Photo courtesy of the CDC
Doctor evaluating patient
A group of experts from various fields has published appropriate use criteria (AUC) for ventilation/perfusion (V/Q) imaging in patients with pulmonary embolism (PE).
The AUC document lists 21 clinical scenarios and provides scores that indicate whether V/Q imaging is appropriate.
For example, the document says V/Q imaging is appropriate in patients who are considered likely to have PE but are D-dimer-negative and in patients who are considered unlikely to have PE but are D-dimer-positive.
V/Q imaging may be appropriate in patients who are ventilator-dependent and likely have a PE as well as in male or non-pregnant female patients with suspected PE who have a significant abnormal chest radiograph.
However, V/Q imaging is rarely appropriate in patients with recent or prior documentation of a PE with computerized tomography pulmonary angiography (CTPA) and a suspected new PE. And V/Q imaging is rarely appropriate in pregnant patients with likely PE who have a severe abnormal chest radiograph.
The complete AUC document is available for download from the Society of Nuclear Medicine and Molecular Imaging (SNMMI) website. An abbreviated version was published in the May issue of The Journal of Nuclear Medicine.
The AUC are intended to assist referring physicians and ordering professionals in the US so they can fulfill the requirements of the 2014 Protecting Access to Medicare Act.
Beginning January 1, 2018, the act will require referring physicians to consult AUC developed by a provider-led entity to ensure cost-effective and appropriate utilization of advanced diagnostic imaging services.
The AUC were developed by a group consisting of representatives from SNMMI, the European Association of Nuclear Medicine (EANM), the American Society of Hematology (ASH), the Society of Thoracic Surgeons (STS), the American College of Chest Physicians (ACCP), and the American College of Emergency Physicians (ACEP).
Their expertise was supplemented by a systematic review of existing evidence conducted by the Oregon Health Science University’s Evidence-based Practice Center.
