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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Expert Panel on Thoracic Imaging:, Donnelly EF, Kazerooni EA, et al. ACR Appropriateness Criteria R Lung Cancer Screening. J. Am. Coll. Radiol.. 15(11S):S341-S346, 2018 Nov. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for lung cancer screening. No results stated in abstract. 4
2. Kerr IH. The preoperative chest X-ray. Br J Anaesth. 1974;46(8):558-563. Review/Other-Dx N/A No abstract available. No abstract available. 4
3. Adeko OO, Ariba AJ, Olatunji AA, Toyobo OO. Routine chest radiograph in pre-employment medical examination for healthcare workers: Time for a review of the protocol. [Review]. Niger Postgrad Med J. 24(2):93-96, 2017 Apr-Jun. Observational-Dx 633 patients To determine the number of prospective employees with abnormal findings on routine chest X-ray (CXR), describe their characteristics and reassess the value of chest X-ray (CXR) in Pre-employment medical examination (PEME). The mean age of the prospective employees was 26.6 years ± 5 with a range of 20-49 years. Three hundred and ninety-six (95.2%) employees had normal CXR report while 20 (4.8%) had abnormal CXR. The only abnormality reported was cardiomegaly which was found in 66% of those aged =41 years. Cardiomegaly was significantly associated with increasing age (P = 0.003). 4
4. Ndii MK, Kimani NM, Onyambu CK. Utility of Routine Chest Radiographs in Kenya. East Afr Med J 2014;91:216-8. Review/Other-Dx 402 patients To determine the prevalence of radiological findings consistent with PTB among routine medical examination chest radiographs. Sixty three radiographs had abnormal but clinically insignificant findings (16%). Only one radiograph (0.25%) had radiological features of PTB. The rest were reported as normal (84%). 4
5. Preoperative chest radiology. National study by the Royal College of Radiologists. Lancet. 1979;2(8133):83-86. Review/Other-Dx 10619 patients Eight hospitals in England, Wales, and Scotland took part in an investigation into the use of preoperative CXR in patients undergoing non-acute, non-cardiopulmonary surgery. Preoperative CXR did not seem to influence the decision to operate or the choice of anesthetic; nor was there any evidence that preoperative CXR, at the levels of utilization observed in this study, would be of much value as a baseline against which subsequent radiographs in patients with postoperative pulmonary complications could be judged. 4
6. Rucker L, Frye EB, Staten MA. Usefulness of screening chest roentgenograms in preoperative patients. Jama. 1983;250(23):3209-3211. Review/Other-Dx 905 surgical admissions To develop clinical criteria for preoperative CXR. 368 had no risk factors. 1 patient (0.3%) of 368 had an abnormal radiograph. No material abnormalities were found in the remainder of the group without risk factors. 504 patients had identifiable risk factors. Of these, 114 (22%) were found to have serious abnormalities on preoperative CXR. 4
7. Skinner S. Guide to thoracic imaging. Aust Fam Physician. 44(8):558-62, 2015 Aug. Review/Other-Dx N/A To summarize current indications for imaging the thorax with chest X-ray and computed tomography. No results stated in the abstract. 4
8. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
9. Millor M, Bartolome P, Pons MJ, et al. Whole-body computed tomography: a new point of view in a hospital check-up unit? Our experience in 6516 patients. Radiol Med (Torino). 124(12):1199-1211, 2019 Dec. Observational-Dx 6516 patients To determine frequency and spectrum of  whole-body computed tomography (WB-CT) findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%). 2
10. Kanza RE, Allard C, Berube M. Cardiac findings on non-gated chest computed tomography: A clinical and pictorial review. [Review]. Eur J Radiol. 85(2):435-51, 2016 Feb. Review/Other-Dx N/A To 1.) review the normal cardiac anatomy in non-gated chest CT and to propose a stepwise approach to assess the heart for a systematic evaluation of the heart structures during the interpretation of non-cardiac, non-gated chest CT; and 2.) to describe common and less common cardiac abnormalities encountered on routine (non-ECG gated) thoracic CT scans, ranging from simple curiosity to benign, malignant, or even life threatening discoveries. No results stated in abstract. 4
