American College of Radiology
ACR Appropriateness Criteria®

Chronic Dyspnea-Noncardiovascular Origin

Variant 1: Chronic dyspnea. Unclear etiology. 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 Limited 1 ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 0 0 0 0 13
References Study Quality
2 (15864893) 4
3 (22962929) 4
7 (21215608) 2
11 (2802893) 3
CT chest without IV contrast May be appropriate (Disagreement) Expert Opinion 2 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 2 3 3 2 2 0 0
References Study Quality
8 (1535900) 4
12 (8153310) 2
13 (25447621) 3
CT chest with IV contrast May be appropriate Limited 1 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 3 2 3 5 0 0 0 0
References Study Quality
8 (1535900) 4
12 (8153310) 2
13 (25447621) 3
CT chest without and with IV contrast Usually not appropriate Limited 1 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 1 0 2 0 0 0 0
References Study Quality
8 (1535900) 4
12 (8153310) 2
13 (25447621) 3
MRI chest without IV contrast Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 8 3 1 0 1 0 0 0 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 8 3 0 0 2 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus 1 ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 3 0 0 0 0 0 0 0
US chest Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 1 1 7 5 0 1 0 0 0 0 0
Variant 2: Chronic dyspnea. Suspected chronic obstructive pulmonary disease (COPD). 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 Limited 3 ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 0 0 1 1 11
References Study Quality
14 (11194777) 4
15 (19631518) 4
CT chest without IV contrast May be appropriate Strong 3 07 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 0 1 5 4 1 1 0
References Study Quality
16 (25961632) 4
17 (26098755) 2
18 (23220894) 2
19 (25442794) 3
20 (24710855) 3
21 (18351420) 3
22 (25474145) 3
23 (24703520) 3
24 (24334816) 2
25 (22514236) 3
26 (27776670) 3
27 (19938970) 3
28 (25844673) 3
29 (22016483) 2
30 (16537852) 3
CT chest with IV contrast May be appropriate Strong 3 07 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 2 3 5 2 1 0 0 0
References Study Quality
16 (25961632) 4
17 (26098755) 2
18 (23220894) 2
19 (25442794) 3
20 (24710855) 3
21 (18351420) 3
22 (25474145) 3
23 (24703520) 3
24 (24334816) 2
25 (22514236) 3
26 (27776670) 3
27 (19938970) 3
28 (25844673) 3
29 (22016483) 2
30 (16537852) 3
MRI chest without IV contrast Usually not appropriate Moderate 1 O 0 mSv O 0 mSv [ped] 2 2 6 2 1 1 3 0 0 0 0
References Study Quality
31 (26744928) 3
32 (21392914) 2
33 (25575114) 3
MRI chest without and with IV contrast Usually not appropriate Moderate 1 O 0 mSv O 0 mSv [ped] 2 2 6 1 3 0 3 0 0 0 0
References Study Quality
31 (26744928) 3
32 (21392914) 2
33 (25575114) 3
US chest Usually not appropriate Expert Consensus 1 O 0 mSv O 0 mSv [ped] 2 2 6 4 3 0 0 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Strong 3 07 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 1 1 0 0 0 1 0
References Study Quality
16 (25961632) 4
17 (26098755) 2
18 (23220894) 2
19 (25442794) 3
20 (24710855) 3
21 (18351420) 3
22 (25474145) 3
23 (24703520) 3
24 (24334816) 2
25 (22514236) 3
26 (27776670) 3
27 (19938970) 3
28 (25844673) 3
29 (22016483) 2
30 (16537852) 3
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus 1 ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 9 4 0 0 0 0 0 0 0
Variant 3: Chronic dyspnea. Suspected central airways 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 Limited 1 ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 0 0 1 4 8
References Study Quality
34 (24297576) 2
35 (22760718) 4
CT chest without IV contrast Usually appropriate Limited 3 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 1 1 4 5 1
References Study Quality
36 (26102379) 4
37 (17527116) 3
38 (17356090) 3
39 (24361144) 3
40 (17913426) 3
41 (20591697) 3
CT chest with IV contrast May be appropriate Limited 3 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 1 1 5 4 1 0 0
References Study Quality
36 (26102379) 4
37 (17527116) 3
38 (17356090) 3
39 (24361144) 3
40 (17913426) 3
41 (20591697) 3
MRI chest without IV contrast May be appropriate Strong 3 07 O 0 mSv O 0 mSv [ped] 4 4 1 3 0 5 3 1 0 0 0
References Study Quality
42 (23086288) 1
43 (28796542) 2
44 (28199136) 4
45 (16941092) 4
MRI chest without and with IV contrast May be appropriate Strong 3 07 O 0 mSv O 0 mSv [ped] 4 4 1 3 0 5 3 1 0 0 0
References Study Quality
42 (23086288) 1
43 (28796542) 2
44 (28199136) 4
45 (16941092) 4
CT chest without and with IV contrast Usually not appropriate Limited 3 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 2 2 0 0 0 0 0 0
References Study Quality
36 (26102379) 4
37 (17527116) 3
38 (17356090) 3
39 (24361144) 3
40 (17913426) 3
41 (20591697) 3
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus 1 ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 9 3 1 0 0 0 0 0 0
US chest Usually not appropriate Limited 1 O 0 mSv O 0 mSv [ped] 1 1 7 5 1 0 0 0 0 0 0
References Study Quality
46 (23966375) 2
