Promoting Appropriate Use of Cardiac Imaging: No Longer an Academic Exercise
Authors: Rami Doukky, Gretchen Diemer, Andria Medina, David E. Winchester, Venkatesh L. Murthy, Lawrence M. Phillips, Kathleen Flood, Linda Giering, Georgia Hearn, Ronald G. Schwartz, Raymond Russell, David Wolinsky
Journal: Annals of Internal Medicine (2017)

Ideas and Opinions21 March 2017Promoting Appropriate Use of Cardiac Imaging: No Longer an Academic ExerciseRami Doukky, MD, MSc, Gretchen Diemer, MD, Andria Medina, MD, PhD, David E. Winchester, MD, MS, Venkatesh L. Murthy, MD, PhD, Lawrence M. Phillips, MD, Kathleen Flood, BS, Linda Giering, PhD, Georgia Hearn, JD, Ronald G. Schwartz, MD, MS, Raymond Russell, MD, PhD, and David Wolinsky, MDRami Doukky, MD, MScFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., Gretchen Diemer, MDFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., Andria Medina, MD, PhDFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., David E. Winchester, MD, MSFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., Venkatesh L. Murthy, MD, PhDFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., Lawrence M. Phillips, MDFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., Kathleen Flood, BSFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., Linda Giering, PhDFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., Georgia Hearn, JDFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., Ronald G. Schwartz, MD, MSFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., Raymond Russell, MD, PhDFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida., and David Wolinsky, MDFrom Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2673 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In response to rapid and unsustainable growth in the use of cardiac imaging procedures, various professional medical organizations have developed appropriate use criteria (AUC) to guide physicians and payers on effective use of these procedures. The AUC serve as a guide for physicians to incorporate symptoms, risk factors, and clinical history in selecting the patients for whom testing is most appropriate based on the best available evidence or expert consensus; further, the AUC can help physicians steer other patients to alternative tests or no testing at all. The AUC classify the appropriateness of testing across a range of clinical scenarios ...References1. Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, Kramer CM, et al; American College of Cardiology Foundation Appropriate Use Criteria Task Force. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;63:380-406. [PMID: 24355759] doi:10.1016/j.jacc.2013.11.009 CrossrefMedlineGoogle Scholar2. Doukky R, Frogge N, Appis A, Hayes K, Khoudary G, Fogg L, et al. Impact of appropriate use on the estimated radiation risk to men and women undergoing radionuclide myocardial perfusion imaging. J Nucl Med. 2016;57:1251-7. 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[PMID: 25975961] doi:10.1186/s12968-015-0137-x CrossrefMedlineGoogle Scholar9. Lin FY, Dunning AM, Narula J, Shaw LJ, Gransar H, Berman DS, et al. Impact of an automated multimodality point-of-order decision support tool on rates of appropriate testing and clinical decision making for individuals with suspected coronary artery disease: a prospective multicenter study. J Am Coll Cardiol. 2013;62:308-16. [PMID: 23707319] doi:10.1016/j.jacc.2013.04.059 CrossrefMedlineGoogle Scholar10. Saifi S, Taylor AJ, Allen J, Hendel R. The use of a learning community and online evaluation of utilization for SPECT myocardial perfusion imaging. JACC Cardiovasc Imaging. 2013;6:823-9. [PMID: 23643281] doi:10.1016/j.jcmg.2013.01.012 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Cook County Health and Hospitals System, Chicago, Illinois; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Florida College of Medicine, Gainesville, Florida; University of Michigan, Ann Arbor, Michigan; New York University Langone Medical Center, New York, New York; American Society of Nuclear Cardiology, Bethesda, Maryland; University of Rochester Medical Center, Rochester, New York; Alpert Medical School of Brown University, Providence, Rhode Island; and Cleveland Clinic Florida, Weston, Florida.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2673.Corresponding Author: Rami Doukky, MD, MSc, Division of Cardiology, John H. Stroger Jr. Hospital of Cook County, 1901 West Harrison Street, Suite 3620, Chicago, IL 60612; e-mail, [email protected]org.Current Author Addresses: Dr. Doukky: Division of Cardiology, John H. Stroger Jr. Hospital of Cook County, 1901 West Harrison Street, Suite 3620, Chicago, IL 60612.Dr. Diemer: Sidney Kimmel Medical College of Thomas Jefferson University, 1025 Walnut Street, 100 College Building, Philadelphia, PA 19107.Dr. Medina: University of Oklahoma Health Sciences Center, OU Physicians Building, Internal Medicine, Suite 4E, 825 NE 10th Street, Oklahoma City, OK 73104.Dr. Winchester: University of Florida College of Medicine, 1600 SW Archer Road, Box 100277, Gainesville, FL 32610.Dr. Murthy: University of Michigan, 1338 Cardiovascular Center, 1500 East Medical Center Drive, SPC 5873, Ann Arbor, MI 48109.Dr. Phillips: New York University Langone Medical Center, 530 First Avenue, New York, NY 10016.Ms. Flood, Dr. Giering, and Ms. Hearn: American Society of Nuclear Cardiology, 4340 East-West Highway, Suite 1120, Bethesda, MD 20814.Dr. Schwartz: University of Rochester Medical Center, 601 Elmwood Avenue, Box 679-N, Rochester, NY 14642.Dr. Russell: Rhode Island Hospital Cardiovascular Institute, 593 Eddy Street, Floor 5, Providence, RI 02903.Dr. Wolinsky: Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331.Author Contributions: Conception and design: R. Doukky, G. Diemer, A. Medina, D.E. Winchester, V.L. Murthy, R.G. Schwartz, D. Wolinsky.Analysis and interpretation of the data: R. Doukky, A. Medina.Drafting of the article: R. Doukky, G. Diemer, D.E. Winchester, V.L. Murthy, L.M. Phillips, R.G. Schwartz, R. Russell.Critical revision of the article for important intellectual content: R. Doukky, A. Medina, D.E. Winchester, V.L. Murthy, L.M. Phillips, K. Flood, L. Giering, G. Hearn, R.G. Schwartz, D. Wolinsky.Final approval of the article: R. Doukky, G. Diemer, A. Medina, D.E. Winchester, V.L. Murthy, L.M. Phillips, K. Flood, L. Giering, R.G. Schwartz, R. Russell, D. Wolinsky.Administrative, technical, or logistic support: L. Giering.This article was published at Annals.org on 28 February 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCardiovascular Imaging Through the Prism of Modern MetricsAnalysis of the 2019 ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS Appropriate Use Criteria for Multimodal Imaging in the Assessment of Structural Heart DiseasePAMA implementation: The road aheadAtherosclerosisClinical Risk Scores to Minimize Low Yield Coronary Artery Disease TestingStress Electrocardiography vs Radionuclide Myocardial Perfusion Imaging among Patients Admitted for Chest Pain: Comparison of Teaching and Nonteaching Hospital ServicesValue-Based Healthcare Purchasing 21 March 2017Volume 166, Issue 6Page: 438-440KeywordsArea under the curveCardiac surgeryHealth care utilizationInterleukinsLower back painMagnetic resonance imagingMedicareMotivationRadionuclide imagingStable coronary artery disease ePublished: 28 February 2017 Issue Published: 21 March 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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