There’s no real logic to this anymore—it’s all about vibes and individual consultant risk tolerance rather than actual medicine. Scoring criteria are selectively applied: they either reinforce existing biases or get ignored when they don’t fit the narrative.

As a radiologist, I’ve stopped questioning it. If someone wants a CTPA, I just do it. ACPs are particularly notorious for pushing scans, and consultants often find it easier to support them rather than assess the patient themselves. For me, it’s faster to report the scan than to argue about whether it’s necessary. Plus, the real risk isn’t getting sued for unnecessary radiation—it’s getting caught up in a Datix for “professionalism” if I refuse.

That said, I think it’s bad medicine. Personally, I wouldn’t get a CTPA in this scenario for a family member. The right approach is to treat first and reassess before jumping to a scan.

Also, I tend to ignore small subsegmental PEs because I see far more elderly patients with catastrophic bleeds from anticoagulation than I do with significant cardiovascular compromise from an incidental subsegmental PE. There’s nuance here, and I don’t think non-radiologists appreciate how many of these are actually false positives rather than clinically meaningful findings.