The Society of Thoracic Radiology (STR) membership enthusiastically embraced the launch of its mentorship program, with peaks in participation and engagement after annual meetings and during the COVID pandemic. The program provides a valuable resource for early to mid-career thoracic radiologists, especially those lacking local resources. This report describes the program’s inception and design, and summarizes the program’s successes and challenges at 5 years, based on a 2023 mentorship survey. STR mentees, spanning early to mid-career stages, most frequently sought mentorship in career development, graduate medical education, research portfolio development, publishing, cardiac imaging, grant funding, and artificial intelligence. Mentors offered expertise in these areas, plus lung cancer screening, career development, and workplace navigation. The committee prioritized creating dyads based on mutual interest and expertise, achieving mutual top-choice match rates of 70% to 97%. Enduring dyads flourished as the program matured. At 5 years, a survey of participants was fielded. Mentees reported moderate to high program impact on scholarly activities, leadership, networking, clinical service, education, and career satisfaction. Mentors described satisfaction in their roles, highlighting networking, career satisfaction, and the opportunity to influence upcoming generations of cardiothoracic radiologists, thereby impacting the field’s future. Most participants expressed high career satisfaction. Descriptive comments further enriched findings. Survey results confirmed that strengthening dyad formation and enhancing mentoring outcomes remain pivotal. Remote mentorship, while valuable, presents challenges—personal connections and contextual familiarity, considered essential to successful mentorship relationships, are typically absent in these settings. Activities to potentially enhance the STR mentorship program are offered.

Mechanical circulatory support devices (MCSDs) have revolutionized the management of advanced heart failure and critical cardiopulmonary conditions. These devices, categorized into temporary and long-term systems, provide crucial circulatory and respiratory support in patients with cardiogenic shock, refractory heart failure, and/or acute respiratory distress syndrome or act as a bridge to recovery or transplant. Temporary devices such as intra-aortic balloon pumps, percutaneous heart pumps, percutaneous ventricular assist devices (VADs), and dual-lumen cannulas are essential for acute hemodynamic stabilization. Long-term devices, including VADs and total artificial hearts (TAHs), offer durable solutions and may be used as a destination therapy or a bridge to heart transplant. Extracorporeal membrane oxygenation, also referred to as extracorporeal life support, provides cardiopulmonary support for patients with severe respiratory failure with or without cardiac failure. Despite their transformative role, MCSDs are associated with significant risks, including mechanical and medical complications. Imaging modalities such as echocardiography and CT are integral to optimal management of MCSDs and aid in device placement, functionality assessment, and early identification of complications, ensuring patient safety and improved outcomes. Recent advancements in device technology, including third-generation continuous-flow VADs and TAH systems, have led to improved survival and reduced complication rates. However, recent recalls and regulatory updates underscore the need for ongoing vigilance in device selection, implantation, and monitoring. The authors highlight the types of and indications for using MCSDs, their normal imaging appearances, and findings associated with common complications. The latest updates in MCSD technology are discussed, and the pivotal role of imaging in optimizing the management of patients with MCSDs is emphasized. ©RSNA, 2025.

Pulmonary embolism (PE) is a heterogeneous disease with variable severity. Risk factors and occurrence of PE differ in patients by gender, age, and comorbidity. Our goal was to determine long-term mortality in imaging diagnosed PE in men and women while accounting for differences in age and health status. This was a retrospective study of adults imaged for PE with ventilation/perfusion scintigraphy or CT pulmonary angiography over a 7-year period at our multisite urban academic medical center. Electronic health records (EHR) were reviewed for patient data, including Charlson comorbidity index (CCI). Mortality at one-year was determined from EHR and National Death Index. Association between PE and survival was assessed using Cox proportional hazard model. 33,628 patients (55yo ± 19, 69 % women) were imaged for PE, 9.5 % of exams were positive. One-year mortality for the cohort was 9.9 % for women vs. 16.8 % for men, p < 0.001. Women with PE had higher increased one-year mortality (HR 2.75[2.48-3.06]) than men with PE (HR:1.38[1.21-1.58]). Women with PE also had higher hazard ratio after inclusion of age and CCI as covariates in the Cox proportional hazard model (women HR 1.68 [1.51-1.86] versus men HR 1.20 [1.05-1.36]). The higher impact of PE on the mortality of women yielded a similar one-year mortality for women and men with PE, 21.9 % vs. 21.5 %, respectively (P = 0.83). Positive PE study was associated with significantly increased one-year mortality, however this effect was much stronger in women. This gender difference persists after accounting for age and comorbidities.

