ACR Appropriateness Criteria® Acute Chest Pain—Suspected Pulmonary Embolism

Panels on Cardiac and Thoracic Imaging:, Jacobo Kirsch, Richard K.J. Brown, Travis S. Henry, Cylen Javidan-Nejad, Clinton Jokerst, Paul R. Julsrud, Jeffrey P. Kanne, Christopher M. Kramer, Jonathon A. Leipsic, Kalpesh K. Panchal, James G. Ravenel, Amar B. Shah, Tan-Lucien Mohammed, Pamela K. Woodard, Suhny Abbara

Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion scans remain largely accurate and useful in certain settings. Lower-extremity ultrasound can substitute by demonstrating deep vein thrombosis; however, if negative, further studies to exclude PE are indicated. In all cases, correlation with the clinical status, particularly with risk factors, improves not only the accuracy of diagnostic imaging but also overall utilization. Other diagnostic tests have limited roles. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.