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Appropriateness Criteria

Variant 1: Chronic chest pain, noncardiac etiology unlikely: low to intermediate probability of coronary artery disease. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US echocardiography transthoracic stress Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 1 0 4 5 2
References Study Quality
51 (15215802) 2
52 (17222734) Good
53 (25896850) 3
MRI heart with function and vasodilator stress perfusion without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 2 5 4 1
References Study Quality
55 (12403662) 3
56 (15289384) 2
58 (22196944) 3
59 (16580532) 3
60 (22084203) 1
57 (23578348) 4
CTA coronary arteries with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 0 0 0 4 8
References Study Quality
39 (26330417) 1
18 (26892420) 4
19 (27043808) 4
10 (25984459) 4
11 (26782999) 4
13 (26112200) 4
14 (23684682) 3
15 (27081014) 3
21 (25714275) 4
22 (22830462) 1
27 (21565735) 2
31 (27318587) 4
33 (22032711) 2
34 (22922562) 1
36 (23934536) 4
37 (24110575) 3
25 (25773919) 1
12 (25844996) 4
23 (23517254) 2
30 (25125300) 2
35 (23562923) 4
26 (28389572) 2
40 (27470449) 2
24 (25788230) 1
28 (25473041) 1
32 (27502292) 3
16 (28973101) Good
29 (23727215) 3
38 (28444153) 3
20 (26746631) 1
17 (28329294) 2
SPECT or SPECT/CT MPI stress only Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 1 0 2 3 6 1 0
References Study Quality
41 (11397352) 3
25 (25773919) 1
44 (24026478) 3
42 (25745089) 2
43 (26052677) 2
Rb-82 PET/CT heart Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
66 (16949498) 2
67 (20541718) 4
Rb-82 PET/CT heart Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 0 0 0 1 1 0 11 1 1
References Study Quality
66 (16949498) 2
67 (20541718) 4
SPECT or SPECT/CT MPI rest and stress Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
41 (11397352) 3
25 (25773919) 1
44 (24026478) 3
42 (25745089) 2
43 (26052677) 2
SPECT or SPECT/CT MPI rest and stress Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 0 0 0 0 0 2 5 3 3
References Study Quality
41 (11397352) 3
25 (25773919) 1
44 (24026478) 3
42 (25745089) 2
43 (26052677) 2
US echocardiography transthoracic resting May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 4 7 3 0 0
References Study Quality
54 (26455270) 4
MRA coronary arteries without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 0 3 5 5 2 0 0 0
References Study Quality
62 (11471654) 1
63 (15931354) 4
61 (11756576) 1
MRI heart function and morphology without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 3 3 5 3 1 0 0
References Study Quality
55 (12403662) 3
56 (15289384) 2
58 (22196944) 3
59 (16580532) 3
60 (22084203) 1
57 (23578348) 4
MRI heart with function and inotropic stress without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 4 4 1 4 0
References Study Quality
55 (12403662) 3
56 (15289384) 2
58 (22196944) 3
59 (16580532) 3
60 (22084203) 1
57 (23578348) 4
MRI heart with function and inotropic stress without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 4 3 2 2 0
References Study Quality
55 (12403662) 3
56 (15289384) 2
58 (22196944) 3
59 (16580532) 3
60 (22084203) 1
57 (23578348) 4
CT chest with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 1 0 7 3 3 1 0 0
CT coronary calcium May be appropriate Limited ☢☢☢ 1-10 mSv 5 5 1 0 0 0 9 4 1 0 0
References Study Quality
45 (22825529) 4
46 (23733236) 3
47 (22919038) 4
48 (22461571) 2
49 (23370817) 3
50 (21067988) 4
Arteriography coronary Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 1 1 11 1 0 1 0 0 0
References Study Quality
64 (24139951) 2
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 2 7 2 0 1 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 2 1 3 1 0 0 0
SPECT or SPECT/CT MPI rest only Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 2 1 10 2 0 0 0 0 0
References Study Quality
41 (11397352) 3
25 (25773919) 1
44 (24026478) 3
42 (25745089) 2
43 (26052677) 2
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.