CT pulmonary angiogram

Patients can step up or step down onto virtual wards.

So, you know, if the urgent community response goes out and says, I think this patient could have a PE, but they might need to have a CTPA, you can step that patient up onto an oncology virtual ward, get the CTPA done, manage them whilst they are entirely at home with them only having to come in for a planned diagnostic of a CTPA.

So these things can be done and have been done in pockets of excellence.

So we've got to just share that knowledge of how we roll that out nationally.

Yeah

... and plus or minus a CTPA.

Like, depending on like what's actually happening here, do I need, do I need [laughs] do we need a bedside echo right now? Um-

[coughs]

We hear constantly that AI will make radiologists more efficient, but the authors of this study called Efficiency and Financial Gains from Artificial Intelligence Algorithm Implementation by Dr. Berdella and co-authors asked the much more practical question.

Does that efficiency actually translate into enough money to justify the cost? They built a financial calculator using three real-world AI applications, intracranial hemorrhage triage on head CT, pulmonary embolism triage on CTPA, and breast cancer detection on screening mammography.

And the results were really different.

For intracranial hemorrhage AI, radiologists saved about 1.15 minutes per case.

It's not going to happen.

But we did get her to the lab pretty quickly, which was nice because she got a CTPA.

We knew exactly where her clot was and then brought her to the lab.

And these were her starting hemodynamics.

Outwith pregnancy, they're more likely to be distal, but it's just worth remembering that if you have a negative Doppler in pregnancy, then anticoagulate if you've got a high enough index of suspicion and then see them in two weeks.

Now, the big conversation is, as always, the VQ scan versus CTPA.

Before we get into that, and I know I've said this lots already, please do a chest x-ray.

Because even though you might have a woman that has right-sided pain, it's come on very acutely and they've coughed up blood, actually you still don't know if she's got TB or unusual atypical pneumonia or sadly maybe there's a cancer there.

And what you don't want to do is diagnose something on a VQ scan or a CTPA that you could have diagnosed off of a chest x-ray.

Now, everybody will have very different opinions on what scan to do, and that is absolutely fine.

The important thing is whether or not you are confident in your decision making.

And I'll talk you through how I decide whether or not a VQ scan or a CTPA is more helpful.