International, multidisciplinary update of the 2006 Appropriateness Criteria for cardiac computed tomography

BACKGROUND: A multi-society document outlining appropriateness criteria for cardiac CT (CCT) was published in 2006. Since then, CCT has experienced rapid growth in technologic advances and clinical use. We sought to reassess opinion about the appropriate use of CCT among an international group of experts in the field. METHODS: Seventy-two international experts in the field of CCT independently rated all 39 indications listed in the original 2006 appropriateness statement. Indications were classified as either "appropriate," "uncertain," or "inappropriate" based on an assessment of the clinical balance between risk and benefit to the patient in daily practice. Median rater scores were considered to represent current opinion for each indication and were compared with the original value in the 2006 document. RESULTS: Survey respondents averaged 5.8+/-4.1 years of CCT experience, with a median total of 1200 contrast-enhanced CCT examinations performed and interpreted. Cardiologists (40; 55.6%) and radiologists (32; 44.4%) were included. Five of 12 previously "uncertain" indications shifted to "appropriate," resulting in a total of 18 "appropriate" of 39 possible indications. Conversely, all previously "appropriate" indications remained so. Among the 14 previously "inappropriate" indications, 10 shifted to "uncertain," none to "appropriate." Overall, 26 of 39 indications showed increased appropriateness scores (range of shift, 1-4 points; median value, 1; interquartile range, 0-2). No significant differences were observed between US and non-US expert respondents or between cardiology and radiology respondents in the overall appropriateness category ratings. CONCLUSIONS: When compared with the 2006 Appropriateness Criteria, opinion regarding clinical use of CCT has experienced a significant shift toward appropriateness across most indications, similarly judged among international cardiology and radiology experts in the field.