11. Shimoni Z, Rosenberg M, Amit L, Froom P. Chest Radiography Should Be Requested Only on Admission Based on Clinical Grounds. South Med J. 113(1):20-22, 2020 01. Observational-Dx 273 patients To determine the clinical utility and adverse consequences of routine admission chest x-ray (CXR) findings in patients with and without respiratory complaints and/or an abnormal chest examination. Of the 35 patients with respiratory tract symptoms/signs, 7 (20%) had a change in therapy based on CXR findings, which was effective in 5 of them. In the other 238 patients, an unexpected pleural empyema was detected in a hypotensive dialysis patient (0.4%, 95% confidence interval 0-2.3). Besides costs and radiation exposure, major adverse effects included two patients (0.8%, 95% confidence interval 0.1-3.0) with a false-positive test result that resulted in inappropriate hospitalizations and antibiotic therapy. In patients without respiratory tract symptoms or findings on physical examination, the clinical benefits and major adverse consequences were uncommon. 2
12. Malnick S, Duek G, Beilinson N, et al. Routine chest X-ray on hospital admission: does it contribute to diagnosis or treatment? Isr Med Assoc J. 2010;12(6):357-361. Observational-Dx 675 patients To examine the current role of the routine admission CXR in patient management in a university-affiliated department of medicine. There were 675 patients whose mean age was 64.5 +/- 17.2 years. In 19.6% (130 cases) CXR was not performed. Of the 545 CXRs done, 260 (48%) were normal. In only 128 (23.5%) did the admission CXR make a major positive contribution to diagnosis or treatment. In 61 (11.2%) it provided a minor positive contribution and in 153 (28.1%) a major negative contribution. In 184 patients (33.8%) the CXR did not affect either diagnosis or management. It made a major positive contribution to management in patients for whom there was an indication for performing the CXR (odds ratio 10.3, P<0.0005) and in those with a relevant finding on physical examination (odds ratio 1.63, P=0.110). For the 329 patients who had neither a clinical indication for performing a CXR nor an abnormal chest examination the admission CXR contributed to patient management in only 12 cases (3.6%). 4
13. Martinez-Palli G, Cardenas A. Pre operative cardio pulmonary assessment of the liver transplant candidate. Ann Hepatol 2011;10:421-33. Review/Other-Dx 1 To discuss the cardiac and pulmonary aspects of liver disease that may impact recipient selection. No results stated in the abstract 4
14. Prediletto R, Catapano G, Bottai M, et al. Role of the chest radiograph in the preoperative assessment of the pulmonary function in patients with cirrhosis candidates to liver transplant. Radiol Med 2004;108:320-34. Observational-Dx N/A To appraise the role of chest radiography (CXR) in the clinical assessment of pulmonary complications occurring as a result of liver disease of any cause, a standardised reading of CXR was compared both with the results of lung function studies and with the severity of liver disease in 60 consecutive patients with cirrhosis candidates to liver transplant. The CXR score of this complete vascular-interstitial deficiency showed a high interobserver reproducibility and was significantly increased in those patients with a more decompensated liver cirrhosis. Moreover, a larger number of CXR signs of vascular and interstitial deficiency was present in those patients who had a more severe cirrhosis (Child-Pugh class 3). Functional indices of pulmonary gas exchange and diffusing capacity were worse in patients with end-stage liver cirrhosis, and for some indices the correlation was statistically significant. The comparison between lung function and CXR score showed that on average lung function impairment was significantly less severe in patients with lower CXR scores. 4
15. Martin P, DiMartini A, Feng S, Brown R, Jr., Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology 2014;59:1144-65. Review/Other-Dx N/A To discuss the practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. No results state din the abstract. 4
16. Young EM, Farmer JD. Preoperative Chest Radiography in Elective Surgery: Review and Update. [Review]. S D Med. 70(2):81-87, 2017 Feb. Review/Other-Dx N/A To update providers on the indications for preoperative chest radiography (POCR) and encourage more selective use. POCR frequently detects abnormalities; however, a majority of abnormalities detected are in patients with a history of cardiopulmonary disease or signs and symptoms indicative of cardiopulmonary disease. The frequency with which detected abnormalities influence perioperative management is low and evidence suggests that the clinical examination alone provides sufficient information to dictate any necessary changes in management in a majority of cases. Current evidence does not support the ability of POCR to reliably predict postoperative pulmonary complications. 4
17. Joo HS, Wong J, Naik VN, Savoldelli GL. The value of screening preoperative chest x-rays: a systematic review. Can J Anaesth. 2005;52(6):568-574. Review/Other-Dx 14 studies Systematically review the literature on the value of screening CXR and establish evidence to support guidelines for the use of preoperative screening CXR. Association between preoperative screening CXR and decrease in morbidity and mortality not established. 4
18. Archer C, Levy AR, McGregor M. Value of routine preoperative chest x-rays: a meta-analysis. Canadian Journal of Anaesthesia. 40(11):1022-7, 1993 Nov. Meta-analysis 21 reports Meta-analysis. To estimate the frequency with which routine postoperative CXR lead to clinically relevant new information. 0.1% of preoperative CXR caused modification of management. Concludes that in North American or European populations when a reliable history and a clinical examination are carried out, the cost of test is so high in relation to the clinical information provided that it is no longer justifiable. M
19. Gagner M, Chiasson A. Preoperative chest x-ray films in elective surgery: a valid screening tool. Can J Surg. 1990;33(4):271-274. Review/Other-Dx 1000 patients Retrospectively review patients who had a preoperative CXR made and who underwent elective surgery. 5.8% of women and 10.5% of men (7.4% of all patients) had abnormal preoperative CXR. Abnormalities were more frequent (30%) in patients >50 years of age than in younger patients (3%). Guidelines recommended for selective ordering of preoperative CXR. 4
20. Bozbas SS, Yilmaz EB, Dogrul I, et al. Preoperative pulmonary evaluation of liver transplant candidates: results from 341 adult patients. Ann Transplant 2011;16:88-96. Observational-Dx 341 patients To define the prevalence and types of respiratory disorders in patients with advanced liver disease evaluated for liver transplant (LT) candidacy, and to determine factors affecting postoperative outcome With a mean age of 45.1 years, 73 (21.4%) patients presented with respiratory symptoms or signs. The most common radiographic abnormality on chest X-ray was right diaphragm elevation (53.2%). Hypoxemia was detected in 38.1% of the patients. Pulmonary hypertension was detected in 100 of 327 (30.6%) patients on Doppler echocardiography. There were 141 patients who underwent surgery. Postoperative pulmonary complications developed in 60 patients, with pneumonia being the most prevalent complication (n=28). Smoking, emphysema, abnormal spirometry, pulmonary hypertension, hypoxia and orthodeoxia were found to be factors associated with increased postoperative pulmonary complications (P<0.05 for all). Mortality rate was 24.1% (n=34) and found to be significantly higher in patients who developed a postoperative complication than in those who did not (38.7% vs. 13.8%, respectively; p=0.001). 2
21. den Harder AM, de Heer LM, de Jong PA, Suyker WJ, Leiner T, Budde RPJ. Frequency of abnormal findings on routine chest radiography before cardiac surgery. Journal of Thoracic & Cardiovascular Surgery. 155(5):2035-2040, 2018 05. Observational-Dx 1136 patients To  investigate the frequency of abnormal findings on a routine chest radiograph before cardiac surgery. One half of the patients (570/1136; 50%) had 1 or more abnormalities on the chest radiograph. Most frequent abnormalities were cardiomegaly, aortic elongation, signs of chronic obstructive pulmonary disease, vertebral fractures or height loss, possible pulmonary or mediastinal mass, pleural effusion, and atelectasis. In 2 patients (2/1136; 0.2%), the chest radiograph led to postponement of surgery, whereas in none of the patients the surgery was cancelled. In 1 patient (1/1136; 0.1%) the surgical approach was altered and in 15 patients (15/1136; 1.3%) further analysis was performed without having an impact on the planned surgical approach. 4
22. Charpak Y, Blery C, Chastang C, Szatan M, Fourgeaux B. Prospective assessment of a protocol for selective ordering of preoperative chest x-rays. Can J Anaesth. 1988;35(3 ( Pt 1)):259-264. Review/Other-Dx 3866 patients Prospective evaluation of a protocol for selective ordering of preoperative CXR. 568 radiographs (52%) were abnormal. 166 (15%) were considered useful by the anesthetists. Routine ordering of preoperative CXR should be abandoned. 4
23. Grier DJ, Watson LJ, Hartnell GG, Wilde P. Are routine chest radiographs prior to angiography of any value? Clin Radiol. 1993;48(2):131-133. Review/Other-Dx 240 patients Prospective study to determine role of CXR prior to angiography. 116 radiographs were normal. 117 abnormalities on radiographs of 104 patients, mainly cardiac enlargement and heart failure. Preangiography radiographs had no effect on the practice of peripheral angiography. Routine CXR is not necessary. 4