Variant 4: Chronic dyspnea. Suspected interstitial lung disease. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT chest without IV contrast Usually appropriate Strong 3 07 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 3 1 2 7
References Study Quality
48 (24481766) 4
49 (19926869) 3
50 (2717730) 2
51 (15878493) 2
52 (3797650) 2
53 (1620845) 3
54 (25317858) 3
55 (18982210) 4
56 (18806139) 4
57 (26571061) 2
58 (15256390) 3
59 (18057059) 1
60 (23220902) 3
61 (21926853) 3
62 (20622689) 2
Radiography chest Usually appropriate Limited 3 ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 0 0 2 3 8
References Study Quality
47 (642974) 4
CT chest with IV contrast May be appropriate (Disagreement) Expert Opinion 2 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 1 0 3 3 3 1 0 0
References Study Quality
48 (24481766) 4
49 (19926869) 3
50 (2717730) 2
51 (15878493) 2
52 (3797650) 2
53 (1620845) 3
54 (25317858) 3
55 (18982210) 4
56 (18806139) 4
57 (26571061) 2
58 (15256390) 3
59 (18057059) 1
61 (21926853) 3
62 (20622689) 2
60 (23220902) 3
MRI chest without IV contrast Usually not appropriate Strong 3 07 O 0 mSv O 0 mSv [ped] 2 2 5 4 2 1 0 0 1 0 0
References Study Quality
63 (23523024) 2
64 (24355658) 2
65 (18356432) 2
66 (25871501) 2
MRI chest without and with IV contrast Usually not appropriate Strong 3 07 O 0 mSv O 0 mSv [ped] 2 2 5 5 1 1 0 0 1 0 0
References Study Quality
63 (23523024) 2
64 (24355658) 2
65 (18356432) 2
66 (25871501) 2
US chest Usually not appropriate Strong 1 04 O 0 mSv O 0 mSv [ped] 2 2 6 2 1 3 1 0 0 0 0
References Study Quality
72 (22589373) 2
73 (24791173) 3
74 (-3123437) 3
75 (26494471) 3
CT chest without and with IV contrast Usually not appropriate Strong 3 07 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 1 0 1 0 0 0 0
References Study Quality
48 (24481766) 4
49 (19926869) 3
50 (2717730) 2
51 (15878493) 2
52 (3797650) 2
53 (1620845) 3
54 (25317858) 3
55 (18982210) 4
56 (18806139) 4
57 (26571061) 2
58 (15256390) 3
59 (18057059) 1
60 (23220902) 3
61 (21926853) 3
62 (20622689) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong 3 07 ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 8 1 0 1 3 0 0 0 0
References Study Quality
10 (27581824) 4
67 (21242947) 2
68 (23900129) 4
69 (19289428) 3
70 (27842667) 2
71 (27339874) 3
Variant 5: Chronic dyspnea. Suspected disease of the pleura or chest wall. 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 Limited 3 ☢ <0.1 mSv ☢ <0.03 mSv [ped] 8 8 0 0 0 0 0 1 1 5 6
References Study Quality
76 (8796649) 3
CT chest with IV contrast Usually appropriate Limited 1 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 0 0 1 4 5 1 1
References Study Quality
77 (9017800) 4
78 (25077699) 4
79 (26076488) 2
CT chest without IV contrast Usually appropriate Limited 1 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 2 3 4 2 1
References Study Quality
77 (9017800) 4
78 (25077699) 4
79 (26076488) 2
MRI chest without IV contrast May be appropriate Limited 1 O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 8 0 1 1 0
References Study Quality
80 (2028857) 4
81 (26502346) 2
82 (26214770) 3
MRI chest without and with IV contrast May be appropriate (Disagreement) Expert Opinion 2 O 0 mSv O 0 mSv [ped] 5 5 1 0 1 1 5 2 2 1 0
References Study Quality
80 (2028857) 4
81 (26502346) 2
82 (26214770) 3
US chest May be appropriate (Disagreement) Expert Opinion 2 O 0 mSv O 0 mSv [ped] 5 6 1 0 1 0 4 3 2 2 0
References Study Quality
83 (27613540) 3
84 (-3123448) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus 1 ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 3 3 1 1 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Limited 1 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 3 2 0 1 0 0 0 0
References Study Quality
77 (9017800) 4
78 (25077699) 4
79 (26076488) 2
Variant 6: Chronic dyspnea. Suspected diaphragm dysfunction. 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 Limited 1 ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 1 0 2 1 9
References Study Quality
85 (17368210) 2
Fluoroscopy chest Usually appropriate Limited 1 ☢☢☢ 1-10 mSv 8 8 1 0 0 1 0 1 0 4 6
References Study Quality
86 (22411950) 4
87 (23778774) 2
MRI chest without IV contrast May be appropriate Limited 3 O 0 mSv O 0 mSv [ped] 5 5 0 0 0 5 5 2 0 1 0
References Study Quality
88 (17145404) 3
89 (27391236) 3
MRI chest without and with IV contrast May be appropriate Limited 3 O 0 mSv O 0 mSv [ped] 5 5 0 0 0 5 6 1 0 1 0
References Study Quality
88 (17145404) 3
89 (27391236) 3
US chest May be appropriate Strong 3 07 O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 5 5 1 0 0
References Study Quality
90 (24211983) 3
91 (23382111) 4
92 (25165390) 2
93 (26994409) 2
94 (23110443) 3
95 (27701744) 3
96 (24700122) 3
97 (26620221) 2
98 (26357011) 3
99 (25971723) 2
100 (27167428) 3
CT chest with IV contrast Usually not appropriate Expert Consensus 1 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 0 5 1 3 1 1 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus 1 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 2 8 0 0 1 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus 1 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 3 1 0 1 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.