The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has published appropriate use criteria for ventilation/perfusion (V/Q) imaging in pulmonary embolism (PE). This is the second in a series of new AUC developed by SNMMI in its role as a qualified provider–led entity (PLE) under the Medicare Appropriate Use Criteria program for advanced diagnostic imaging. The AUC for bone scintigraphy was published in April 2017.

The new AUC are intended to assist referring physicians and ordering professionals in fulfilling the requirements of the 2014 Protecting Access to Medicare Act (PAMA). Beginning January 1, 2018, PAMA will require referring physicians to consult AUC developed by a PLE to ensure cost–effective and appropriate utilization of advanced diagnostic imaging services.

A PE occurs when a blood clot from a deep–vein thrombosis detaches from a vein wall, travels to the lungs and blocks blood supply. PEs affect 300,000 to 600,000 Americans each year, and sudden death is the first symptom in about 25 percent of cases. A V/Q scan measures both breathing and circulation in all areas of the lungs and, used appropriately, is an important tool for diagnosing PE. It exposes patients to much less radiation than a CT scan.

This AUC was developed by a workgroup composed of representatives from SNMMI, the European Association of Nuclear Medicine (EANM), and the American Society of Hematology (ASH), the Society of Thoracic Surgeons (STS), the American College of Chest Physicians (ACCP) and the American College of Emergency Physicians (ACEP). Their expertise was supplemented by a systematic review of existing evidence conducted by the Oregon Health Science University's (OHSU) Evidence–based Practice Center.

In addition to the V/Q and bone scintigraphy AUC, the SNMMI Guidance Oversight Committee is developing AUC for hepatobiliary scintigraphy in abdominal pain, F–18–FDG PET restaging of malignant disease, gastrointestinal transit, infection imaging, PET myocardial perfusion imaging, prostate cancer imaging, somatostatin imaging, and thyroid imaging and therapy.