Recipe for joint appropriateness criteria: ACR, ACCF target cardiac imaging

The American College of Radiology (ACR) and the American College of Cardiology Foundation (ACCF) jointly developed a method to define appropriate utilization of cardiovascular imaging, and laid out their process for creating the joint documents in an article published in both the Journal of the American College of Radiology and the Journal of the American College of Cardiology.

The ACR and ACCF have both produced appropriate use guidance documents on cardiovascular imaging before, but the current process aimed to integrate qualities from both associations, wrote J. Jeffrey Carr, MD, MSc, and fellow writing committee members.

“The joint effort by ACCF and ACR maintains a rigorous, but transparent, methodology that includes the comparative and multimodality imaging features of the ACR approach, as well as the more specific set of clinical presentations contained within the ACC method,” wrote Carr and colleagues.

They began by explaining the organizational structure of the committee creating the appropriateness criteria. Panels consisted of an Oversight Committee, which provided methodological oversight, defined scope and supported continuity; Writing Panel, which identified relevant indications and summarized available evidence in the literature on application of imaging in each case; Review Panel, which refined the indication narratives and evidence tables; and Rating Panel, which rated the appropriateness of the clinical indications.

Narratives constructed for each class of indications included rationales for clinical exam and imaging, along with literature review summaries and evidence tables, explained the authors.

The Rating Panel assigned an appropriateness score on a scale of 1 to 9, with higher numbers being more appropriate, while indicating whether scenarios labeled as “maybe appropriate” (scores of 4, 5, or 6) were rated ambiguously due to lack of evidence or due to conflicting evidence.

“By obtaining broad input during the development process from radiologists, cardiologists, primary care physicians, and other stakeholders, these documents are intended to provide practical evidence-based guidance to ordering providers, imaging laboratories, interpreting physicians, patients, and policymakers as to optimal cardiovascular imaging utilization,” wrote Carr and colleagues.