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Appropriateness Criteria

Variant 1: Acute nonspecific chest pain; low 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
Radiography chest Usually appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 8 8 0 0 0 0 1 2 3 3 8
CTA coronary arteries with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 1 0 1 4 10 0
US echocardiography transthoracic resting May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 2 0 0 4 4 6 1 0
References Study Quality
22 (25378470) 4
Radiography ribs and thoracic spine May be appropriate Expert Consensus ☢☢ 0.1-1mSv 5 5 0 1 2 5 7 1 0 0 0
CT chest with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 1 10 4 0 0 0
CT chest without and with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 1 1 4 7 2 1 0 0
References Study Quality
38 (19486717) 4
20 (27819965) 4
CT chest without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 2 3 3 4 4 0 0 0 1
CTA chest with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 1 9 1 4 1 0
V/Q scan lung May be appropriate Expert Consensus ☢☢☢ 1-10 mSv 5 5 2 1 2 2 10 0 0 0 0
US echocardiography transesophageal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 5 1 3 1 0 1 0 0
References Study Quality
22 (25378470) 4
US echocardiography transthoracic stress Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 2 8 3 1 2 0 0 1 0
References Study Quality
15 (26910053) 4
23 (28378340) 3
22 (25378470) 4
24 (29909113) 3
Arteriography coronary Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 10 3 2 2 0 0 0 0 0
References Study Quality
44 (26112200) 4
Fluoroscopy barium swallow and upper GI series Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 6 4 1 1 3 1 1 0 0
MRA chest without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 7 6 0 0 0 0 0 0
References Study Quality
40 (27533160) 4
MRA chest without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 2 7 3 0 4 0 0 1 0
References Study Quality
40 (27533160) 4
MRA coronary arteries without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 6 5 1 1 0 0 0 0
MRA coronary arteries without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 8 3 0 1 0 0 0 0
MRI heart function and morphology without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 2 7 7 0 0 0 0 0 1
References Study Quality
42 (19389557) 4
41 (28005512) 4
43 (27899132) 4
MRI heart function and morphology without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 0 8 6 0 2 0 0 0 1
References Study Quality
41 (28005512) 4
MRI heart with function and inotropic stress without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 5 3 0 3 0 1 0 0
MRI heart with function and inotropic stress without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 5 2 0 3 0 1 0 0
References Study Quality
31 (25863305) Inadequate
MRI heart with function and vasodilator stress perfusion without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 6 2 0 2 0 0 0 1
References Study Quality
31 (25863305) Inadequate
Nuclear medicine scan gallbladder Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 2 2 6 3 1 4 2 0 0 1 0
CT heart function and morphology with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 4 9 1 1 0 0 0 0
References Study Quality
39 (28027742) 4
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
25 (28549119) 4
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 5 8 1 1 0 0 0 0
References Study Quality
25 (28549119) 4
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.