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## Complete Summary

#### GUIDELINE TITLE

Acute respiratory illness.

#### BIBLIOGRAPHIC SOURCE(S)

Haramati LB, Davis SD, Goodman PC, Khan A, Leung AN, McLoud TC, Rosado
de Christenson ML, Rozenshtein A, White CS, Kaiser LR, Expert Panel on
Thoracic Imaging. Acute respiratory illness. \[online publication\].
Reston (VA): American College of Radiology (ACR); 2005. 6 p. \[18
references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Westcott J, Davis SD,
Fleishon H, Gefter WB, Henschke CI, McLoud TC, Pugatch RD, Sostman HD,
Tocino I, White CS, Yankelevitz D, Bode FR. Acute respiratory illness.
American College of Radiology. ACR Appropriateness Criteria. Radiology
2000 Jun;215 (Suppl):645-8.

The appropriateness criteria are reviewed annually and updated by the
panels as needed, depending on introduction of new and highly
significant scientific evidence.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Acute respiratory illness

#### GUIDELINE CATEGORY

Diagnosis

#### CLINICAL SPECIALTY

Family Practice\
Internal Medicine\
Pulmonary Medicine\
Radiology

#### INTENDED USERS

Health Plans\
Hospitals\
Managed Care Organizations\
Physicians\
Utilization Management

#### GUIDELINE OBJECTIVE(S)

To evaluate the appropriateness of initial radiologic examinations for
patients with acute respiratory illness

#### TARGET POPULATION

Patients with acute respiratory illness

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  X-ray

2.  Computed tomography (CT)

#### MAJOR OUTCOMES CONSIDERED

Utility of radiologic examinations in differential diagnosis

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The guideline developer performed literature searches of peer-reviewed
medical journals and the major applicable articles were identified and
collected.

#### NUMBER OF SOURCE DOCUMENTS

The total number of source documents identified as the result of the
literature search is not known.

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Not Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not stated

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

One or two topic leaders within a panel assume the responsibility of
developing an evidence table for each clinical condition, based on
analysis of the current literature. These tables serve as a basis for
developing a narrative specific to each clinical condition.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus (Delphi)

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Since data available from existing scientific studies are usually
insufficient for meta-analysis, broad-based consensus techniques are
needed for reaching agreement in the formulation of the appropriateness
criteria. The American College of Radiology (ACR) Appropriateness
Criteria panels use a modified Delphi technique to arrive at consensus.
Serial surveys are conducted by distributing questionnaires to
consolidate expert opinions within each panel. These questionnaires are
distributed to the participants along with the evidence table and
narrative as developed by the topic leader(s). Questionnaires are
completed by participants in their own professional setting without
influence of the other members. Voting is conducted using a scoring
system from 1-9, indicating the least to the most appropriate imaging
examination or therapeutic procedure. The survey results are collected,
tabulated in anonymous fashion, and redistributed after each round. A
maximum of three rounds is conducted and opinions are unified to the
highest degree possible. Eighty percent agreement is considered a
consensus. This modified Delphi technique enables individual, unbiased
expression, is economical, easy to understand, and relatively simple to
conduct.

If consensus cannot be reached by the Delphi technique, the panel is
convened and group consensus techniques are utilized. The strengths and
weaknesses of each test or procedure are discussed and consensus reached
whenever possible. If \"No consensus\" appears in the rating column,
reasons for this decision are added to the comment sections.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Criteria developed by the Expert Panels are reviewed by the American
College of Radiology (ACR) Committee on Appropriateness Criteria.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**ACR Appropriateness Criteria®**

**Clinical Condition: Acute Respiratory Illness**

**Variant 1: Greater than 40 years old.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         8                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

**Variant 2: Dementia, any age.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         8                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

**Variant 3: Less than 40 years old, negative physical exam, and no
other signs, symptoms, or risk factors.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         4                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

**Variant 4: Less than 40 years old, positive physical exam, or other
risk factors.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         8                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

**Variant 5: Complicated pneumonia.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray chest          9                    

  CT, chest            8                   If pneumonia is not resolving or
                                           intervention is contemplated.

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 6: Suspected SARS.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         9                    

  CT, chest            9                   If chest radiograph is normal or
                                           equivocal.

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 7: Suspected Anthrax.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         9                    

  CT, chest            8                   If lungs or mediastinum are
                                           abnormal on chest radiographs and
                                           anthrax is suspected.

