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Appropriateness Criteria

Variant 1: Suspected cardiac injury following blunt trauma, hemodynamically stable patient.
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 0 0 0 0 3 10 9
References Study Quality
11 (26857839) 4
10 (23102031) 4
53 (15674170) 4
58 (24043608) 4
42 (24843237) 4
56 (29691906) 4
57 (29226380) 4
55 (28703435) 4
7 (29173678) 4
32 (22582351) 4
52 (7617506) 4
54 (2989545) 4
59 (10421603) 3
Radiography chest Usually appropriate Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 0 1 3 2 16
References Study Quality
72 (23925583) 2
23 (19820586) 4
60 (17099521) 3
68 (18492911) 3
67 (8505524) 4
71 (11450784) 3
70 (2258953) 3
73 (17045268) 3
66 (16374282) 3
69 (16494179) 3
61 (29079373) 4
62 (26395222) 4
63 (24530038) 4
26 (24218497) 4
64 (21997988) 4
65 (-3149759) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 3 12 7
References Study Quality
21 (26882960) 4
24 (24522690) 3
23 (19820586) 4
22 (18936021) 4
68 (18492911) 3
43 (11740271) 3
28 (28390914) 4
61 (29079373) 4
20 (28499862) 4
62 (26395222) 4
26 (24218497) 4
29 (23861498) 4
7 (29173678) 4
27 (28255632) 4
32 (22582351) 4
30 (18025505) 4
33 (11419177) 4
31 (16096553) 4
34 (20971301) 4
CT chest without and with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 0 15 5 1
References Study Quality
21 (26882960) 4
24 (24522690) 3
23 (19820586) 4
22 (18936021) 4
68 (18492911) 3
43 (11740271) 3
28 (28390914) 4
61 (29079373) 4
20 (28499862) 4
62 (26395222) 4
26 (24218497) 4
29 (23861498) 4
7 (29173678) 4
27 (28255632) 4
32 (22582351) 4
30 (18025505) 4
33 (11419177) 4
31 (16096553) 4
34 (20971301) 4
CTA chest with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 1 9 6 5
CTA chest without and with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv 7 7 0 0 0 0 1 7 5 6 2
US echocardiography transesophageal May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 5 1 8 6 0 0 0
References Study Quality
50 (8295249) 2
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 0 0 0 8 8 4 1 0
References Study Quality
21 (26882960) 4
24 (24522690) 3
23 (19820586) 4
22 (18936021) 4
68 (18492911) 3
43 (11740271) 3
28 (28390914) 4
61 (29079373) 4
20 (28499862) 4
62 (26395222) 4
26 (24218497) 4
29 (23861498) 4
7 (29173678) 4
27 (28255632) 4
32 (22582351) 4
30 (18025505) 4
33 (11419177) 4
31 (16096553) 4
34 (20971301) 4
CT heart function and morphology with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 0 3 8 8 1 1 0 0
US echocardiography transthoracic stress Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 7 5 0 1 0 0 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 9 2 2 0 0 0 1
MRI heart function and morphology without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 11 4 1 1 0 1 0 0
MRI heart with function and inotropic stress without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 1 1 0 0 0 0 0 0
MRI heart with function and inotropic stress without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 21 0 1 0 0 0 0 0 0
MRI heart with function and vasodilator stress perfusion without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 21 0 1 0 0 0 0 0 0
CTA coronary arteries with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 2 8 5 4 0 0 1 0
SPECT or SPECT/CT MPI rest only Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 20 1 0 1 0 0 0 0 0
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 18 2 2 0 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 19 1 2 0 0 0 0 0 0
Variant 2: Suspected cardiac injury following blunt trauma, hemodynamically unstable patient.
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] 9 9 0 0 0 0 0 0 1 5 16
References Study Quality
50 (8295249) 2
7 (29173678) 4
Radiography chest Usually appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 1 0 1 0 0 1 2 0 17
CT chest with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 0 12 4 4
CT chest without and with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 1 15 2 2
CTA chest with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 0 8 10 2
CTA chest without and with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv 7 7 0 0 0 0 1 2 8 8 2
CT heart function and morphology with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 1 0 1 4 0 12 1 1
References Study Quality
21 (26882960) 4
40 (21234635) 4
37 (8639191) Inadequate
41 (28761404) 4
6 (26374420) 4
35 (29350374) 4
39 (24585276) 4
38 (24444069) 4
36 (23622508) 4
US echocardiography transesophageal May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 5 9 3 1 0
References Study Quality
50 (8295249) 2
7 (29173678) 4
CT chest without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 1 6 1 9 2 0 0 0
CTA coronary arteries with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 0 0 1 9 8 0 1 0
References Study Quality
21 (26882960) 4
40 (21234635) 4
43 (11740271) 3
46 (16041562) 4
42 (24843237) 4
39 (24585276) 4
45 (23809387) 4
36 (23622508) 4
44 (23599204) 4
7 (29173678) 4
US echocardiography transthoracic stress Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 11 2 8 0 0 1 0 0 0
References Study Quality
41 (28761404) 4
MRI heart function and morphology without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 4 4 2 6 0 0 0 0
References Study Quality
46 (16041562) 4
48 (15845942) 4
41 (28761404) 4
MRI heart function and morphology without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 2 7 1 5 0 0 0 0
References Study Quality
46 (16041562) 4
48 (15845942) 4
41 (28761404) 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] 1 1 14 4 4 0 0 0 0 0 0
MRI heart with function and inotropic stress without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 4 4 0 0 0 0 0 0
MRI heart with function and vasodilator stress perfusion without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 4 5 0 0 0 0 0 0
SPECT or SPECT/CT MPI rest only Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 4 3 0 0 0 2 0 0
FDG-PET/CT heart Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 5 0 0 0 0 0 0
References Study Quality
47 (16498043) 4
37 (8639191) Inadequate
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 17 1 4 0 0 0 0 0 0
References Study Quality
37 (8639191) Inadequate
49 (2293955) 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.