J Am Coll Radiol. 2006 Oct;3(10):751-71. doi: 10.1016/j.jacr.2006.08.008.
Under the auspices of the American College of Cardiology Foundation (ACCF) together with key specialty and subspecialty societies, appropriateness reviews were conducted for 2 relatively new clinical cardiac imaging modalities, cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) imaging. The reviews assessed the risks and benefits of the imaging tests for several indications or clinical scenarios and scored them based on a scale of 1 to 9, where the upper range (7 to 9) implies that the test is generally acceptable and is a reasonable approach, and the lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach. The mid-range (4 to 6) indicates an uncertain clinical scenario. The indications for these reviews were drawn from common applications or anticipated uses, as few clinical practice guidelines currently exist for these techniques. These indications were reviewed by an independent group of clinicians and modified by the Working Group, and then panelists rated the indications based on the ACCF Methodology for Evaluating the Appropriateness of Cardiovascular Imaging, which blends scientific evidence and practice experience. A modified Delphi technique was used to obtain first and second round ratings of clinical indications after the panelists were provided with a set of literature reviews, evidence tables, and seminal references. The final ratings were evenly distributed among the 3 categories of appropriateness for both CCT and CMR. Use of tests for structure and function and for diagnosis in symptomatic, intermediate coronary artery disease (CAD) risk patients was deemed appropriate, while repeat testing and general screening uses were viewed less favorably. It is anticipated that these results will have a significant impact on physician decision making and performance, reimbursement policy, and future research directions.
在美国心脏病学会基金会（ACCF）以及主要的专科和亚专科协会的支持下，对两种相对较新的临床心脏成像模式——心脏计算机断层扫描（CCT）和心脏磁共振成像（CMR）进行了适宜性评估。这些评估针对几种适应症或临床情况，分析了成像检查的风险和益处，并根据1至9的评分标准进行打分，其中较高分数范围（7至9）意味着该检查总体上是可接受的，是一种合理的方法，而较低分数范围（1至3）意味着该检查总体上不可接受，不是一种合理的方法。中间分数范围（4至6）表示临床情况不确定。这些评估的适应症来自常见应用或预期用途，因为目前针对这些技术的临床实践指南很少。这些适应症由一组独立的临床医生进行审查，并由工作组进行修改，然后专家小组成员根据ACCF评估心血管成像适宜性的方法对适应症进行评分，该方法融合了科学证据和实践经验。在向专家小组成员提供了一组文献综述、证据表和重要参考文献后，采用改良的德尔菲技术获得对临床适应症的第一轮和第二轮评分。CCT和CMR的最终评分在适宜性的三个类别中均匀分布。对于有症状的、中度冠状动脉疾病（CAD）风险患者，使用这些检查来评估结构和功能以及进行诊断被认为是合适的，而重复检查和一般筛查用途则不太受认可。预计这些结果将对医生的决策和行为、报销政策以及未来的研究方向产生重大影响。