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 8: Febrile, neutropenic.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         9                    

  CT, chest            8                   If chest radiograph is normal or
                                           equivocal.

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 9: Acute asthma uncomplicated.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         4                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

**Variant 10: Acute asthma, suspected pneumonia, pneumothorax.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         9                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

**Variant 11: Acute exacerbation of COPD, \"uncomplicated\" (no history
of CAD or CHF, no leukocytosis, bandemia, fever, or chest pain).**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         7                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 12: Acute exacerbation of COPD with one or more of the
following: leukocytosis, bandemia, pain, history of CAD or CHF.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, chest         9                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

Acute respiratory illness (ARI) is defined as one or more of the
following: cough, sputum, chest pain, dyspnea, (with or without fever).
The work-up of a patient with ARI, including the need for chest
radiography and computed tomography (CT), depends on many factors,
including severity of the illness; age of patient; presence of fever,
leukocytosis or hypoxemia; clinical history; presence of other risk
factors; and physical examination. Not all studies concur as to which
patients with ARI should have chest x-rays.

In a study of 1,102 outpatients with ARI, the researchers found patient
age, the physical examination, and the presence or absence of hemoptysis
to be important factors. Only 4% (7/175) of patients with symptoms of
ARI, a negative physical examination, no hemoptysis, and age \< 40 years
had acute significant radiographic findings, whereas patients either
over 40, with hemoptysis, or with a positive physical examination had a
much higher incidence of chest x-ray abnormalities. In a study of 464
patients with ARI, the authors also found a low incidence (3%) of
pneumonia in patients with negative physical examinations. A notable
exception was found for patients with dementia, in whom the incidence of
pneumonia was very high regardless of the results of the physical
examination. Conversely, in a study of 221 patients with ARI researchers
found that 77 (35%) had new clinically important findings. Furthermore,
the clinical findings did not differ significantly between those with
positive radiographic findings and those with negative findings (i.e.,
clinical history and physical examination were poor predictors of x-ray
detected abnormality). Patients with substance abuse have an increased
risk of acute respiratory illness due to two mechanisms: respiratory
pump failure and pulmonary pathology. Respiratory pump failure generally
does not have radiographic manifestations. However pulmonary pathology
includes multiple diagnosis with chest radiographic manifestations,
including aspiration, pulmonary edema, pneumonia, hemorrhage, and septic
emboli.

Another study found a low incidence (4%) of pneumonia in febrile, but
otherwise asymptomatic, neutropenic patients with a normal physical
examination. Other researchers evaluated the utility of thin-section CT
in a group of febrile neutropenic patients with normal or nonspecific
chest radiographs. There were 146 episodes in 87 patients. Among the 14%
with nonspecific chest radiographs, CT suggested pneumonia in all. 48%
had a normal chest radiograph, but CT findings of pneumonia. Of these, a
specific pathogen was identified in 43%. Both chest radiographs and CTs
were normal in 38%. The CT changed patient\'s therapy in 18%.

According to American Thoracic Society guidelines, posterioranterior
(PA) (and lateral when possible) chest radiography should be obtained
whenever pneumonia is suspected in adults. Findings on chest radiography
are one of several parameters used to determine: (1) which patients
should be hospitalized (greater than one lobe involvement, cavitation,
rapid progression, presence of pleural effusion); and (2) which patients
should be classified as severe (bilateral or multilobar involvement
[\>]{.underline} 50% progression within 48 hours). CT may play a role in
the management of severe pneumonia. It can serve as a guide to pleural
drainage or localize an appropriate site for biopsy. Severe pneumonias
bear a strong relationship to etiologic pathogens and have implications
for antimicrobial treatment. Patients with severe pneumonia should be
considered as candidates for intensive care unit admission

The need for chest roentgenography in adult patients with acute asthma
is controversial. One group of researchers found clinically important
(i.e., patient management affected) radiographic findings in 9% of their
patients and concluded that chest radiography is indicated. However,
another study observed that 99% of their patients either had normal
chest radiographic exams or showed only slightly prominent markings or
hyperinflation. Other researchers reported that patients with acute
asthma rarely have pneumonia. One study recommended chest x-rays only
when pneumonia or pneumothorax are suspected. But another study found
significant chest radiographic abnormalities in 34% of adults whose
asthma exacerbation warranted admission to the hospital.

