The American College of Cardiology Foundation (ACCF) – in conjunction with a number of specialty and subspecialty societies – has released Appropriateness Criteria for two of the newer clinical cardiac imaging modalities: cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMR). ACCF has released these criteria so that the growth in biomedical imaging is appropriate to patient needs, according to a release.    
   
"In response to the need for guidance in ordering and performing advance cardiac imaging procedures, such as CCT and CMR, the ACCF has focused a great deal of resources in helping to determine if it is 'reasonable' or appropriate to perform a test for a specific indication,” said Robert Hendel, MD, FACC, chair of the writing group for the Appropriateness Criteria for CCT and CMR. “We aim to assist patients, clinicians, and payers when determining how best to use cardiac tests and procedures. It is now widely apparent that these imaging studies should be used only when the information provided will have a direct impact on patient care, as medical imaging has undergone tremendous growth in recent years. It also is our hope that the criteria will generate discussion between physicians and payers regarding reimbursement," added Hendel.
   
So what is an appropriate imaging study? It is defined as one in which the expected incremental information, combined with clinical judgment, exceeds the expected negative consequences by enough of a margin so that the procedure is generally considered a reasonable approach for the indication. Negative consequences include the risks of the procedure and the possible impact of poor test performance later on such as a delay in diagnosis or inappropriate diagnosis.
   
The 39 CCT and 33 CMR indications rated encompasses the majority of clinical scenarios referred for CCT and CMR, respectively.
   
"This is the first information available to clinicians and payers to help guide decisions on when to use these two newer imaging procedures in certain clinical scenarios. With payment decisions being made daily and without any criteria to guide clinicians and payers, the ACCF and its partners felt it was critical to provide these criteria now," said Christopher Kramer, MD, FACC, a member of the writing group for the Appropriateness Criteria.
   
These appropriateness reviews assessed the risks and benefits of the imaging tests for several indications or clinical scenarios and scored them based on a scale of 1 to 9. The breakdown:

• A rating of 7 to 9 implies that the test is generally acceptable and is a reasonable approach;
• The lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach; and
• The mid range (4 to 6) indicates an uncertain clinical scenario.

"We recommend that cardiovascular professionals use the CCT and CMR Appropriateness Criteria to avoid ordering tests deemed inappropriate in the clinical setting unless there are very unusual circumstances. In addition, clinical scenarios rated uncertain require more research before we understand whether a given test is appropriate or inappropriate for that particular scenario," said Michael Poon, M.D, FACC, a member of the writing group for the Appropriateness Criteria for CCT and CMR.   

The CT and CMR Appropriateness Criteria are the second and third sets of appropriateness criteria to be developed by the ACCF. The first set, released in October 2005, was for single photon emission computed tomography myocardial perfusion imaging.   

For the complete Appropriateness Criteria for CCT and CMR, visit www.acc.org.