This post is written by Allen J. Taylor, MD, FACC, chair of the writing committee for the new 2010 Appropriate Use Criteria for Cardiac Computed Tomography and a professor of medicine at Georgetown University.

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The ACC and the Society of Cardiovascular Computed Tomography (SCCT) yesterday released updated appropriate use criteria (AUC) for cardiac computed tomography (CCT), which incorporates the many advances in CCT technology that have been made and the explosion in new clinical data since the document’s initial release in 2006.

The CCT AUC were created by developing clinical scenarios in which CCT might be a diagnostic option. The scenarios are then rated as appropriate, inappropriate or uncertain by an external panel of technical advisors. In 2006, the AUC for CCT include 39 clinical scenarios. In this 2010 update, we’ve include 93 different scenarios to cover the range of presentations a clinician might be faced with. The clinical scenarios include two tests: 1) CCT angiography that uses contrast dye and 2) non-contrast CT scanning for calcium scoring.

Overall, 35 indications were appropriate, and 29 each were uncertain and inappropriate. Comparing the 2006 and 2010 criteria, about 25% of the previously rated clinical scenarios showed an increase in their appropriateness rating. Some general findings in the 2010 ratings:

• CCT angiography is appropriate for diagnosis and risk assessment in patients with symptoms of possible heart disease who have low to intermediate risk of a heart problem, or uncertainty regarding their diagnosis after other tests are performed;
• CCT angiography is considered inappropriate in high-risk patients, routine repeat testing and general screening in patients with no symptoms or other clinical scenarios;
• Calcium scanning is considered appropriate among patients without heart symptoms who have an intermediate risk of heart disease or selected patients with low risk (particularly women or younger men) who have a family history of heart problems;
• Left main stents can be appropriately evaluated with CCT; and
• CCT provides an appropriate option for evaluation of cardiac structure and function in many scenarios.

AUC are intended to help clinicians select the right patients for the right diagnostic tests. Certain diagnostic tests, like CCT, are coming increasingly under fire for adding costs to the health care system and increasing radiation risk for patients. These documents give physicians support for their medical judgment and keep clinical decisions within their purview in the face of these cost and radiation concerns. We hope that by providing broadened and more defined clinical scenarios, these criteria will affect clinical decision making, performance and reimbursement policy.

Take the short quiz below to test your knowledge of CCT appropriateness by clicking the red button. Then, read the 2010 Appropriate Use Criteria for Cardiac Computed Tomography in full on the JACC site.

 

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Please note that statements or opinions expressed herein reflect the views of the contributor, and do not reflect the official views of the ACCF, unless otherwise noted.

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