24. De Hert S, Staender S, Fritsch G, et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology. Eur J Anaesthesiol. 35(6):407-465, 2018 06. Review/Other-Dx N/A To report on the update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. No results stated in the abstract. 4
25. Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 116(3):522-38, 2012 Mar. Review/Other-Dx N/A To report an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. No results stated in the abstract. 4
26. Qaseem A, Snow V, Fitterman N, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 144(8):575-80, 2006 Apr 18. Observational-Dx 6516 patients To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%). 2
27. Stone ME, Salter B, Fischer A. Perioperative management of patients with cardiac implantable electronic devices. [Review]. Br J Anaesth. 107 Suppl 1:i16-26, 2011 Dec. Review/Other-Dx N/A To provide recommendations that promote safe management of patients with CIEDs throughout the perioperative period and reduce the likelihood of adverse outcomes No results stated in the abstract. 4
28. Crossley GH, Poole JE, Rozner MA, et al. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management: executive summary this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm. 8(7):e1-18, 2011 Jul. Review/Other-Dx N/A To report on on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management. No results stated in the abstract. 4
29. Healey JS, Merchant R, Simpson C, et al. Society position statement : Canadian Cardiovascular Society/Canadian Anesthesiologists' Society/Canadian Heart Rhythm Society joint position statement on the perioperative management of patients with implanted pacemakers, defibrillators, and neurostimulating devices. Can J Anaesth. 59(4):394-407, 2012 Apr. Review/Other-Dx N/A To report the joint position statement on the perioperative management of patients with implanted pacemakers, defibrillators, and neurostimulating devices. No results stated in the abstract. 4
30. Hobbs SB, Chung JH, Walker CM, et al. ACR Appropriateness Criteria® Diffuse Lung Disease. J Am Coll Radiol 2021;18:S320-S29. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for diffuse lung disease. No results stated in abstract. 4
31. Lee AS, Scofield RH, Hammitt KM, et al. Consensus Guidelines for Evaluation and Management of Pulmonary Disease in Sjogren's. Chest. 159(2):683-698, 2021 02. Review/Other-Dx N/A To developed Clinical practice guidelines for pulmonary manifestations by the Sjögren's Foundation after identifying a critical need for early diagnosis and improved quality and consistency of care. The literature search revealed 1,192 articles, of which 150 qualified for consideration in guideline development. Of the original 85 PICO questions posed by the TRG, 52 recommendations were generated. These were then reviewed by the Consensus Expert Panel and 52 recommendations were finalized, with a mean agreement of 97.71% (range, 79%-100%). The recommendations span topics of evaluating Sjögren's patients for pulmonary manifestations and assessing, managing, and treating upper and lower airway disease, interstitial lung disease, and lymphoproliferative disease. 4
32. Cox CW, Chung JH, Ackman JB, et al. ACR Appropriateness Criteria® Occupational Lung Diseases. J Am Coll Radiol 2020;17:S188-S97. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for occupational lung diseases. No results stated in abstract. 4
33. Sirajuddin A, Donnelly EF, Crabtree TP, et al. ACR Appropriateness Criteria® Suspected Pulmonary Hypertension. J Am Coll Radiol 2017;14:S350-S61. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected pulmonary hypertension. No results stated in abstract. 4
34. Hatabu H, Ohno Y, Gefter WB, et al. Expanding Applications of Pulmonary MRI in the Clinical Evaluation of Lung Disorders: Fleischner Society Position Paper. Radiology. 297(2):286-301, 2020 Nov. Review/Other-Dx N/A To discuss the expanding applications of pulmonary MRI in the Clinical Evaluation of Lung Disorders.To provide recommendations for vendors and infrastructure, identifies methods for hypothesis-driven research, and suggests opportunities for prospective, randomized multicenter trials to investigate and validate lung MRI methods. No results stated in the abstract. 4
35. Ackman JB. A practical guide to nonvascular thoracic magnetic resonance imaging. [Review]. J Thorac Imaging. 29(1):17-29, 2014 Jan. Review/Other-Dx N/A To share the author's experience in developing a successful nonvascular thoracic MRI practice, discuss the fundamentals of nonvascular thoracic MRI, and provide a "how-to" manual for its performance. No results stated in the abstract. 4
36. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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