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Appropriateness Criteria

Variant 1: Suspected pulmonary hypertension. 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 1 1 0 0 4 9
References Study Quality
1 (19324955) 4
11 (15249493) 4
24 (26320113) 4
10 (22267542) 4
28 (23496202) 2
25 (32628737) 2
22 (31109891) 4
51 (30963276) 2
31 (28668978) 2
29 (28655466) 2
26 (28488784) 2
27 (31904543) 2
23 (31871259) Good
30 (19389575) 4
Radiography chest Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 1 0 0 1 0 0 3 10
References Study Quality
15 (1149525) 4
11 (15249493) 4
14 (7103259) 4
16 (7216709) 4
17 (8972316) 4
18 (5418015) 4
19 (3872021) 3
13 (6705299) 3
20 (24393659) 2
10 (22267542) 4
21 (22623544) 4
CT chest with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 2 2 8 1 2
References Study Quality
39 (9596302) 4
40 (17573485) 4
45 (15703314) 4
24 (26320113) 4
48 (17495297) 4
47 (23168063) 4
41 (21447184) 3
21 (22623544) 4
50 (-3100301) 4
49 (30392598) 4
44 (31351047) 2
42 (29254655) 2
46 (29432063) 4
43 (32241822) 4
CTA chest with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 1 4 3 3 2
References Study Quality
36 (17475953) 4
39 (9596302) 4
45 (15703314) 4
24 (26320113) 4
54 (23982287) 2
47 (23168063) 4
41 (21447184) 3
37 (22262242) 2
56 (21926854) 2
21 (22623544) 4
55 (29846802) 2
44 (31351047) 2
58 (32649425) 2
57 (30562223) 2
51 (30963276) 2
35 (29880507) 2
46 (29432063) 4
52 (29237020) 2
53 (28595696) 2
US echocardiography transesophageal May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 2 2 3 2 4 1 1 0 0
References Study Quality
24 (26320113) 4
32 (28826847) 2
MRI heart function and morphology without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 5 0 4 4 0 1 0
References Study Quality
66 (21947513) 3
62 (24509623) 4
64 (22720870) 3
73 (24790032) 4
63 (23474963) 4
70 (23863980) 3
21 (22623544) 4
72 (24974951) 3
74 (24625242) 3
75 (29435739) 2
61 (28376242) 1
59 (31424519) 1
71 (31270715) 2
76 (29934885) 2
69 (30501639) 2
60 (29966635) 4
68 (27121929) 1
65 (27719980) 4
67 (25496540) 2
MRI heart function and morphology without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 4 0 6 3 0 1 0
References Study Quality
66 (21947513) 3
62 (24509623) 4
64 (22720870) 3
73 (24790032) 4
63 (23474963) 4
70 (23863980) 3
21 (22623544) 4
72 (24974951) 3
74 (24625242) 3
75 (29435739) 2
61 (28376242) 1
59 (31424519) 1
71 (31270715) 2
76 (29934885) 2
69 (30501639) 2
60 (29966635) 4
68 (27121929) 1
65 (27719980) 4
67 (25496540) 2
V/Q scan lung May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 3 5 3 0 0 4 0 1 0
References Study Quality
36 (17475953) 4
24 (26320113) 4
10 (22267542) 4
37 (22262242) 2
34 (32531708) 2
33 (30620694) 4
35 (29880507) 2
38 (29055626) 2
Catheterization right heart Usually not appropriate Limited ☢☢ 0.1-1mSv 2 2 5 4 6 0 1 0 0 0 0
References Study Quality
79 (17534570) 4
81 (17174196) 4
24 (26320113) 4
78 (28722077) 4
80 (32088984) 4
Arteriography pulmonary with right heart catheterization Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 7 6 3 0 0 0 0 0 0
References Study Quality
82 (18462902) 3
24 (26320113) 4
83 (28060193) 4
MRA chest without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 2 4 4 3 3 0 0 0 0
References Study Quality
66 (21947513) 3
63 (23474963) 4
75 (29435739) 2
61 (28376242) 1
77 (29147768) 2
65 (27719980) 4
MRA chest without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 2 2 5 1 4 0 1 0 0
References Study Quality
66 (21947513) 3
63 (23474963) 4
75 (29435739) 2
61 (28376242) 1
77 (29147768) 2
65 (27719980) 4
CT chest without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 9 2 0 0 0 0 0 0
References Study Quality
39 (9596302) 4
40 (17573485) 4
45 (15703314) 4
24 (26320113) 4
48 (17495297) 4
47 (23168063) 4
41 (21447184) 3
21 (22623544) 4
50 (-3100301) 4
49 (30392598) 4
44 (31351047) 2
42 (29254655) 2
46 (29432063) 4
43 (32241822) 4
CT chest without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 4 5 2 4 0 0 0 0
References Study Quality
39 (9596302) 4
40 (17573485) 4
45 (15703314) 4
24 (26320113) 4
48 (17495297) 4
47 (23168063) 4
41 (21447184) 3
21 (22623544) 4
50 (-3100301) 4
49 (30392598) 4
44 (31351047) 2
42 (29254655) 2
46 (29432063) 4
43 (32241822) 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.