Did Lawsuits Contribute to the Displacement of Ventilation/Perfusion Studies by Computed Tomography Pulmonary Angiography as the Modality of Choice for the Detection of Pulmonary Embolism?

Abstract

Pulmonary embolism (PE) is a common emergency presentation that can lead to death if left untreated. While catheter pulmonary angiography was the gold standard, ventilation/perfusion studies were the preferred non-invasive diagnostic test for PE. Lawsuits from this era focused on the diagnostic uncertainty created by V/Q scan reports, which are graded by probability of PE. After multidetector computed tomography (MDCT) became widespread, the focus of lawsuits shifted away from the content of the report and towards implying negligence for not ordering imaging. Due to a confluence of factors, including the evolving medicolegal environment, clinicians chose CT as the modality of choice.