One research team studied the utility of chest radiography in 242
patients with acute exacerbations of chronic obstructive pulmonary
disease (COPD) (i.e., dyspnea). Of this group, 135 patients (56%) had
asthma, and 107 (44%) had emphysema and chronic bronchitis. Chest x-rays
were abnormal in 14% but resulted in significant change in management in
only 4.5%. They concluded that the chest x-ray is indicated only if the
worsening dyspnea is accompanied by leukocytosis, bandemia, chest pain,
or edema or by a history of coronary artery disease or congestive heart
failure (CHF).

Emerging infections and biological warfare agents have come to recent
attention as causes of acute respiratory illness. Severe acute
respiratory syndrome (SARS) emerged in China in late 2002. The etiologic
agent is a novel coronavirus (SARS-CoV) that appears to have originated
in Himalayan palm civets and crossed the species barrier. In February
2003 the Program for Monitoring Emerging Diseases identified this novel
presentation of pneumonia which because of air travel, rapidly spread
across continents to involve patients in at least 27 countries. Despite
its very recent emergence, there is already literature supporting the
utility of chest radiography in patients with known or suspected SARS.
The different studies described the chest radiographic findings of SARS
during the Hong Kong and Toronto epidemics. Chest radiographs were
abnormal in 78 to 80% of patients at presentation. The most common chest
radiographic finding was a unifocal opacity with a peripheral and
basilar predominance. Multifocal or diffuse opacities could be present
initially or develop as the disease progressed. Patients whose disease
progressed were generally older, had more comorbidities, and had a
higher fatality rate. Cavitation, pleural effusion, and lymphadenopathy
were not features of SARS.

Thin section chest CT findings of SARS have been described by three
different studies. The most common findings are ground glass opacities
and crazy paving. More extensive findings include focal or multifocal
consolidation. One group of researchers described pleural effusions and
pneumomediastinum developing in 26% of patients scanned during the
course of their illness. Another group describes a major role for CT in
patients who have a high clinical suspicion for SARS and a normal chest
radiograph. In their series, all 17 patients in that category had CT
findings of SARS.

Anthrax is endemic in the soil of Texas, Oklahoma, and the Mississippi
Valley. During the 20th century a number of countries developed
weapon-grade anthrax to be used as a biological warfare agent. Much of
modern medical experience with anthrax arises from a Soviet military
accident in 1979 in which 42 people died of anthrax, and from cases of
anthrax that developed in the U.S. in 2001 as a result of biological
warfare. Anthrax comes in three forms: cutaneous, gastrointestinal, and
inhalational. 95% of anthrax is cutaneous, but the inhalational form is
the most deadly. Inhalation of anthrax spores leads to hemorrhagic
lymphadenitis and mediastinitis, sometimes accompanied by necrotizing
pneumonia. The chest radiographic findings include widened mediastinum
and hila, often accompanied by pleural effusions and parenchymal
opacities. One study described the CT findings in two patients who
survived inhalational anthrax. The CT characteristics were very
suggestive of the diagnosis and included hyperattenuating hilar and
mediastinal lymphadenopathy and hemorrhagic pleural effusion. Less
specific findings included mediastinal edema, peribronchial thickening,
and pleural effusion.

Based on these studies, the chest x-ray seems warranted in ARI when one
or more of the following are present: age \>40; dementia; a positive
physical examination; hemoptysis; associated abnormalities
(leukocytosis, hypoxemia); or other risk factors, including coronary
artery disease, congestive heart failure, or drug-induced acute
respiratory failure. X-ray also seems warranted for any adult patient
with clinical suspicion of pneumonia. It appears that in patients with
ARI, who are \<40 years of age, chest radiography is not routinely
indicated unless there are other abnormalities, a positive physical
exam, or other risk factors. It also appears that chest radiographic
examination is not indicated in most patients with exacerbations of COPD
(including asthma) unless there is a suspected complication such as
pneumonia or pneumothorax or unless one or more of the following are
present: leukocytosis, bandemia, chest pain, edema, or a history of
coronary artery disease or CHF. Chest CT may be warranted in complicated
cases of severe pneumonia and in febrile neutropenic patients with
normal or nonspecific chest radiographic findings. In patients with a
normal chest radiograph and a high clinical suspicion of SARS, CT can be
helpful in making the diagnosis.

