Appropriateness Criteria Effective in Reducing Unnecessary Imaging Exams

imagingBiz | Appropriateness criteria developed in 2009 by the American College of Cardiology (ACC) and the American Society of Nuclear Cardiology (ASNC) perform “fairly well” for certain indications, reducing the number of inappropriate imaging exams, reveals a study presented at ASNC’s annual meeting in Denver, Colorado last week.

The researchers, led by Amit Dande, MD, of Danbury Hospital in Danbury, Connecticut, found that the guidelines resulted in more appropriately ordered SPECT myocardial perfusion imaging (MPI) studies (37%) for outpatients than inappropriately ordered studies (11%).

Also identified during the research was a similar proportion of abnormal studies among those ordered for appropriate and uncertain indications. This, according to the researchers, suggests that providers should gravitate toward testing for uncertain indications in asymptomatic patients and those who are post-revascularization, as well as for preoperative assessment and ischemic equivalent evaluation.

Dande and colleagues conducted their prospective research of outpatient MPI studies over a three-month period to determine the hospital’s adherence to 2009 ACC/ASNC appropriateness criteria.
The study excluded cases in which indications were not addressed in the appropriateness criteria, such as revascularization with both coronary artery bypass surgery and percutaneous coronary intervention. The criteria also excluded patients who had a specific protocol, such being listed for transplant, or if adequate information was not available for classification.

The final analysis takes into account 265 exams; of these, 21% were discovered to have been inappropriate. Of 55 inappropriately ordered exams, six (11%) were abnormal; two (4%) ,equivocal; and 47 (85%) normal.
Moreover, of 39 studies deemed of uncertain appropriateness, 15 (38%) were found to be abnormal, with the remaining 24 (62%) judged as normal. Of the 171 appropriately ordered studies , 63 (37%) were abnormal, one (1%) was equivocal, and 107 (62%) were considered normal.


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