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WELLS Criteria for Pre-test Probability of PE
WELLS Criteria for Pre-test Probability of PE
DVT
PE
Provoked
3 months
3 months
Unprovoked
Extended therapy (> 6 months) unless
high-risk for bleeding
Extended therapy (> 6 months) unless
high-risk for bleeding
Recurrent
Extended therapy (> 6 months) unless
high-risk for bleeding
Extended therapy (> 6 months) unless
high-risk for bleeding
ACR appropriateness, background and radiation
ACR APPROPRIATENESS CRITERIA:
Evidence-based guidelines to assist referring
physicians and other providers in making the
most appropriate imaging or treatment decision
for a specific clinical condition.
http://www.acr.org/Quality-Safety/Appropriateness-Criteria
(or…Google ACR Appropriateness Criteria)
Relative Radiation Level
- RRL
Adult Effective Dose
Estimated Range
Pediatric Effective Dose
Estimated Range
Example Examinations
0
0 mSv
0 mSv
Ultrasound; MRI
☢
<0.1 mSv
<0.03 mSv
Chest Radiographs;
Hand Radiographs
☢☢
0.1-1 mSv
0.03-0.3 mSv
Pelvis Radiographs;
Mammography
☢☢☢
1-10 mSv
0.3-3 mSv
Abd CT; Nuc Med Bone
Scan
☢☢☢☢
10-30 mSv
3-10 mSv
Abd CT with and
without; PET Scan
☢☢☢☢☢
30-100 mSv
10-30 mSv
CTA chest abd pelvis
with contrast; TIPS
The Relative Radiation Level for some of the exams cannot be made, because the actual patient doses in these
procedures vary as a function of a number of factors (ie. Region of body exposed to radiation, imaging guidance used,
etc)
EFFECTIVE DOSE:
Estimate of GENERIC risk to a generic individual (both
sexes, all ages, standard-sized patient) and doesn’t
represent the actual risk for any one individual.
EFFECTIVE DOSE:
US residents receive an average dose of:
- 3.1 mSv - Background Environment
- 3.1 mSv – Average Medical imaging
Effective dose of:
- 15 mSv – CT Angiogram Thorax
- 2.2 mSv – V/Q Scan
Special Scenarios
•
•
•
Pregnancy
Poor Renal Function (Elevated Cr, TXP, etc)
Contra-indication to Anticoagulation
treatments
PREGNANCY AND POST PARTUM:
Post partum/Breast feeding
Pregnant
CT PE
V/Q
Mother
Baby
Dose
Nominal
Dose
Mother
Baby
Dose
Dose
(It’s Complicated)
CT PE
V/Q
Mother
Mother
Dose
Dose
Breasts are 4x more sensitive to radiation during pregnancy and breast feeding.
Poor Renal Function (Elevated Cr, TXP, etc)
Lower Extremity Ultrasound
V/Q
Labs
&/or
Treatment
Anti-Coag
IVC
DVT & Contra-indication to Anticoagulation:
Medicare Reimbursement:
PE CT: Approximately $282 (P-92/T-190)
V/Q: Approximately $324 (P-53/T-271)