"We use it a ton in our institution, and I think clinical use of it is growing," Hollander said. "Use is growing faster than data, because all the early reports look great."
But the key to success is using the scan in appropriate cases, Hollander said. "If you apply it to everyone who walks in the door with a tinge of chest pain, it might actually increase risk," he said, which comes in part from the radiation exposure necessary for CTA.
"I would use it on people who, in a physician's judgment, are at high enough risk to warrant admission into the hospital," Hollander said. "With CTA, you switch testing from the hospital tomorrow to the emergency room today, and save that admission."
A report on the University of Pennsylvania's use of the scans in the emergency room, published last month, shows that "real costs from CTA are cheaper than doing other tests," he said.
A randomized trial would provide final proof of CTA effectiveness, Hollander and Hoffman agreed. Such a trial has been started at the University of Pennsylvania, Hollander said. But even before results of a randomized trial are available, "CTA is being used for triage in a lot of places, given the pressure to control health-care costs today," Hollander said.
The why and how of CTA are explained by the Cleveland Clinic.
SOURCES: Udo Hoffman, M.D., associate professor, medicine, Harvard Medical School/Massachusetts General Hospital, Boston; Judd Hollander, M.D., professor and clinical research director, emergency medicine, University of Pennsylvania, Philadelphia; April 28, 2009, Journal of the American College of C
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