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Appropriateness Criteria

Variant 1: Adult. Suspected heart failure. No history of heart failure. 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 resting Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 3 10
References Study Quality
34 (28741909) 1
33 (26811160) Inadequate
32 (22874137) 2
31 (24863953) 4
30 (18992671) 4
29 (34284098) 3
28 (27037982) 4
27 (26559428) 4
26 (11263606) 3
22 (26910112) Good
1 (35363499) 4
Radiography chest Usually appropriate Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 1 1 0 1 2 2 7
References Study Quality
25 (22104551) 3
24 (30874784) Not Assessed
23 (22994440) 2
22 (26910112) Good
21 (20045607) 3
US echocardiography transthoracic stress May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 3 1 2 3 3 1 0 0 0
MRI heart function and morphology without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 1 3 3 5 0 0 0
References Study Quality
20 (28785465) 4
MRI heart function and morphology without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 4 4 4 0 0 0
References Study Quality
20 (28785465) 4
Nuclear medicine ventriculography May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 0 3 7 2 0 0 0 0
CT heart function and morphology with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 1 1 7 4 0 0 0 0
References Study Quality
19 (31400060) 4
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 0 5 2 0 0 0 0 0
Arteriography coronary Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 8 4 1 0 0 0 0 0 0
MRA coronary arteries without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 2 3 0 1 0 1 0 0
MRI heart function with stress without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 2 3 3 0 1 0 0 0
References Study Quality
20 (28785465) 4
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 3 3 3 1 0 1 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 3 3 2 1 0 1 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 3 3 2 1 0 1 0 0
CT coronary calcium Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 7 1 3 1 1 0 1 0 0
CTA coronary arteries with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 4 1 0 3 0 0 0 0
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 1 1 1 3 0 0 0 1
Rb-82 PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 7 5 0 1 0 0 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 8 3 1 1 0 0 0 0 0
Variant 2: Adult. Known heart failure. Unknown etiology. 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 resting Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 2 1 3 3 4
References Study Quality
64 (32558395) 2
US echocardiography transthoracic stress Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 1 11 1 0
References Study Quality
65 (28327159) 4
66 (22291430) 2
67 (21685198) 4
68 (30451399) 3
MRI heart function and morphology without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 2 7 4
References Study Quality
53 (31910649) 2
52 (29321034) 3
51 (34936084) 3
50 (21789747) 1
49 (21900085) 2
48 (19755468) 2
47 (26251006) 2
46 (30152581) 3
45 (33673946) 4
MRI heart function and morphology without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 5 2 5 0
References Study Quality
45 (33673946) 4
MRI heart function with stress without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 2 6 3 1
References Study Quality
54 (33472397) 2
CTA coronary arteries with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 0 0 1 0 1 5 5 1
References Study Quality
19 (31400060) 4
38 (25281557) 3
39 (23759285) 2
SPECT or SPECT/CT MPI rest and stress Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 0 0 0 0 3 3 5 3 0
References Study Quality
63 (27331209) 3
62 (24948152) 4
61 (34344513) 2
60 (30815834) 3
59 (19152132) 2
58 (15219501) 3
57 (9832104) 2
56 (23990345) 4
US echocardiography transesophageal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 4 6 2 0 1 0
Arteriography coronary May be appropriate Limited ☢☢☢ 1-10 mSv 5 5 0 0 0 1 6 4 1 1 0
References Study Quality
1 (35363499) 4
35 (22499335) 4
CT heart function and morphology with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 5 4 0 4 0 0
References Study Quality
41 (25727003) 4
40 (32548777) 4
19 (31400060) 4
FDG-PET/CT heart May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 4 5 4 0 0 0
References Study Quality
44 (32670472) 4
43 (33688455) 4
42 (35579526) Good
Rb-82 PET/CT heart May be appropriate Limited ☢☢☢☢ 10-30 mSv 5 5 0 0 0 6 5 2 0 0 0
References Study Quality
55 (30902043) 3
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 4 3 6 0 0 0 0 0 0
MRA coronary arteries without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 1 7 0 0 0 0 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 2 5 1 1 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 4 3 1 1 0 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 2 4 1 0 0 0 0 0
CT coronary calcium Usually not appropriate Strong ☢☢☢ 1-10 mSv 3 3 3 1 5 3 1 0 0 0 0
References Study Quality
38 (25281557) 3
37 (28041705) 4
39 (23759285) 2
36 (21257010) 2
Nuclear medicine ventriculography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 2 6 0 0 0 0 0 0
Variant 3: Adult. Known heart failure. Follow-up 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 resting Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 3 3 7
References Study Quality
89 (21788358) 2
88 (31074794) 2
87 (21029826) 1
86 (32004243) 3
85 (32563496) 3
84 (33533883) 3
83 (25783858) 3
82 (15808765) 3
81 (25355298) 4
27 (26559428) 4
US echocardiography transthoracic stress Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 5 4 1 2
References Study Quality
80 (31376903) 4
94 (30777323) 2
93 (26082167) 2
92 (17336751) 2
91 (19609896) 2
90 (16098295) 2
MRI heart function and morphology without and with IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 1 5 3 3
References Study Quality
75 (32312112) 3
74 (21911738) 2
73 (28017348) Good
72 (33221422) Good
MRI heart function and morphology without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 2 1 7 3 0
MRI heart function with stress without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 3 2 5 1 2
References Study Quality
78 (18634983) 3
77 (34419409) 2
76 (32771575) 3
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 1 0 4 7 0 1 0 0
References Study Quality
79 (6507238) 3
Nuclear medicine ventriculography May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 2 5 5 0 0 0
CT heart function and morphology with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 4 9 0 0 0 0
FDG-PET/CT heart May be appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 4 7 1 1 0 0
References Study Quality
71 (27609816) 2
70 (31233411) 4
69 (32771569) 3
Rb-82 PET/CT heart May be appropriate Limited ☢☢☢☢ 10-30 mSv 5 5 0 1 0 3 4 1 4 0 1
References Study Quality
80 (31376903) 4
SPECT or SPECT/CT MPI rest and stress May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 1 0 0 5 6 1 0 0 0
References Study Quality
80 (31376903) 4
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 2 4 2 4 1 0 0 0 0
Arteriography coronary Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 0 2 0 1 0 0 0 0
MRA coronary arteries without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 4 3 0 0 1 1 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 5 2 0 0 0 1 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 5 2 0 0 0 1 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 5 2 0 0 1 0 0 0
CT coronary calcium Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 8 3 1 0 0 1 1 0 0
CTA coronary arteries with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 6 0 0 1 0 0 0
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.