University of Wisconsin–Madison Medical College of Wisconsin

Patient Preferences for Diagnostic Imaging: CTA vs MRA When Diagnosing Pulmonary Embolism

Rebecca L. Bracken, BA; Kenneth D. Croes, PhD; Elizabeth A. Jacobs, MD, MPP; Manish N. Shah, MD, MPH; Michael S. Pulia, MD, MS; Azita G. Hamedani, MD, MPH, MBA; Scott K. Nagle, MD, PhD; Michael D. Repplinger, MD, PhD

WMJ. 2021;120(4):286-292.

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Objective: To identify preferences regarding choice of diagnostic imaging (computed tomographic angiography [CTA] vs magnetic resonance angiography [MRA]) for the evaluation of pulmonary embolism.

Methods: We conducted 4 focus group discussions with residents of 2 Wisconsin cities. Community members ≥18 years old were recruited via telephone using a commercially available telephone database. The discussions were audio recorded and professionally transcribed. Three investigators (a research specialist, emergency physician, and qualitative methodologist) independently analyzed these transcripts using inductive thematic coding to identify the overarching themes and underlying concepts. Intercoder discrepancies were resolved through consensus discussion by the reviewers.

Results: Focus groups were held over a 3-month period and included 29 participants (16 female). Ages were well represented: 18-30 (n = 7), 31-40 (n = 8), 41-55 (n = 6), and 56+ (n = 8) years old. Analysis revealed 3 central themes: time, risk, and experience. Participants who preferred CTA commonly cited the need for immediate results in the emergency department. When nonemergent scenarios were discussed, the option to undergo MRA was considered more strongly; participants weighed additional details like radiation and diagnostic accuracy. Regarding risks, discussants expressed concerns from multiple sources, including radiation and intravenous contrast. However, understanding of this risk varied across the groups. Prior experience with medical imaging—both personal and indirect experiences—carried considerable weight.

Conclusions: Preferences regarding imaging choice in the diagnosis of pulmonary embolism were mixed, often reliant on vicarious experiences and an exaggerated notion of the difference in timing of imaging results. Participants frequently used incomplete or even incorrect information as the basis for decision-making.

Author Affiliations: BerbeeWalsh Department of Emergency Medicine, University of Wisconsin (UW) School of Medicine and Public Health (SMPH), Madison, Wisconsin (Bracken, Shah, Pulia, Hamedani, Repplinger); University of Wisconsin Survey Center, UW–Madison, Madison, Wisconsin (Croes); Department of Medicine, University of Texas–Austin, Austin, Texas (Jacobs); Department of Radiology, UW SMPH, Madison, Wisconsin (Nagle, Repplinger).
Corresponding Author: Michael D. Repplinger, MD, PhD, Suite 310, Mail Code 9123, 800 University Bay Dr, Madison, WI 53705; email; twitter @RepplingerMD
Funding/Support: The authors acknowledge support from the National Institutes of Health, including the National Center for Advancing Translational Sciences grants UL1TR000427 and KL2TR000428, the National Institute on Aging grant K24AG054560, and the National Institute of Diabetes and Digestive and Kidney Diseases grant K08DK111234. Additional funding was received from the Agency for Healthcare Research and Quality, grant K08HS024342. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Agency for Healthcare Research and Quality.
Financial Disclosures: None declared.
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