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ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients

Heitkamp, Darel E. MD*; Albin, Matthias M. MD*; Chung, Jonathan H. MD; Crabtree, Traves P. MD; Iannettoni, Mark D. MD§; Johnson, Geoffrey B. MD, PhD; Jokerst, Clinton MD; McComb, Barbara L. MD#; Saleh, Anthony G. MD**; Shah, Rakesh D. MD††; Steiner, Robert M. MD‡‡; Mohammed, Tan-Lucien H. MD§§; Ravenel, James G. MD∥∥Expert Panel on Thoracic Imaging:

Journal of Thoracic Imaging: May 2015 - Volume 30 - Issue 3 - p W2–W5
doi: 10.1097/RTI.0000000000000153
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The respiratory system is often affected by complications of immunodeficiency, typically manifesting clinically as acute respiratory illness. Ongoing literature reviews regarding the appropriateness of imaging in these patients are critical, as advanced medical therapies including stem cell transplantation, chemotherapy, and immunosuppressive therapies for autoimmune disease continue to keep the population of immunosuppressed patients in our health care system high. This ACR Appropriateness Criteria® topic describes clinical scenarios of acute respiratory illness in immunocompromised patients with cough, dyspnea, chest pain, and fever, in those with negative, equivocal, or nonspecific findings on chest radiography, in those with multiple, diffuse, or confluent opacities on chest radiography, and in those in whom noninfectious disease is suspected. The use of chest radiography, chest computed tomography, transthoracic needle biopsy, and nuclear medicine imaging is discussed in the context of these clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review 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 is not definitive, expert opinion may be used to recommend imaging or treatment.

*Department of Radiology, Indiana University, Indianapolis, IN

National Jewish Health, Denver, CO

Department of Surgery, Society of Thoracic Surgeons, Washington University School of Medicine, Saint Louis, MO

§Department of Cardiothoracic Surgery, Society of Thoracic Surgeons, University of Iowa, Iowa City, IO

Mayo Clinic, Rochester, MN

Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ

#Mayo Clinic, Jacksonville, FL

§§Department of Radiology, University of Florida College of Medicine, Gainesville, FL

**The American College of Chest Physicians, New York Methodist Hospital, Brooklyn, NY

††North Shore University Hospital, Manhasset, NY

‡‡Department of Radiology, Temple University, Philadelphia, PA

∥∥Department of Radiology, Medical University of South Carolina, Charleston, SC

This article is a revised version of the ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients. Practitioners are encouraged to refer to the complete version at www.acr.org/ac.

Reprinted with permission of the American College of Radiology.

The American College of Radiology (ACR) seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply society endorsement of the final document.

Robert M. Steiner, MD is a Consultant and Course Director for Education Symposium Inc. and a Consultant for John and Johnson. The remaining authors declare no conflicts of interest.

Corresponding Author: Darel E. Heitkamp, MD, American College of Radiology, 1891 Preston White Drive, Reston, VA 20191 (e-mail: deheitka@iupui.edu).

Correspondence to: (e-mail: publications@acr.org).

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