American College of Radiology
ACR Appropriateness Criteria®

Acute Nonspecific Chest Pain — Low Probability of Coronary Artery Disease

Variant 1: Acute Nonspecific Chest Pain — Low Probability of Coronary Artery Disease
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
X-ray chest Usually appropriate ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
7 (3171120) 4
8 (10893356) 3
9 (8372182) 3
US echocardiography transthoracic resting Usually appropriate O 0 mSv O 0 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
39 (15055819) 2
40 (9581137) 2
41 (12671809) 4
5 (19451357) 4
6 (22830462) 1
CTA coronary arteries with IV contrast Usually appropriate ☢☢☢ 1-10 mSv 7 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
6 (22830462) 1
10 (22449295) 1
11 (23255742) 3
12 (25622287) 4
13 (25466568) 1
14 (23684682) 3
15 (25151918) 4
19 (20484542) 2
16 (17056911) 2
17 (17267528) 3
18 (16004893) 3
20 (19766923) 4
21 (18195386) 2
22 (18089704) 3
23 (18796669) 2
24 (20729443) 2
25 (19897497) 3
26 (23526082) 3
27 (16738268) 2
28 (17179348) 1
29 (17171528) 2
30 (16037533) 3
31 (15160792) 4
32 (19486717) 4
33 (20513611) 4
34 (16779535) 4
35 (18641247) 3
36 (21511557) 3
37 (19201674) 4
38 (21247533) 3
CTA chest with IV contrast Usually appropriate ☢☢☢ 1-10 mSv 7 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
6 (22830462) 1
10 (22449295) 1
11 (23255742) 3
12 (25622287) 4
13 (25466568) 1
14 (23684682) 3
15 (25151918) 4
19 (20484542) 2
16 (17056911) 2
17 (17267528) 3
18 (16004893) 3
20 (19766923) 4
21 (18195386) 2
22 (18089704) 3
23 (18796669) 2
24 (20729443) 2
25 (19897497) 3
26 (23526082) 3
27 (16738268) 2
28 (17179348) 1
29 (17171528) 2
30 (16037533) 3
31 (15160792) 4
32 (19486717) 4
33 (20513611) 4
34 (16779535) 4
35 (18641247) 3
36 (21511557) 3
37 (19201674) 4
38 (21247533) 3
Tc-99m SPECT MPI rest and stress May be appropriate ☢☢☢☢ 10-30 mSv 6 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
48 (1595764) 4
49 (8144763) 2
50 (10217644) 3
51 (10750439) 4
52 (12460092) 1
53 (8245332) 2
54 (1532141) 4
X-ray rib views May be appropriate ☢☢☢ 1-10 mSv 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
5 (19451357) 4
Tc-99m V/Q scan lung May be appropriate ☢☢☢ 1-10 mSv 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
48 (1595764) 4
49 (8144763) 2
50 (10217644) 3
51 (10750439) 4
52 (12460092) 1
53 (8245332) 2
54 (1532141) 4
US echocardiography transthoracic stress May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
39 (15055819) 2
40 (9581137) 2
41 (12671809) 4
5 (19451357) 4
6 (22830462) 1
MRA chest without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
42 (17449767) 2
43 (20368649) 2
MRI heart stress perfusion without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
44 (18678772) 2
46 (16580532) 3
47 (16754804) 3
MRI heart function and morphology without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
44 (18678772) 2
45 (19389557) 4
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
X-ray barium swallow and upper GI series May be appropriate ☢☢☢ 1-10 mSv 4 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
56 (7812644) 4
5 (19451357) 4
MRA chest without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
42 (17449767) 2
43 (20368649) 2
X-ray thoracic spine May be appropriate ☢☢☢ 1-10 mSv 4 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
5 (19451357) 4
MRI heart function and morphology without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
44 (18678772) 2
45 (19389557) 4
US echocardiography transesophageal Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
39 (15055819) 2
40 (9581137) 2
41 (12671809) 4
5 (19451357) 4
6 (22830462) 1
Arteriography coronary Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
55 (20220183) 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.