ACR Appropriateness Criteria® Imaging for Pulmonary Embolism, Known Clot

Abstract

Acute pulmonary embolism (PE) is a common medical problem associated with high cardiovascular morbidity and mortality. Often, survivors of acute PE present with recurring symptoms and can have long-term functional sequela. Imaging plays a crucial role in initial evaluation of patients with suspected recurrent or residual PE with V/Q scan and CT angiography often used as the initial test of choice. In patients with known chronic thromboembolic disease, imaging is often used to map the disease burden, for surveillance and treatment planning; CT angiography is often used as the preliminary test for this purpose.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.