title: Comparison of the 2006 and 2010 cardiac CT appropriateness criteria in a real-world setting.
abstract: BACKGROUND
  Coronary CT angiography (CCTA) is a relatively new technique whose role has yet to be fully defined. The initial appropriateness criteria (AC) guidelines published in 2006 have already been revised. There is paucity of data on the effect of the AC on the use of CCTA at academic centers and none for the private sector.
  
  
  METHODS
  All CCTA studies ordered at one institution (a large community hospital with internal medicine and cardiovascular training programs) from 2006 to 2008 were retrospectively evaluated, and the ordering indications were categorized per the published AC for both 2006 and 2010.
  
  
  RESULTS
  There were 384 studies, of which 243 were included in this study. The majority of the studies were ordered for chest pain (67.1% of patients). A significant proportion of studies (43.2%) were classified as inappropriate on the basis of the 2006 published criteria. Uncertain indications made up 39.1%, and appropriate indications were a minority. There was a significant regrading of appropriateness using the 2010 guidelines. Inappropriate testing remained similar at 48.1%, but uncertain cases decreased to only 2.8%, while appropriateness increased to 49.0% (P = .0001 for trend).
  
  
  CONCLUSIONS
  The updated 2010 AC guidelines for CCTA resulted in a significant reclassification of the indications for ordering CCTA from the previous 2006 guidelines. This shift in the AC reflects increased familiarity and confidence with this new technology across the imaging community. A large proportion of CCTA studies were ordered for inappropriate indications using both sets of criteria. Further research and enhanced education are needed to disseminate the appropriate role of CCTA in cardiovascular imaging.
authors.affiliation: Division of Cardiovascular Medicine, Kettering Medical Center, Kettering, Ohio 42429, USA. sulamazi@yahoo.com
authors.forename: Sula
authors.initials: S
authors.lastname: Mazimba
authors.forename: Nakash
authors.initials: N
authors.lastname: Grant
authors.forename: Analkumar
authors.initials: A
authors.lastname: Parikh
authors.forename: Trupti
authors.initials: T
authors.lastname: Patel
authors.forename: Bhakti
authors.initials: B
authors.lastname: Dahale
authors.forename: Zurisadai
authors.initials: Z
authors.lastname: Franco
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Dittoe
authors.forename: Tushar
authors.initials: T
authors.lastname: Shah
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Hahn
mesh_terms: D002309:Cardiology / Q000592:standards*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006302:Health Services Research; D006764:Hospitals, Community; D006801:Humans; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*