title: Application of appropriateness criteria to stress single photon emission computed tomography sestamibi studies: a comparison of the 2009 revised appropriateness criteria to the 2005 original criteria.
abstract: BACKGROUND
  The 2005 appropriate use criteria (AUC) for stress single-photon emission computed tomographic myocardial perfusion imaging (SPECT MPI) were revised in 2009 to reflect changes in published evidence, clinical practice and experience with application of the 2005 AUC. The purpose of this study was to compare the 2009 AUC for SPECT MPI with the original 2005 criteria.
  
  
  METHODS
  Using the Mayo Rochester Nuclear Cardiology Laboratory database, we retrospectively examined 281 patients who underwent stress SPECT MPI at Mayo Clinic Rochester between May 1, 2005, and May 15, 2005, using the revised 2009 AUC and compared these findings to our previously published results in this same cohort using the 2005 AUC.
  
  
  RESULTS
  Compared to the 2005 AUC, the 2009 AUC resulted in a highly significant overall change (P < .001) in the classification of appropriateness. The 2009 AUC eliminated unclassified patients, reduced appropriate studies (59.8% vs 63.7%, P = .02), increased studies of uncertain appropriateness (16.0% vs 10.7%, P = .01), and increased inappropriate studies (24.2% vs 14.6%, P < .001).
  
  
  CONCLUSIONS
  In this cohort of patients undergoing SPECT MPI, compared to our previous study using the original 2005 AUC, the 2009 AUC had a significant impact on the classification of appropriateness. The 2009 AUC eliminated unclassified patients, increased inappropriate studies and increased studies of uncertain appropriateness.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Damita J
authors.initials: DJ
authors.lastname: Carryer
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Todd D
authors.initials: TD
authors.lastname: Miller
authors.forename: John W
authors.initials: JW
authors.lastname: Askew
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Gibbons
mesh_terms: D000368:Aged; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000592:standards / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000592:standards*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi