In an effort to respond to the need for objective use of health care services in the delivery of high-quality care, the American College of Radiology (ACR) and the American College of Cardiology Foundation (ACCF) took on the important project of jointly determining the Appropriate Utilization of Cardiovascular Imaging (AUI).

EMERGENCY PATIENTS WITH CHEST PAIN

The latest document was jointly published online by ACR and ACCF in January 2016.

 

The document addresses 20 fundamental clinical scenarios for emergency imaging for chest pain and assesses when imaging is useful in each case, and if so, what information is provided by the specified imaging procedure. The clinical scenarios are broken down into leading critical diagnoses: acute coronary syndrome, pulmonary embolism and acute aortic syndrome. There is a fourth category, triple rule out computerized tomography (CT), for the minority of patients for whom a leading diagnosis is not possible.

 

“This document captures a wide scope of those patients who come to the emergency department with chest pain, although there will always be patients who present unique situations and no document can be a substitute for clinical judgment,” said Frank J. Rybicki, MD, PhD, professor and chair of the department of radiology at the University of Ottawa, head of medical imaging at the Ottawa Hospital and co-chair of the writing committee.

 

The authors explain that the concept of appropriateness assesses the risks and benefits of a treatment, test or procedure and that these criteria provide imaging guidance to inform the clinician’s judgment.

 

Rybicki FJ, Udelson JE, Peacock WF, et al. 2015 ACR/ ACC/ AHA/ AATS/ ACEP/ ASNC/ NASCI/ SAEM/ SCCT/ SCMR/ SCPC/ SNMMI/ STR/ STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Radiol. 2016;13(2):e1-e29.

 

Rybicki FJ, Udelson JE, Peacock WF, et al. 2015 ACR/ ACC/ AHA/ AATS/ ACEP/ ASNC/ NASCI/ SAEM/ SCCT/ SCMR/ SCPC/ SNMMI/ STR/ STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Cardiol. 2016;[E-pub ahead of print].

 

Other publications in this series:

METHODOLOGY

The methodology document titled 2013 Appropriate Utilization of Cardiovascular Imaging: A Methodology for the Development of Joint Criteria for the Appropriate Utilization of Cardiovascular Imaging by the ACR and ACCF, has been published jointly and explains the methodology used in the AUI process.

2015 Appropriate Utilization of Emergency Department Patients With Chest Pain

HEART FAILURE 

The first topic in the Appropriate Utilization of Cardiovascular Imaging addresses heart failure. This report was aimed at systematically creating, reviewing, and categorizing clinical situations where physicians order or use imaging tests for patients with suspected, incompletely characterized, or known heart failure. The scenarios presented represent common clinical scenarios seen in contemporary practice, but do not include every conceivable clinical situation. Both the ACR and ACCF support personalized patient care, emphasizing utilization of diagnostic and therapeutic approaches to meet the specific needs of each patient.

The intent of the AUI document was to examine the benefits of imaging by explicitly considering two complex questions: Is any imaging at all justified for a given heart failure clinical scenario? If imaging is appropriate, which imaging modalities are most likely to provide meaningful incremental information?

ACR published an executive summary in the JACR:
 
2013 ACCF/ACR/ASE/ASNC/SCCT/SCMR Appropriate Utilization of Cardiovascular Imaging in Heart Failure: An Executive Summary - A Joint Report of the ACR Appropriateness Criteria® Committee and the ACCF Appropriate Use Criteria Task Force

The full document can be found on the ACR web site:

2013 ACR/ACCF/ASE/ASNC/SCCT/SCMR Appropriate Utilization of Cardiovascular Imaging in Heart Failure: A Joint Report of the ACR Appropriateness Criteria Committee and the ACCF Appropriate Use Criteria Task Force

Appendix - Imaging Parameter Evidence

The full document can also be found in JACC. Patel MR, White RD, Abbara S, et al. 2013 ACCF/ACR/ASE/ASNC/ SCCT/SCMR Appropriate utilization of cardiovascular imaging in heart failure: a joint report of the ACR Appropriateness Criteria Committee and the American College of Cardiology Foundation Appropriate Use Criteria Task Force. J Am Coll Cardiol. 2013;61:2207–2231.