June 18, 2012

The American College of Cardiology, through its Foundation, recently reviewed common indications when ultrasound and physiological testing (defined as “evaluation of the peripheral circulation based on measurement of limb blood pressures with pulse volume recordings or Doppler waveforms, or other parameters without utilizing data from direct imaging of the blood vessels”) are often considered, in order to update its guidelines for use.

The Foundation intends that its new noninvasive vascular testing guidelines be helpful to determine the appropriate use of the testing for selected indications (Medicare’s reimbursement under its physician fee schedule increased more rapidly for diagnostic imaging services from 1999 to 2003 than for all other types of physician services).

The Foundation identified 159 indications for such testing that were then given a score between 1 and 9 to determine appropriate use (that is, the test is generally acceptable and is a reasonable approach for the indication — those with median scores from 7 to 9), uncertain use (the test may be generally acceptable and may be a reasonable approach for the indication — those with median scores from 4 to 6), and inappropriate use (the test is not generally acceptable and is not a reasonable approach for the indication — those with median scores from 1 to 3).

Of the 255 indications that were scored, 117 indications were rated as appropriate, 84 indications were rated as uncertain, and 54 were rated as inappropriate.

A summary of the guidelines appear in the online version of the Journal of the American College of Cardiology published on June 11, 2012.


Medicine is an art as well as a science. Medicine constantly changes as technology changes and data from past experiences is gathered, analyzed, and published. What’s appropriate today may become inappropriate or outdated tomorrow, based on on-going research and gained knowledge and experience. Health care providers must keep themselves current and up-to-date regarding information about appropriate and available medical treatments. Patients rely on the expertise of their health care providers, especially medical specialists to whom they may be referred for specialized medical care, in treating their medical conditions and in keeping them safe and healthy.

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