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
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.