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Appropriateness Criteria

Variant 1: Adult. Suspected coronary artery anomaly. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA coronary arteries without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 0 14 3 1
References Study Quality
13 (18586979) 4
15 (19038677) 4
MRA coronary arteries without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 0 0 14 2 1
References Study Quality
16 (30655052) 1
17 (10096326) 4
CTA coronary arteries with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 1 0 3 13
References Study Quality
15 (19038677) 4
14 (18084017) 4
13 (18586979) 4
12 (31178934) 4
11 (23799727) 4
10 (23442943) 4
9 (25004927) 3
US echocardiography transthoracic resting May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 1 6 7 2 0 0 1
References Study Quality
18 (33421195) 2
19 (31981242) 3
Arteriography coronary May be appropriate Limited ☢☢☢ 1-10 mSv 6 6 0 0 0 4 5 3 6 0 0
References Study Quality
8 (2208265) 4
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 3 4 1 3 1 0 1 0
US echocardiography transthoracic stress Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 2 1 0 0 0 0 0
MRA chest with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 2 7 0 0 0 0 0 0
MRA chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 2 3 2 2 0 0 1 0
MRA chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 3 3 2 0 0 1 0 0
MRI heart function and morphology without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 3 8 2 0 0 0 0 0
MRI heart function and morphology without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 3 4 3 0 0 1 1 0
MRI heart function with stress without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 6 4 2 0 0 0 0 0
MRI heart function with stress without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 3 5 0 1 1 1 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 3 4 2 2 1 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 4 3 1 1 1 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 6 1 0 0 0 0 0 0
CT coronary calcium Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 3 3 7 1 6 0 3 0 0 0 0
CTA chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 7 4 2 0 0 0 0 0
CTA chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 6 6 6 0 0 0 0 0 0
CT heart function and morphology with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 3 8 3 0 1 0 0 0
Rb-82 PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 8 4 4 0 1 0 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 8 3 4 0 1 0 0 1 0
Variant 2: Adult. Pretreatment planning for known coronary artery anomaly. Initial Imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Arteriography coronary Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv 7 7 0 0 0 0 0 0 13 3 2
CTA coronary arteries with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 1 1 2 13
References Study Quality
21 (25304820) 3
US echocardiography transthoracic resting May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 3 5 4 3 2 1 0
US echocardiography transthoracic stress May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 6 8 1 1 0
MRA coronary arteries without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 3 9 4 0 0
MRA coronary arteries without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 7 8 2 0 0
MRI heart function and morphology without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 8 8 0 0 0
MRI heart function and morphology without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 7 8 0 0 0
MRI heart function with stress without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 5 2 7 0 0
References Study Quality
22 (36129514) 2
MRI heart function with stress without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 7 7 2 0 0
CTA chest with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 6 0 2 4 4 1 0 0 0
Rb-82 PET/CT heart May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 1 0 3 3 3 6 2 0 0
SPECT or SPECT/CT MPI rest and stress May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 0 0 1 3 4 6 3 1 0
References Study Quality
23 (27539240) 4
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 0 3 1 5 2 0 0 0
MRA chest with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 2 5 0 1 1 1 0 0
MRA chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 3 4 1 0 1 1 0 0
MRA chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 3 5 1 0 0 0 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 2 3 2 3 1 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 3 2 3 1 1 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 3 1 0 0 0 0 0
CT coronary calcium Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 8 1 4 0 3 1 0 0 0
CTA chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 3 3 6 0 3 4 2 2 0 0 0
CT heart function and morphology with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 10 0 2 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.