**Abbreviations**

-   CAD, coronary artery disease

-   CHF, congestive heart failure

-   COPD, chronic obstructive pulmonary disease

-   CT, computed tomography

-   SARS, severe acute respiratory syndrome

#### CLINICAL ALGORITHM(S)

Algorithms were not developed from criteria guidelines.

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The recommendations are based on analysis of the current literature and
expert panel consensus.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Selection of appropriate radiologic imaging procedures for evaluation of
patients with severe respiratory illness

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

An American College of Radiology (ACR) Committee on Appropriateness
Criteria and its expert panels have developed criteria for determining
appropriate imaging examinations for diagnosis and treatment of
specified medical condition(s). These criteria are intended to guide
radiologists, radiation oncologists, and referring physicians in making
decisions regarding radiologic imaging and treatment. Generally, the
complexity and severity of a patient\'s clinical condition should
dictate the selection of appropriate imaging procedures or treatments.
Only those exams generally used for evaluation of the patient\'s
condition are ranked. Other imaging studies necessary to evaluate other
co-existent diseases or other medical consequences of this condition are
not considered in this document. The availability of equipment or
personnel may influence the selection of appropriate imaging procedures
or treatments. Imaging techniques classified as investigational by the
U.S. Food and Drug Administration (FDA) have not been considered in
developing these criteria; however, study of new equipment and
applications should be encouraged. The ultimate decision regarding the
appropriateness of any specific radiologic examination or treatment must
be made by the referring physician and radiologist in light of all the
circumstances presented in an individual examination.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Personal Digital Assistant (PDA) Downloads

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Haramati LB, Davis SD, Goodman PC, Khan A, Leung AN, McLoud TC, Rosado
de Christenson ML, Rozenshtein A, White CS, Kaiser LR, Expert Panel on
Thoracic Imaging. Acute respiratory illness. \[online publication\].
Reston (VA): American College of Radiology (ACR); 2005. 6 p. \[18
references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1995 (revised 2005)

#### GUIDELINE DEVELOPER(S)

American College of Radiology - Medical Specialty Society

#### SOURCE(S) OF FUNDING

The American College of Radiology (ACR) provided the funding and the
resources for these ACR Appropriateness Criteria®.

#### GUIDELINE COMMITTEE

Committee on Appropriateness Criteria, Expert Panel on Thoracic Imaging

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Panel Members*: Linda B. Haramati, MD; Sheila D. Davis, MD; Philip C.
Goodman, MD; Arfa Khan, MD; Ann N. Leung, MD; Theresa C. McLoud, MD;
Melissa L. Rosado de Christenson, MD; Anna Rozenshtein, MD; Charles S.
White, MD; Larry R. Kaiser, MD

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Westcott J, Davis SD,
Fleishon H, Gefter WB, Henschke CI, McLoud TC, Pugatch RD, Sostman HD,
Tocino I, White CS, Yankelevitz D, Bode FR. Acute respiratory illness.
American College of Radiology. ACR Appropriateness Criteria. Radiology
2000 Jun;215 (Suppl):645-8.

The appropriateness criteria are reviewed annually and updated by the
panels as needed, depending on introduction of new and highly
significant scientific evidence.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[American College of Radiology (ACR) Web
site](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonThoracicImaging/AcuteRespiratoryIllnessDoc1.aspx).

ACR Appropriateness Criteria® *Anytime*, *Anywhere*™ (PDA application).
Available from the [ACR Web
site](http://www.acr.org/SecondaryMainMenuCategories/ACRStore/FeaturedCategories/QualityandSafety/ac_pda.aspx).

Print copies: Available from the American College of Radiology, 1891
Preston White Drive, Reston, VA 20191. Telephone: (703) 648-8900.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   ACR Appropriateness Criteria®. Background and development. Reston
    (VA): American College of Radiology; 2 p. Electronic copies:
    Available in Portable Document Format (PDF) from the [American
    College of Radiology (ACR) Web
    site](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/background_dev.aspx).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on April 3, 2006.

#### COPYRIGHT STATEMENT

Instructions for downloading, use, and reproduction of the American
College of Radiology (ACR) Appropriateness Criteria® may be found on the
[ACR Web
site.](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/ACRAppropriatenessCriteriaTermsandConditionsDoc1.aspx)

### DISCLAIMER

#### NGC DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008