7 Modalities
1
Exercise electrocardiogram (ECG)
2
Stress radionuclide imaging (single-photon emission computed tomography [SPECT]; positron emission tomography [PET])
Part of the Medicare AUC Program
SPECT images on left courtesy of Kim Allan Williams, MD. PET images on right courtesy of W. A. Jaber, MD.
3
Stress echocardiography (echo)
Image courtesy of H. C. Lewin, MD.
4
Stress cardiovascular magnetic resonance (CMR) imaging
Part of the Medicare AUC Program
Images courtesy of D. H. Kwon, MD.
5
Coronary artery calcium (CAC) scoring
Image courtesy of H. C. Lewin, MD.
6
Coronary computed tomography angiography (CCTA)
Part of the Medicare AUC Program
Images courtesy of H. C. Lewin, MD.
7
Invasive coronary angiography
Images courtesy of D. Wolinsky, MD.
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Rating Appropriateness
The Multimodality AUC rate each imaging test by appropriateness for each indication based on technical capabilities, evidence, and clinical experience. When you use AUC, you'll get 1 of 3 ratings: appropriate, may be appropriate, or rarely appropriate.5
- Benefits generally outweigh risks
- Generally an effective option
- Dependent on physician judgment and patient-specific preferences
- Variable evidence regarding the risk-benefit ratio
- Potentially an effective option
- Dependent on clinical variables, physician judgment, and patient preferences
- Lack of evidence that benefits clearly outweigh risks
- Rarely an effective option
- Exceptions should have documentation of clinical reasons
For patients who may have more than one clinical indication, there is a flowchart that places indications into a hierarchy to help stratify test appropriateness.5
