Comments on: Evaluation of Coronary CTA Appropriateness Criteria in an Academic Medical Center http://www.thepreparedminds.com/archives/1206 In the field of observation, chance favors the prepared minds. Sat, 04 Feb 2012 14:45:45 +0000 hourly 1 http://wordpress.org/?v=3.3 By: Eric M. Dandes http://www.thepreparedminds.com/archives/1206/comment-page-1#comment-1064 Eric M. Dandes Wed, 17 Feb 2010 19:22:51 +0000 http://www.thepreparedminds.com/?p=1206#comment-1064 I agree with Dr. Rubinshtein. Cardiac CT is the fastest growing imaging modality in cardiac imaging. However, the appropriate selection of patients for Cardiac CT has not been well established. Over the last 5 years, there are 3 guidelines that have been used for clinical indications and reimbursement: Regional Medicare (Empire NY/NJ), Local Coverage Determinants (LCD, L22380) and ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR Appropriateness Criteria for Cardiac CT. I agree with Dr. Rubinshtein.
Cardiac CT is the fastest growing imaging modality in cardiac imaging. However, the appropriate selection of patients for Cardiac CT has not been well established. Over the last 5 years, there are 3 guidelines that have been used for clinical indications and reimbursement: Regional Medicare (Empire NY/NJ), Local Coverage Determinants (LCD, L22380) and ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR Appropriateness Criteria for Cardiac CT.

]]> By: Ronen Rubinshtein, MD http://www.thepreparedminds.com/archives/1206/comment-page-1#comment-1063 Ronen Rubinshtein, MD Wed, 17 Feb 2010 17:07:55 +0000 http://www.thepreparedminds.com/?p=1206#comment-1063 Interesting observation! It seems that patient's needs and clinical judgment still lead to the use of coronary CT angiography even if indication is not found in published appropriateness criteria. Appropriateness criteria guidelines are wise recommendations, but can not cover all possible scenarios and clinical needs. While evidence based medicine is important, and guidelines are intended to assist physicians; the "inappropriate" of today may be the "appropriate" of tomorrow (and vice versa)... Please also see an original call for evidence based medicine in cardiac CT: Coronary artery imaging with multidetector computed tomography: a call for an evidence-based, multidisciplinary approach. Schoenhagen P, Stillman AE, Garcia MJ, Halliburton SS, Tuzcu EM, Nissen SE, Modic MT, Lytle BW, Topol EJ, White RD. Am Heart J 2006;151:945-948. PMID: <a href="http://www.ncbi.nlm.nih.gov/pubmed/16644309" rel="nofollow">16644309</a> Interesting observation! It seems that patient’s needs and clinical judgment still lead to the use of coronary CT angiography even if indication is not found in published appropriateness criteria. Appropriateness criteria guidelines are wise recommendations, but can not cover all possible scenarios and clinical needs. While evidence based medicine is important, and guidelines are intended to assist physicians; the “inappropriate” of today may be the “appropriate” of tomorrow (and vice versa)…

Please also see an original call for evidence based medicine in cardiac CT:

Coronary artery imaging with multidetector computed tomography: a call for an evidence-based, multidisciplinary approach.
Schoenhagen P, Stillman AE, Garcia MJ, Halliburton SS, Tuzcu EM, Nissen SE, Modic MT, Lytle BW, Topol EJ, White RD.
Am Heart J 2006;151:945-948.
PMID: 16644309

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