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The new chest x ray

BMJ 2018; 360 doi: (Published 19 February 2018) Cite this as: BMJ 2018;360:k769
  1. Giles Maskell, radiologist
  1. Truro, UK
  1. gilesmaskell{at}

What would we need if we seriously contemplated replacing chest radiography with CT scanning in acute care?

The medical registrar was on the phone for the third time that morning. “Another CTPA?” I asked, aiming for a tone of polite surprise but probably failing. She said, “Haven’t you heard? It’s the new chest x ray.”

Computed tomography pulmonary angiography (CTPA) was introduced into clinical practice about 20 years ago.1 It has obvious appeal as an accurate test for pulmonary embolism, a common condition that can present acutely, is known to be hard to diagnose, and is sometimes fatal. And, unlike the traditional alternative—the perfusion lung scan—CTPA can suggest or exclude a range of other possible diagnoses. It has proved to be a very popular test, to the point where concerns have been raised that its use may have resulted in potentially harmful overdiagnosis.2

Chest …

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