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Journal of Thoracic Imaging:
doi: 10.1097/RTI.0b013e31823efeb6
Web Exclusive Content-Appropriateness Criteria Review

ACR Appropriateness Criteria® Acute Chest Pain—Suspected Pulmonary Embolism

Bettmann, Michael A. MD*; White, Richard D. MD; Woodard, Pamela K. MD; Abbara, Suhny MD§; Atalay, Michael K. MD, PhD; Dorbala, Sharmila MD; Haramati, Linda B. MD, MS#; Hendel, Robert C. MD**; Martin, Edward T. III MD††; Ryan, Thomas MD‡‡; Steiner, Robert M. MD§§



In the article appearing on page W28 of the March 2012 issue, the author name Scott G. Baginski, MD, was omitted from the author line in error. Dr Baginski is affiliated with Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC. The correct author line is as follows.

Michael A. Bettmann, MD,* Scott G. Baginski, MD,* Richard D. White, MD,† Pamela K. Woodard, MD,‡ Suhny Abbara, MD,§ Michael K. Atalay, MD, PhD,‖ Sharmila Dorbala, MD,¶ Linda B. Haramati, MD, MS,# Robert C. Hendel, MD,** Edward T. Martin, III, MD,†† Thomas Ryan, MD,‡‡ Robert M. Steiner, MD§§

Journal of Thoracic Imaging. 27(4):W86, July 2012.

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Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. In the absence of high pretest probability and with a negative high-sensitivity D-dimer test, PE can be effectively excluded; in other situations, diagnostic imaging is necessary. The diagnosis of PE has been facilitated by technical advancements and multidetector computed tomography pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion (V/Q) 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 every 2 years by a multidisciplinary expert panel. The development and review of the guidelines include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

© 2012 Lippincott Williams & Wilkins, Inc.


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