ACR Appropriateness Criteria® Chronic Dyspnea-Noncardiovascular Origin: 2024 Update

Abstract

For patients with chronic dyspnea of noncardiovascular origin, chest radiography is usually appropriate as the first-line imaging modality. Chest CT without contrast is either usually appropriate or may be appropriate as a second-line option for conditions of unclear etiology or suspected chronic obstructive pulmonary disease, small airways disease, and post–COVID-19 complications. Chest CT with contrast may have a role in patients with pleura/chest wall disease or diaphragm dysfunction. Although MRI, fluoroscopy, and FDG-PET/CT have limited roles, special imaging techniques such as inspiratory/expiratory CT and hyperpolarized xenon gas MRI are noted for their specific uses. This document aims to help clinicians choose the most suitable imaging tests, enhancing diagnostic accuracy and patient care.

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.