Evaluation of coronary CTA Appropriateness Criteria in an academic medical center.
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 kappa 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 kappa value of 0.31, which was considered to indicate fair agreement.


CONCLUSIONS
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.
Department of Radiology, Mayo Clinic, Rochester, Minnesota 55904, USA. miller.john2@mayo.edu
John A
JA
Miller
Eugenia
E
Raichlin
Eric E
EE
Williamson
Robert B
RB
McCully
Patricia A
PA
Pellikka
David O
DO
Hodge
Todd D
TD
Miller
Raymond J
RJ
Gibbons
Philip A
PA
Araoz
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000592:standards* / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards* / Q000706:statistics & numerical data*; D014481:United States