Original Article
ASNC Imaging Indications (ASNC-I2): Multisocietal indications for radionuclide imaging in the multimodality context—Series rationale and methodology

https://doi.org/10.1007/s12350-021-02800-wGet rights and content

Abstract

Background

Appropriate use criteria (AUC) enhance application of cardiovascular imaging techniques but have been applied in limited settings, primarily in common cardiovascular disease processes. There are several complex systemic diseases with cardiovascular implications and special populations with unique cardiovascular considerations that could benefit from appropriateness analysis. Moreover, the high medical complexity of these topics indicate they would benefit from high-yield expert consensus recommendations of the available imaging options. The ASNC Imaging Indications (ASNC-I2) Series will provide a concise overview of relevant disease processes and their multimodality evaluation and will provide consensus clinical indications, diagnostic criteria, and clinical algorithms with representative clinical cases.

Methods

For each ASNC-I2 document, a diverse writing group and rating panel will be composed of experts from societies pertinent to the topic, including relevant imaging societies and clinical societies that manage the disease under evaluation. The rating panel will follow robust modified Delphi methodology and commonly-accepted appropriateness methods to create consensus diagnostic criteria, clinical algorithms, and clinical indications that they will then rate with level of agreement recorded. The clinical and imaging experts will provide concise, high-yield clinical summaries of the disease process, the non-imaging evaluation, and multimodality imaging. Relevant cases will be provided highlighting application of the diagnostic criteria and clinical algorithms.

Conclusion

The ASNC Imaging Indications (ASNC-I2) Series will complement the diverse portfolio of documents from ASNC. It will use a multisocietal approach with robust appropriateness methodology to guide use of radionuclide imaging in the multimodality imaging context for the cardiovascular care of patients.

Section snippets

Series Rationale

The ASNC-I2 Series will fill an important gap and serve as a unique educational resource and practice tool in the context of existing guidelines, practice points, and appropriate use (AUC) documents that will be of high clinical value to ASNC members and other interested parties. The field has greatly benefited from AUC documents issued by the American College of Cardiology (ACC), American College of Radiology (ACR), and others.1,2 However, ASNC believes there are several areas related to

Proposed Document Content

Documents in the ASNC-I2 Series will follow a standard structure as shown in Table 1. These sections will be authored by the appropriate content experts. A disease overview will be provided first; this summary is particularly important as many diseases that may be covered in the ASNC-I2 Series are multifaceted systemic disorders. Brief sections on clinical and biomarker criteria for diagnosing cardiovascular involvement will constitute a section on the non-imaging evaluation of cardiac

Methodology

The clinical expert section of the ASNC-I2 Series will adhere to a rigorous methodology that incorporates elements of the original RAND/UCLA Appropriateness Method and refinements made in prior radionuclide imaging and other cardiovascular appropriateness documents.3, 4, 5, 6, 7, 8 An overview of the process flow is provided in Figure 2. The writing group and clinical expert rating panel will be carefully assembled from recommended members of participating imaging and clinical societies. A

Summary

Appropriate Use documents have been beneficial in major cardiovascular conditions but have not been undertaken in less common and complex diseases with systemic and cardiovascular manifestations. Morover, there are additional specific understudied populations that could benefit from appropriateness analysis. The ASNC Imaging Indications (ASNC-I2) Series seeks to facilitate the application of radionuclide imaging in an appropriate clinical and multimodality context using a multidisciplinary,

New Knowledge Gained

This manuscript provides the rationale and detailed methodology for a novel assessment of indications for radionuclide imaging in the multimodality context in complex systemic diseases and special populations. Readers will understand the background, design, implementation, and optimal application of this valuable series addition to the ASNC diverse portfolio of Guidelines and Information Statements.

Disclosures

Jamieson Bourque has received consulting honoraria from Pfizer and GE Healthcare and has an investment interest in Locus Health. Andrew Einsten has received research grants from GE Healthcare and Roche Medical Systems. He has been a speaker for Ionetix.

Funding

Sharmila Dorbala reports research grant support from GE Healthcare, Pfizer, and Attralus. She has received consulting honoraria from GE Healthcare, Pfizer, Attralus, and Ionetix. There are no funding sources to disclose.

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