[CTPA in suspected pulmonary embolism: diagnostic strategy]

De Bruin and colleagues recently analysed the performance of the CTPA scan in patients with suspected pulmonary embolism. Their study shows that in a significant number of patients no abnormalities were found on a CTPA scan, a troubling finding given the radiation exposure. Young patients and ambulatory patients, in particular, often had a completely normal CTPA scan. Better stratification of patients with a high suspicion of pulmonary embolism is required, including evaluation of the value of clinical decision rules in ambulatory patients with suspected pulmonary embolism. In addition, the use of perfusion scanning, which involves significantly less radiation exposure, deserves further research in young people. Principally, a diagnostic strategy for pulmonary embolism comprising a clinical decision rule, followed by a D-dimer test if necessary, should be applied in clinical practice. This strategy will significantly reduce the number of CTPA scans showing no pulmonary embolism.