Understanding Appropriate Use Criteria in Nuclear Medicine

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FIGURE 1.
Ranking of indications.
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FIGURE 2.
Hierarchy of potential test ordering. ACS = acute coronary syndrome; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft. Reprinted with permission of (3).

TABLE 1

2009 AUC Tables (by Indication)

Table no.	Description
Table 1	Detection or diagnosis of coronary artery disease in symptomatic patients
Table 2	Detection of coronary artery disease in asymptomatic patients
Table 3	Use of radionuclide imaging in patients with prior test results
Table 4	Risk assessment for preoperative evaluation for noncardiac surgery in patients without active cardiac conditions
Table 5	Risk assessment in patients with acute coronary syndrome within 3 mo
Table 6	Risk assessment after revascularization, such as percutaneous coronary intervention or coronary artery bypass surgery
Table 7	Assessment of viability or ischemia
Table 8	Evaluation of left ventricular function

TABLE 2

Pretest Probability of CAD by Age, Sex, and Symptoms

Age (y)	Sex	Typical/definite angina pectoris	Atypical/probable angina pectoris	Nonanginal chest pain	Asymptomatic
<39	Men	Intermediate	Intermediate	Low	Very low
	Women	Intermediate	Very low	Very low	Very low
40–49	Men	High	Intermediate	Intermediate	Low
	Women	Intermediate	Low	Very low	Very low
50–59	Men	High	Intermediate	Intermediate	Low
	Women	Intermediate	Intermediate	Low	Very low
>60	Men	High	Intermediate	Intermediate	Low
	Women	High	Intermediate	Intermediate	Low

CAD = coronary artery disease; high = >90 pretest probability; intermediate = 10%–90% pretest probability; low = 5%–10% pretest probability; very low = <5% pretest probability
Reprinted with permission of (3).

TABLE 3

Most Frequent Inappropriate Indications

Indication	Inappropriate studies (%)	% of total studies
Detection of CAD; asymptomatic, low CHD risk^*	44.5	6.4
Asymptomatic, postrevascularization; <2 y after PCI, symptoms before PCI	23.8	3.4
Evaluation of chest pain, low probability; interpretable ECG and able to exercise	16.1	2.3
Asymptomatic/stable symptoms, known CAD < 1 y after catheterization or abnormal prior SPECT findings	3.9	0.6
Preoperative assessment; low-risk surgery	3.7	0.5
Total^†	92.0	13.2

↵* CHD risk was determined by Framingham Risk score.
↵† Remaining 8% of inappropriate studies are contained among the remaining inappropriate indications.
CAD = coronary artery disease; CHD = coronary heart disease; PCI = percutaneous coronary intervention; ECG = electrocardiogram.
Reprinted with permission of (16).