CT angiography (CTA) is the modality used most frequently for diagnosing acute pulmonary embolism (PE). Given the vast amount of information that can be extracted from CTA, the CTA report should be written in a way that conveys all relevant findings using standardized nomenclature and definitions. Broad consensus on a core set of CTA findings that are relevant for all PE patients is not currently available. This clinical consensus statement written by the European Society of Cardiology (ESC) Working Group on Pulmonary Circulation & Right Ventricular Function, the Fleischner Society, and the Association for Acute Cardiovascular Care and the European Association of Cardiovascular Imaging of the ESC provides a current update of CTA techniques, a definition of often-used nomenclature and recommendations on the proposed content of CTA reports along with a detailed image atlas with instructions on how to assess all relevant CTA findings and a lay language guidance on the meaning of these findings. Ultimately, upon implementation, this document is expected to standardize CTA radiology reports with respect to diagnostic and prognostic CT imaging findings to guide and harmonize management decisions, ultimately improving outcomes of care for PE patients. This article has been co-published with permission in the European Heart Journal – Cardiovascular Imaging and Radiology. All rights reserved. © The European Society of Cardiology and the Fleischner Society 2025. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Either citation can be used when citing this article. Supplemental material is available for this article. Keywords: Pulmonary embolism • Computed tomography • Reference standards • Outcome • Prognosis • Diagnosis

Objectives To evaluate the prevalence of intra-myocardial fatty scars (IMFS) most likely indicating previous silent myocardial infarction (SMI), as detected on coronary artery calcium (CAC) computed tomography (CT) scans in diabetic patients without history of coronary heart disease (CHD). Methods Diabetic patients screened for silent coronary insufficiency in a tertiary-care, university hospital between Jan-2015 and Dec-2016 were categorized according to their CAC score in two groups comprising 242 patients with CACS = 0 and 145 patients with CACS ≥ 300. CAC-CT scans were retrospectively evaluated for subendorcardial and transmural IMFS of the left ventricle. Adipose remodeling, patients’ characteristics, cardiovascular risk factors and metabolic profile were compared between groups. Results Eighty-three (21%) patients with IMFS were identified, 55 (37.9%) in the group CACS ≥ 300 and 28 (11.6%) in the CACS = 0 (OR = 4.67; 95% CI = 2.78–7.84; p < 0.001). Total and average surface of IMFS and their number per patient were similar in both groups ( p = 0.55; p = 0.29; p = 0.61, respectively). In the group CACS ≥ 300, patients with IMFS were older ( p = 0.03) and had longer-lasting diabetes ( p = 0.04). Patients with IMFS were older and had longer history of diabetes, reduced glomerular filtration rate, more coronary calcifications (all p < 0.05), and higher prevalence of carotid plaques (OR = 3.03; 95% CI = 1.43–6.39, p = 0.004). After correction for other variables, only a CACS ≥ 300 (OR = 5.12; 95% CI = 2.66–9.85; p < 0.001) was associated with an increased risk of having IMFS. Conclusions In diabetic patients without known CHD, IMFSs were found in patients without coronary calcifications, although not as frequently as in patients with heavily calcified coronary arteries. It remains to be established if this marker translates in an upwards cardiovascular risk restratification especially in diabetic patients with CACS = 0. Clinical relevance statement In diabetic patients without history of coronary heart disease, intramyocardial fatty scars, presumably of post-infarction origin, can be detected on coronary artery calcium CT scans more frequently, but not exclusively, if the coronary arteries are heavily calcified as compared to those without calcifications. Key Points • Intramyocardial fatty scars (IMFS), presumably of post-infarction origin, can be detected on coronary artery calcium (CAC) CT scans more frequently, but not exclusively, in diabetic patients with CACS ≥ 300 as compared to patients CACS = 0. • Patients with IMFS were older and had longer history of diabetes, reduced glomerular filtration rate, and more coronary calcifications. • Carotid plaques and CACS ≥ 300 were associated with an increased risk of having IMFS, about three and five folds respectively.

