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Dr Simon Padley FRCP, FRCR is Consultant Radiologist at the Chelsea and Westminster Hospital and the Royal Brompton Hospital. Following a fellowship in Vancouver in 1991–2 he has maintained a longstanding interest in all aspects of thoracic imaging and is widely published in the field.
Imaging of pulmonary embolism

Simon PG Padley,1 Kapila Jain2
1 Department of Radiology, Chelsea and Westminster
Hospital, London, UK;
2 Department of Radiology, Royal Brompton Hospital,
London, UK

Address for correspondence:
Dr Simon PG Padley
Consultant Radiologist,
Royal Brompton Hospital, Sydney Street,
London, SW3 6NP, UK
Tel: +44 (0)20 8746 8562
Fax: +44 (0)20 8746 8588
Email: s.padley@ic.ac.uk

Abstract
If a diagnosis of pulmonary embolism (PE) has not been excluded after the initial clinical assessment and chest X-ray, the options for further evaluation include V/Q scintigraphy and CT. CT pulmonary angiography allows the pulmonary arterial system to be visualised and inter-observer agreement is generally very good for a diagnosis of PE. The advantage of CT over other imaging techniques is that it also demonstrates other aspects of the thoracic anatomy and facilitates alternative diagnoses. This is important since up to two-thirds of patients with suspected PE may eventually receive a different diagnosis. The advent of spiral MDCT provides a powerful tool for diagnosis of PE that is currently being compared with various combinations of tests in the PIOPED II study. CT is undoubtedly very valuable for the diagnosis of PE, but in order to reduce radiation exposure, it should be the last step in a sequential clinical evaluation.

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