ACR appropriateness criteria® acute chest pain-suspected pulmonary embolism

Michael A. Bettmann, Richard D. White, Pamela K. Woodard, Suhny Abbara, Michael K. Atalay, Sharmila Dorbala, Linda B. Haramati, Robert Hendel, Edward T. Martin, Thomas Ryan, Robert M. Steiner

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. In the absence of high pretest probability and with a negative high-sensitivity D-dimer test, PE can be effectively excluded; in other situations, diagnostic imaging is necessary. The diagnosis of PE has been facilitated by technical advancements and multidetector computed tomography pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion (V/Q) scans remain largely accurate and useful in certain settings. Lower-extremity ultrasound can substitute by demonstrating deep vein thrombosis; however, if negative, further studies to exclude PE are indicated. In all cases, correlation with the clinical status, particularly with risk factors, improves not only the accuracy of diagnostic imaging but also overall utilization. Other diagnostic tests have limited roles. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The development and review of the guidelines include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Original languageEnglish
JournalJournal of Thoracic Imaging
Volume27
Issue number2
DOIs
StatePublished - Mar 1 2012

Fingerprint

Acute Pain
Chest Pain
Pulmonary Embolism
Diagnostic Imaging
Guidelines
Multidetector Computed Tomography
Expert Testimony
Routine Diagnostic Tests
Radiology
Venous Thrombosis
Signs and Symptoms
Ventilation
Lower Extremity
Perfusion
History
Lung
Therapeutics

Keywords

  • Appropriateness Criteria
  • CTPAgrams
  • diagnosis of pulmonary embolism and DVT
  • ventilation and perfusion (V/Q) scan

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Pulmonary and Respiratory Medicine

Cite this

Bettmann, M. A., White, R. D., Woodard, P. K., Abbara, S., Atalay, M. K., Dorbala, S., ... Steiner, R. M. (2012). ACR appropriateness criteria® acute chest pain-suspected pulmonary embolism. Journal of Thoracic Imaging, 27(2). https://doi.org/10.1097/RTI.0b013e31823efeb6

ACR appropriateness criteria® acute chest pain-suspected pulmonary embolism. / Bettmann, Michael A.; White, Richard D.; Woodard, Pamela K.; Abbara, Suhny; Atalay, Michael K.; Dorbala, Sharmila; Haramati, Linda B.; Hendel, Robert; Martin, Edward T.; Ryan, Thomas; Steiner, Robert M.

In: Journal of Thoracic Imaging, Vol. 27, No. 2, 01.03.2012.

Research output: Contribution to journalArticle

Bettmann, MA, White, RD, Woodard, PK, Abbara, S, Atalay, MK, Dorbala, S, Haramati, LB, Hendel, R, Martin, ET, Ryan, T & Steiner, RM 2012, 'ACR appropriateness criteria® acute chest pain-suspected pulmonary embolism', Journal of Thoracic Imaging, vol. 27, no. 2. https://doi.org/10.1097/RTI.0b013e31823efeb6
Bettmann, Michael A. ; White, Richard D. ; Woodard, Pamela K. ; Abbara, Suhny ; Atalay, Michael K. ; Dorbala, Sharmila ; Haramati, Linda B. ; Hendel, Robert ; Martin, Edward T. ; Ryan, Thomas ; Steiner, Robert M. / ACR appropriateness criteria® acute chest pain-suspected pulmonary embolism. In: Journal of Thoracic Imaging. 2012 ; Vol. 27, No. 2.
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