부산대학교 도서관

Under governmental pressure from potential over-utilization of imaging, physicians recognized they needed to set guidelines that best promoted optimal use for patient benefit. Nuclear cardiology was at the forefront of this effort, adopting one of the first sets of appropriateness criteria. These rely heavily on conditional probability. They also require an understanding of incremental value and cost-effectiveness. The strong theme for the majority of the guidelines, which are based on evidence from clinical trials and the clinical literature, is that intermediate-risk patients benefit the most from noninvasive testing. Consequently, understanding how clinical risk is assigned is another critical piece of knowledge. Another key component is symptomatic versus asymptomatic patients, where appropriateness is strongly in favor for testing patients with symptoms. The clinical guidelines have an indication category as well as a level-of-evidence rating. Appropriate use criteria were developed subsequent to the initial clinical guidelines. These were intended to be more applicable to individual patients and reflect what the average reasonable clinician might order and less reliant on clinical trials. Both the guidelines and the appropriate use criteria have evolved extensively and are now incorporated into specific disease states rather than by imaging modality. European guidelines have followed much of the same path but are generally more inclusive of other imaging modalities.