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Appropriateness Criteria

Variant 1: Acute chest pain; suspected acute aortic syndrome.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US echocardiography transesophageal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 0 12 4 1
References Study Quality
47 (24030294) 3
40 (1735142) 3
43 (1934402) 3
45 (1555267) 3
46 (10593804) 4
44 (8772749) 3
Radiography chest Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 7 7 0 0 1 0 2 1 6 2 6
References Study Quality
41 (5848976) 4
10 (10589336) 4
42 (24055476) 3
MRA chest abdomen pelvis without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 1 14 2 0
MRA chest without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 1 0 0 1 1 3 9 2 1
References Study Quality
24 (7824707) 2
26 (8668776) 2
39 (8416269) 4
40 (1735142) 3
25 (8416265) 1
38 (9395943) 3
35 (16831999) M
CT chest with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 2 0 4 3 5 3 1
CT chest without and with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 5 1 3 3 5
References Study Quality
17 (25415694) 2
CTA chest with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 1 1 2 14
References Study Quality
27 (28360261) 3
17 (25415694) 2
21 (12008187) 3
24 (7824707) 2
26 (8668776) 2
22 (12819341) 2
23 (1934367) 3
25 (8416265) 1
32 (18790585) 4
33 (19703877) 4
30 (15115998) 3
CTA chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 0 0 1 1 7 3 6
References Study Quality
21 (12008187) 3
34 (12598026) 4
35 (16831999) M
US echocardiography transthoracic resting May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 10 3 3 0 0
References Study Quality
39 (8416269) 4
40 (1735142) 3
25 (8416265) 1
48 (2563839) 3
49 (20037148) 2
44 (8772749) 3
Aortography chest May be appropriate Limited ☢☢☢ 1-10 mSv 5 5 1 0 4 3 7 2 0 1 0
References Study Quality
3 (12900496) 4
14 (1621436) 4
13 (8074043) 3
1 (26205591) 3
MRA chest abdomen pelvis without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 4 9 4 0 0 0
MRA chest without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 6 9 0 0 0
References Study Quality
37 (11930077) 3
36 (20013276) 3
MRI chest abdomen pelvis without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 0 5 3 7 2 0 0 0 0
CT chest without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 1 7 3 3 2 1 0 0
References Study Quality
15 (23521452) 2
16 (24939821) 2
CTA coronary arteries with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 8 4 2 2 1
MRI chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 0 4 5 2 4 1 1 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.