{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:12:05Z","timestamp":1790712725848,"version":"4.1.0"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"1186","license":[{"start":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T00:00:00Z","timestamp":1780704000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Evaluate the prevalence of true-positive and false-positive incidental pulmonary embolism (iPE) diagnoses and the impact of expert review on diagnostic accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective study included consecutive contrast-enhanced thoracic CT examinations without dedicated PE protocols which reported iPE over an 18-month period (2022-24). Electronic health records were reviewed to identify requests to confirm PE based on previous non-dedicated studies. Studies identifying iPE were graded from 1 (most certain) to 5 by original report diagnostic certainty and compared between PE-positive and PE-negative subgroups using Fisher\u2019s exact test. Identified imaging received retrospective expert review to calculate expert agreement with CTPA, where CTPA had been performed, using Cohen\u2019s kappa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 25\u00a0214 CT examinations, 260 (1%) reported iPE (mean age 73\u2009\u00b1\u200912\u2009years; 51% women). Of these, 25% (n\u2009=\u200965\/260) underwent confirmatory CTPA. Patients receiving CTPA had lower initial iPE diagnostic certainty (median 3 versus 1, P\u2009&amp;lt;\u2009.01) and 52% (n\u2009=\u200934\/65) were PE-positive on CTPA. Patients with false-positive diagnoses had reduced diagnostic certainty on non-dedicated studies compared to those with a true-positive diagnosis (median 3 versus 2, P\u2009&amp;lt;\u2009.001). Agreement between the expert review of the iPE scan and the ground-truth CTPA diagnosis had \u03ba of 0.96.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Expert review could be an effective tool to reduce CTPA requirement in cases of intermediate (grade 3) iPE diagnostic certainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>Low-certainty incidental pulmonary embolism diagnoses on initial non-dedicated CT are more likely to be false-positives according to CTPA findings or expert thoracic radiologist review. Expert review of initial CT may therefore reduce excessive imaging and avoid treating false-positive cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjr\/tqag140","type":"journal-article","created":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T07:42:39Z","timestamp":1780731759000},"page":"2164-2171","source":"Crossref","is-referenced-by-count":0,"title":["Incidental pulmonary embolism and the value of CT pulmonary angiography follow-up versus expert review"],"prefix":"10.1093","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6948-9576","authenticated-orcid":false,"given":"Callum R T","family":"Kidson","sequence":"first","affiliation":[{"name":"University of Bristol Bristol Medical School, Faculty of Health & Life Sciences, , Bristol, BS8 1UD,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyon-Mok","family":"Sohn","sequence":"additional","affiliation":[{"name":"Royal United Hospitals Bath NHS Foundation Trust Department of Radiology, , Bath, BA1 3NG,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Page","sequence":"additional","affiliation":[{"name":"Royal United Hospitals Bath NHS Foundation Trust Respiratory Department, , Bath, BA1 3NG,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2744-3509","authenticated-orcid":false,"given":"Jonathan C L","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Royal United Hospitals Bath NHS Foundation Trust Department of Radiology, , Bath, BA1 3NG,","place":["United Kingdom"]},{"name":"Department of Health, University of Bath , Bath, BA3 7AY, BA1 3NG,","place":["United Kingdom"]},{"name":"The HLH Imaging Group LTD, Middlesex, HA4 0BW, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"2026092915465147500_tqag140-B1","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur Heart J"},{"key":"2026092915465147500_tqag140-B2","volume-title":"Hospital Admitted Patient Care Activity, 2024-25\u2014NHS England Digital","author":"NHS Digital","year":"2025"},{"key":"2026092915465147500_tqag140-B3","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1007\/s00330-022-09071-0","article-title":"Incidental pulmonary embolism in patients with cancer: prevalence, underdiagnosis and evaluation of an AI algorithm for automatic detection of pulmonary embolism","volume":"33","author":"Wiklund","year":"2023","journal-title":"Eur Radiol"},{"key":"2026092915465147500_tqag140-B4","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1148\/rg.245045008","article-title":"CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis","volume":"24","author":"Wittram","year":"2004","journal-title":"Radiographics"},{"key":"2026092915465147500_tqag140-B5","doi-asserted-by":"publisher","first-page":"1700275","DOI":"10.1183\/13993003.00275-2017","article-title":"Management of incidental pulmonary embolism","volume":"49","author":"Klok","year":"2017","journal-title":"Eur Respir J"},{"key":"2026092915465147500_tqag140-B6","volume-title":"Diagnostic Imaging Dataset Annual Statistical Release","author":"NHS England","year":"2024"},{"key":"2026092915465147500_tqag140-B7","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1016\/j.mayocp.2015.07.011","article-title":"Answers to common questions about the use and safety of CT scans","volume":"90","author":"McCollough","year":"2015","journal-title":"Mayo Clin Proc"},{"key":"2026092915465147500_tqag140-B8","doi-asserted-by":"publisher","first-page":"741018","DOI":"10.1155\/2014\/741018","article-title":"Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention","volume":"2014","author":"Andreucci","year":"2014","journal-title":"Biomed Res Int"},{"key":"2026092915465147500_tqag140-B9","doi-asserted-by":"publisher","first-page":"11","DOI":"10.5811\/westjem.2014.12.22933","article-title":"Anticoagulation drug therapy: a review","volume":"16","author":"Harter","year":"2015","journal-title":"West J Emerg Med"},{"key":"2026092915465147500_tqag140-B10","doi-asserted-by":"publisher","first-page":"2","DOI":"10.2214\/AJR.15.15895","article-title":"How sure are you, doctor? 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