ACR Appropriateness Criteria® Suspected Pulmonary Embolism: 2022 Update.

Area of Science:

• Radiology
• Cardiology
• Pulmonology

Background:

• Pulmonary embolism (PE) is a significant clinical challenge, often undiagnosed based solely on clinical presentation.
• Accurate diagnosis of PE relies heavily on advanced imaging techniques.
• Clinical correlation, including risk factor assessment, is crucial for improving diagnostic accuracy and resource utilization.

Framework:

• Multidetector CT pulmonary angiography (MDCTPA) is the current gold standard for PE diagnosis.
• Ventilation/perfusion (V/Q) scans remain valuable in specific clinical contexts.
• MR angiography and lower-extremity ultrasound are adjunctive tools, with negative ultrasound results necessitating further PE investigation.

Implementation:

• The ACR Appropriateness Criteria provide evidence-based guidelines for PE diagnostic procedures.
• Guidelines are developed and revised annually by multidisciplinary expert panels.
• Methodologies like Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the RAND/UCLA Appropriateness Method inform guideline creation.

Implications:

• Systematic literature analysis from peer-reviewed journals underpins guideline recommendations.
• Expert opinion serves as a primary evidence source when literature is limited or equivocal.
• These guidelines aim to optimize the appropriate use of diagnostic imaging for PE.