uSpecialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia. vSpecialty Chair, UT Southwestern Medical Center, Dallas, Texas. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Syncope Although there is conflicting data regarding its utility, multisociety guidelines suggest a resting 12-lead electrocardiogram (ECG) for all patients to detect arrhythmias or abnormality indicative of higher risk for arrhythmia (eg, prolonged QT interval) [7-9,11]. Although additional laboratory, physiologic, and image-based testing can be performed, it is recommended that testing be limited to select patients based on clinical assessment. In most instances, nonfocused additional testing in a patient with syncope or presyncope does not improve diagnostic yield, however, it does increase the hospitalization rate and significantly increases cost, and therefore is not endorsed by any major medical society [3,8,9,20,24]. All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. Syncope Discussion of Procedures by Variant Variant 1: Presyncope or syncope. Clinical suspicion for cardiovascular etiology based on history, physical examination, and ECG findings. Initial imaging. CT Head Serial studies of patients with syncope or presyncope have shown that head CT does not influence treatment management in this clinical scenario [15-19].
Syncope. uSpecialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia. vSpecialty Chair, UT Southwestern Medical Center, