title: ACR appropriateness criteria(®)acute respiratory illness in immunocompromised patients.
abstract: The respiratory system is often affected by complications of immunodeficiency, typically manifesting clinically as acute respiratory illness. Ongoing literature reviews regarding the appropriateness of imaging in these patients are critical, as advanced medical therapies such as stem cell transplantation, chemotherapy, and immunosuppressive therapies for autoimmune disease continue to keep high the population of immunosuppressed patients in our health care system today. This ACR Appropriateness Criteria(®) topic describes clinical scenarios of acute respiratory illness in immunocompromised patients with cough, dyspnea, chest pain, and fever; in those with negative, equivocal, or nonspecific findings on chest radiography; in those with diffuse or confluent opacities on chest radiography; and in those in whom noninfectious disease is suspected. The use of chest radiography, chest CT, transthoracic needle biopsy, and nuclear medicine imaging are all discussed in the contexts of these clinical scenarios. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana, USA. deheitka@iupui.edu
authors.forename: Darel E
authors.initials: DE
authors.lastname: Heitkamp
authors.forename: Tan-Lucien H
authors.initials: TL
authors.lastname: Mohammed
authors.forename: Jacobo
authors.initials: J
authors.lastname: Kirsch
authors.forename: Judith K
authors.initials: JK
authors.lastname: Amorosa
authors.forename: Kathleen
authors.initials: K
authors.lastname: Brown
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Chung
authors.forename: Debra Sue
authors.initials: DS
authors.lastname: Dyer
authors.forename: Mark E
authors.initials: ME
authors.lastname: Ginsburg
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Kanne
authors.forename: Ella A
authors.initials: EA
authors.lastname: Kazerooni
authors.forename: Loren H
authors.initials: LH
authors.lastname: Ketai
authors.forename: J Anthony
authors.initials: JA
authors.lastname: Parker
authors.forename: James G
authors.initials: JG
authors.lastname: Ravenel
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Saleh
authors.forename: Rakesh D
authors.initials: RD
authors.lastname: Shah
mesh_terms: D000208:Acute Disease; D003952:Diagnostic Imaging / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000528:radiation effects*; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D013902:Radiography, Thoracic / Q000592:standards; D011871:Radiology / Q000592:standards; D012141:Respiratory Tract Infections / Q000000981:diagnostic imaging* / Q000276:immunology; D012680:Sensitivity and Specificity; D012955:Societies, Medical / Q000592:standards; D014057:Tomography, X-Ray Computed / Q000592:standards; D014481:United States