Pulmonary embolism (PE) remains a significant cause of mortality requiring prompt diagnosis and risk stratification. This review focuses on the role of computed tomography (CT) in the risk stratification of acute PE, highlighting its impact on patient management. We will explore basic pathophysiology of pulmonary embolism (PE) and review current guidelines, which will help radiologists interpret images within a broader clinical context. This review covers key CT findings which can be used for risk stratification including indicators of right ventricular (RV) dysfunction, clot burden, clot location and left atrial volume. We will discuss the measurement of RV/LV diameter ratio as a key indicator of RV dysfunction and its limitations and challenges within various patient populations. While these parameters should be included in a radiologist's report, their predictive value for mortality depends on the patient's existing cardiopulmonary reserve and should not be interpreted in isolation.

Rationale and ObjectivesTo determine the recent impact of illicit substance use on imaging utilization and associated costs.MethodsRetrospective study from an inner city urban multi-site academic medical center. Institutional Review Board (IRB) approval was obtained with a waiver of informed consent. A substance use cohort comprised patients 12 years old presenting to the Emergency Department (ED) January 2017 to June 2019 with a positive urine toxicology and an ICD code associated with substance use. The comparison cohort was randomly selected from a group of ED patients who presented with no or negative urine toxicology and no documented substance use ICD code. Data extracted from the EMR included demographics, number and type of imaging studies, Charlson comorbidity index, and in-hospital mortality during the study period.ResultsThe substance use and comparison cohorts comprised 3191 and 3200 patients, respectively. The substance use cohort was older on average (mean age 45.67 ± 14.88 vs 43.91 ± 20.57 years), more often male (63% [2026/3191] vs. 39% [1255/3200]) and had a mean Charlson score 88% higher than the comparison cohort (3.33 vs 1.78). The majority of both cohorts were ethnic minorities (<10% white). The substance use cohort had significantly more imaging vs the comparison cohort, total 36,413 (mean 11.41 exams/patient) vs total 12,399 (mean 3.87 exams/patient), p < 0.0001, and was higher for all modalities except mammography. Average imaging costs per patient were nearly 300% higher for the substance use vs comparison cohort, ($1287.18 vs. $434.70).ConclusionImaging utilization and associated costs were substantially higher for patients with a positive urine toxicology and substance use related ICD codes compared to the broader ED population in an underserved urban population.

Cardiac tumors, although rare, carry high morbidity and mortality rates. They are commonly first identified either at echocardiography or incidentally at thoracoabdominal CT performed for noncardiac indications. Multimodality imaging often helps to determine the cause of these masses. Cardiac tumors comprise a distinct category in the World Health Organization (WHO) classification of tumors. The updated 2021 WHO classification of tumors of the heart incorporates new entities and reclassifies others. In the new classification system, papillary fibroelastoma is recognized as the most common primary cardiac neoplasm. Pseudotumors including thrombi and anatomic variants (eg, crista terminalis, accessory papillary muscles, or coumadin ridge) are the most common intracardiac masses identified at imaging. Cardiac metastases are substantially more common than primary cardiac tumors. Although echocardiography is usually the first examination, cardiac MRI is the modality of choice for the identification and characterization of cardiac masses. Cardiac CT serves as an alternative in patients who cannot tolerate MRI. PET performed with CT or MRI enables metabolic characterization of malignant cardiac masses. Imaging individualized to a particular tumor type and location is crucial for treatment planning. Tumor terminology changes as our understanding of tumor biology and behavior evolves. Familiarity with the updated classification system is important as a guide to radiologic investigation and medical or surgical management. ©RSNA, 2024 Supplemental material is available for this article.

Imaging-based screening is an important public health focus and a fundamental part of Diagnostic Radiology. Hence, radiologists should be familiar with the concepts that drive imaging-based screening practice including goals, risks, biases and clinical trials. This review article discusses an array of imaging-based screening exams including the key epidemiology and evidence that drive screening guidelines for abdominal aortic aneurysm, breast cancer, carotid artery disease, colorectal cancer, coronary artery disease, lung cancer, osteoporosis, and thyroid cancer. We will provide an overview on societal interests in screening, screening-related inequities, and opportunities to address them. Emerging evidence for opportunistic screening and the role of AI in imaging-based screening will be explored. In-depth knowledge and formalized training in imaging-based screening strengthens radiologists as clinician scientists and has the potential to broaden our public health leadership opportunities. Summary sentence An overview of key screening concepts, the evidence that drives today's imaging-based screening practices, and the need for radiologist leadership in screening policies and evidence development.

Survival following lung transplant is low. With limited donor lung availability, predicting post-transplant survival is key. We investigated the predictive value of pre-transplant CT biomarkers on survival. In this single-center retrospective cohort study of adults in a diverse, underserved, urban lung transplant program (11/8/2017–5/20/2022), chest CTs were analyzed using TeraRecon to assess musculature, fat, and bone. Erector spinae and pectoralis muscle area and attenuation were analyzed. Sarcopenia thresholds were 34.3 (women) and 38.5 (men) Hounsfield Units (HU). Visceral and subcutaneous fat area and HU, and vertebral body HU were measured. Demographics and pre-transplant metrics were recorded. Survival analyses included Kaplan–Meier and Cox proportional hazard. The study cohort comprised 131 patients, 50 women, mean age 60.82 (SD 10.15) years, and mean follow-up 1.78 (SD 1.23) years. Twenty-nine percent were White. Mortality was 32.1

To compare residential geography, sex, socioeconomic status (SES), and race/ethnicity of patients screened at Montefiore’s Lung Cancer Screening Program with those of patients diagnosed with lung cancer, assessing whether screening efforts are appropriately focused. This retrospective cohort study involved patients within a multisite urban medical center undergoing lung cancer screening or diagnosed with lung cancer from January 1, 2015 to December 31, 2019. Inclusion criteria were residence within the Bronx, NY and age between 55 and 80 years. Institutional review board approval was obtained. Data were analyzed using the Wilcoxon two-sample t test and χ2. The cohorts comprised 1568 (50.3%) women and 1551 (49.7%) men (mean age 65.6 ± 6.16). The Southeast Bronx had the most diagnosed lung cancers (29.96%) and screenings (31.22%). Sex did not significantly differ (p = 0.053). Cancer and screening cohorts were from impoverished neighborhoods with mean SES of − 3.11 ± 2.78 and − 3.44 ± 2.80 (p < 0.01). The lower tier SES neighborhoods demonstrated more patients in the screening cohort than cancer cohort (p = 0.01). Both cohorts included a majority of Hispanic patients, although race/ethnicity differed significantly (p = 0.01). Lower SES neighborhoods showed no significant difference in race/ethnicity between cancer and screening cohorts (p = 0.262). Though statistically significant differences were found between cohorts, likely due to sample size, few clinically meaningful differences were found, implying our lung cancer screening program was effective in reaching the desired population. Demographics-based programs should be considered in global efforts to screen vulnerable populations.

Rationale and objectives: The COVID-19 pandemic led to the national shutdown and subsequent reopening of cancer screening programs. Our diverse inner-city lung cancer screening program serves patients in the Bronx NY, which was severely affected by COVID-19, with the highest mortality in New York State in the spring of 2020. Staffing redeployment, quarantine protocols, increased safety measures, and changes in follow up resulted. The purpose of this study is to analyze the effect of the pandemic on lung cancer screening volumes during the first year of the pandemic. Methods and materials:Retrospective cohort comprised of all patients enrolled in our Bronx, NY lung cancer screening program from March 2019 to March 2021 who underwent LDCT or appropriate follow-up imaging. The pre-pandemic and pandemic period were defined as 3/28/2019 to 3/21/2020 and 3/22/2020 to 3/17/2021, respectively, dichotomized by the New York State lockdown.Results: 1218 exams were performed in the pre-pandemic period and 857 in the pandemic period, a 29.6% decrease. The percentage of exams performed on newly enrolled patients decreased from 32.7% to 13.8% (p < 0.001). Patients in the pre-pandemic period and pandemic period respectively had the following demographic breakdown: mean age 66.9 +/- 5.9 vs 66.5 +/- 6.0, women 51.9% vs 51.6%, White 20.7% vs 20.3%, Hispanic/ Latino 42.0% vs 36.3%. There was no significant difference in Lung-RADS scores for pre-pandemic and pandemic exams (p > 0.05). In the pandemic period, exam volume followed an inverted parabolic pattern, reflecting Covid surges for the cohort and all demographic subgroups. Conclusion: The COVID-19 pandemic significantly decreased lung cancer screening volume and new enrollment in our urban inner-city program. Screening volumes demonstrated a parabolic curve reflecting pandemic surges following the initial wave, unlike other reports. The combination of the impact of COVID on our population and lack of staffing redundancy in the screening program, in the face of typical COVID isolation and quarantine absences, impeded early pandemic rebound of our lung cancer screening program. This highlights the necessity of fostering resilience by developing robust programmatic resources.

In the 3rd year of the SARS-CoV-2 pandemic, much has been learned about the long-term effects of COVID-19 pneumonia on the lungs. Approximately one-third of patients with moderate-to-severe pneumonia, especially those requiring intensive care therapy or mechanical ventilation, have residual abnormalities at chest CT 1 year after presentation. Abnormalities range from parenchymal bands to bronchial dilation to frank fibrosis. Less is known about the long-term pulmonary vascular sequelae, but there appears to be a persistent, increased risk of venothromboembolic events in a small cohort of patients. Finally, the associated histologic abnormalities resulting from SARS-CoV-2 infection are similar to those seen in patients with other causes of acute lung injury.

Objective: To determine lung cancer screening eligibility, knowledge, and interest and to quantify the effect of the expanded 2021 lung cancer screening eligibility criteria among women presenting for screening mammography, a group with demonstrable interest in cancer screening. Methods: A single-page survey was distributed to patients presenting for screening mammography, from January–March 2020 and June 2020–January 2021, at 2 academic medical centers on the East and West Coasts. The population served by the East Coast institution has greater poverty, greater ethnic/racial diversity, and lower education levels. Survey questions included age, smoking history, lung cancer screening knowledge, participation, and interest. Lung cancer screening eligibility was determined for both 2013 and 2021 USPSTF guidelines. Descriptive statistics were calculated, and data were compared between groups using the Chi-square test, Mann-Whitney nonparametric test, and the 2-sample t test. Results: 5512 surveys were completed; 33% (1824) of women reported a history of smoking—30% (1656) former smokers and 3% (156) current smokers. Among women with a smoking history, 7% (127/1824) were eligible for lung cancer screening using 2013% and 11% (207/1824) using the 2021 USPSTF criteria. Interest in lung cancer screening was high (73%; 151/207) among eligible women using 2021 USPSTF criteria, but only 42% (87/207) had heard of lung cancer screening and only 28% (57/207) had received prior LDCT screening. Conclusion: Eligible screening mammography patients reported high levels of interest in lung cancer screening but low levels of knowledge and participation. Linking mammography and LDCT appointments may improve lung cancer screening participation.

The purpose of this study was to evaluate a pulmonary embolism (PE) perfusion-only screening (POS) protocol introduced during the coronavirus disease 2019 (COVID-19) pandemic surge. Subjects without dense parenchymal lung opacities were studied; those with less than 1 segmental perfusion defect were considered to have no PE, whereas those exhibiting 1 or more defects were indeterminate, mandating additional examinations to determine the final diagnosis. Methods: We analyzed demographic information, clinical data, imaging findings, and follow-up data from the electronic records of COVID-19 patients who underwent lung scintigraphy during the 60-d study period. Results: In total, 53 studies were performed on 17 COVID-19-positive and 36 COVID-19-negative patients. The POS protocol efficiently excluded PE in 79% of cases; the remaining 21%, indeterminate for PE, were generally referred for alternative testing or were directly anticoagulated. In patients with negative POS results, there was a very low mortality before hospital discharge (1/42) and normal results on follow-up studies (6/6). Conclusion: The POS protocol, implemented during the COVID-19 surge, efficiently and safely excluded PE in 79% of patients.

PURPOSE:To evaluate the chest radiographic severity score (CXR-SS) for coronavirus disease 2019 (COVID-19) patients who are kidney transplant recipients compared with patients on the waitlist. STUDY DESIGN AND METHODS:This retrospective cohort includes 78 kidney transplant recipients (50 men, mean age 59.9±11.9 y) and 59 kidney transplant waitlist patients (33 men, mean age 58.8±10.8 y) diagnosed with COVID-19 between March 15 and May 30, 2020 with reverse transcriptase-polymerase chain reaction. Patient chest radiographs were divided into 6 zones and examined for consolidation. Primary outcome was mortality. Secondary outcomes included hospital admission, intensive care unit (ICU) admission, and intubation. Predictors of our primary and secondary outcomes were identified by bivariate analysis and multivariate regression analysis. RESULTS:No significant difference was found in CXR-SS between 2 groups (P=0.087). Transplant recipients had significantly higher rates of hospitalization (odds ratio, 6.8; 95% confidence interval: 1.7, 39.3; P<0.001), ICU admission (odds ratio, 6.5; 95% confidence interval [CI]: 1.8-35.9; P=0.002), intubation (odds ratio, 11; 95% CI: 2.4-96.9; P=0.001), and mortality (odds ratio, 17; 95% CI: 3.9-153.1; P<0.001). A higher CXR-SS was not predictive of mortality, intubation, or ICU admission. CXR-SS was associated with hospital admission overall (odds ratio, 1.613; 95% CI: 1.04-2.49; P=0.0314). CONCLUSION:The CXR-SS was not predictive of mortality, ICU admission or intubation in our population. Kidney transplant patients with COVID-19 had near universal hospital admission, more than one-third mortality and about a quarter were intubated and admitted to the ICU-all significantly worse outcomes than for patients on the transplant waitlist.

