Journal of the American College of Radiology
Volume 7, Issue 2 , Pages 125-131, February 2010

Evaluation of Coronary CTA Appropriateness Criteria® in an Academic Medical Center

  • John A. Miller, MD

      Affiliations

    • Department of Radiology, Mayo Clinic, Rochester, Minnesota
    • Corresponding Author InformationCorresponding author and reprints: John A. Miller, MD, Mayo Clinic, Department of Radiology, 200 1st Street SW, Rochester MN, 55904
    • ,
  • Eugenia Raichlin, MD

      Affiliations

    • Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
    • ,
  • Eric E. Williamson, MD

      Affiliations

    • Department of Radiology, Mayo Clinic, Rochester, Minnesota
    • ,
  • Robert B. McCully, MD

      Affiliations

    • Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
    • ,
  • Patricia A. Pellikka, MD

      Affiliations

    • Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
    • ,
  • David O. Hodge

      Affiliations

    • Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
    • ,
  • Todd D. Miller, MD

      Affiliations

    • Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
    • ,
  • Raymond J. Gibbons, MD

      Affiliations

    • Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
    • ,
  • Philip A. Araoz, MD

      Affiliations

    • Department of Radiology, Mayo Clinic, Rochester, Minnesota

Background

The aim of this study was to evaluate published appropriateness criteria for CT angiography (CTA) at the authors' academic medical center.

Methods

Two observers independently reviewed the medical records of 251 patients who had undergone dual-source coronary CTA from June 1 to December 31, 2007. Patients were assigned to indications from 1 of 7 tables from the American College of Cardiology Foundation and ACR Appropriateness Criteria®. Agreement between the two observers was assessed using κ statistics. Disagreements were resolved by consensus panel. The final numbers of appropriate, uncertain, inappropriate, and not classifiable indications were recorded.

Results

Indications for testing were classified as appropriate in 69 patients (27%), inappropriate in 42 patients (17%), and uncertain in 25 patients (10%). One hundred fifteen indications for coronary CTA (46%) were not classifiable. Analysis of interobserver variability for overall appropriateness yielded a κ value of 0.31, which was considered to indicate fair agreement.

Conclusion

The results of this study suggest that a significant proportion (46%) of the coronary CTA studies performed at the authors' institution are for indications that are not covered by the published appropriateness criteria. Modifications to these criteria could help decrease the number of studies that are not classifiable. Physician education could decrease the number of inappropriate studies.

Key Words: Coronary artery disease, CT, x-ray, utilization, guidelines as a topic, evidence-based medicine

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 30.00 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 This study was funded by internal grants from the Department of Radiology and the Department of Medicine, Mayo Clinic.

 Disclosures: Dr Williamson is a consultant for GE and for Siemens AG, is a member of the expert advisory committees of Siemens AG and of Bayer AG, and has received research support from Bayer AG. Dr Miller has received research grants from King Pharmaceuticals, TargeGen, KAI Pharmaceuticals, Radiant Medical, TherOx, and Lantheus Medical Imaging and is a consultant for GE Healthcare, The Medicines Company, and Molecular Insight Pharmaceuticals. Dr Gibbons has received research grants from Radiant Medical, KAI Pharmaceuticals, TargeGen, TherOx, and King Pharmaceuticals and is a research consultant for Consumers Union and for Thrombolysis in Myocardial Infarcation 37A. Dr Araoz is a consultant for Medtronic.

PII: S1546-1440(09)00420-7

doi:10.1016/j.jacr.2009.08.013

Journal of the American College of Radiology
Volume 7, Issue 2 , Pages 125-131, February 2010

Article Tools

* Image Usage & Resolution