For inconclusive findings on V/Q scan, 72% of respondents would investigate further with CTPA, if there were no contraindications. Only 12% of clinicians would consider therapeutic anticoagulation and repeat V/Q scan in 7-14 days in this situation. There were 16% of clinicians who would trust their clinical judgement and treat as confirmed pulmonary embolism in the case of an inconclusive study. There were 77% of respondents who understood thata negative V/Q scan rules out PE. Conclusion: The majority of respondents understood the intended meaning of the probability of PE described in V/Q reports in our clinical setting. Most clinicians would consider referral for CTPA or an alternative diagnosis in the event of a negative study but a high clinical suspicion for PE. The majority of respondents would refer the patient for CTPA if the V/Q scan was reported as inconclusive. The majority of clinicians understood that a negative V/Q study rules out a diagnosis of PE. Areas where V/Q scans may be improved are important to evaluate as this will facilitate better communication with referring clinicians and ultimately improve patient care.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Nuclear Medicine to the Faculty of Health Sciences, School of Clinical Medicine University of the Witwatersrand, Johannesburg, 2021