Prone position is known to improve acute lung injury, and chest radiographs are often necessary to monitor disease and confirm support device placement. However, there is a paucity of literature regarding radiographs obtained in this position. We evaluated prone radiographs for distinguishing features and ability to identify support devices. Pairs of prone and supine radiographs obtained during the COVID-19 pandemic were assessed retrospectively. IRB approval and waiver of informed consent were obtained. Radiographs were assessed for imaging adequacy, distinguishing features, and support device identification (endotracheal tube, enteric tube, or central line). Radiographs were reviewed by ≥ 2 cardiothoracic radiologists. Radiographs from 81 patients (63yo ± 13, 30% women) were reviewed. Prone and supine radiographs were comparable for imaging the lung bases (81% vs. 90%, p = 0.35) and apices (93% vs. 94%, p = 1); prone radiographs more frequently had significant rotation (36% vs. 19%, p = 0.021). To identify prone technique, scapula tip located beyond the rib border was 89% sensitive (95%CI 80–95%) and 85% specific (76–92%), and a fundal stomach bubble was 44% sensitive (33–56%) and 90% specific (81–96%). For women, displaced breast shadow was 46% sensitive (26–67%) and 92% specific (73–99%). Prone and supine radiographs each identified > 99% of support devices. Prone exams trended toward increased rate of malpositioned device (12% vs. 6%, p = 0.07). Scapula position reliably distinguishes prone from supine position; fundal stomach bubble or displaced breast shadow is specific for prone position. Prone radiographs reliably identify line and tube position, which is particularly important as prone patients appear at increased risk for malpositioned devices.

Virtual non-contrast (VNC) coronary artery calcium scoring (CAC) may obviate the need for traditional non-contrast (TNC) CAC. There is no data on the influence of body mass index (BMI) on VNC reliability. We aimed to evaluate the influence of BMI on VNC CAC agreement with TNC. All patients who underwent sequential CAC and coronary CT angiography (CCTA) using spectral CT with TNC CAC > 0 between August 2020 and December 2021 were included. Agatston CAC scores were calculated manually by 2 blinded readers from VNC scans. A correction factor was calculated from the slope of the linear regression using the method of least squares and applied to the VNC scores. Bland-Altman plots and Cohen’s weighted Kappa were utilized. We included 174 patients (57.5

ObjectiveThis study investigated the use of routine contrast-enhanced chest computed tomography (CT) to diagnose unsuspected pulmonary embolism (PE).MethodsAll adult routine contrast-enhanced chest CTs performed at Montefiore in 2018 were included. Pulmonary artery enhancement was measured by placing regions of interest in the pulmonary vasculature. Adequate enhancement was defined as 200 Hounsfield units (HU) or greater. Presence or absence of PE was noted. Descriptive statistics and logistic regression analysis were performed.ResultsA total of 3164 CTs were evaluated (55.8% women; mean age, 63.2 years). Main pulmonary enhancement was highly correlated with peripheral enhancement. Of all cases, 28.7% (907 of 3164) reached the 200 HU threshold. Greater enhancement was associated with female sex, older age, outpatients, and contrast amount administered. Pulmonary embolism-positive cases comprised 1.8% (58 of 3164) of total cases. Furthermore, 39.7% (23 of 58) of PE-positive cases reached the 200 HU threshold.ConclusionsOver one quarter of routine contrast-enhanced chest CT scans met the 200 HU threshold indicative of adequate pulmonary artery enhancement, including nearly half of the 2% of examinations positive for PE.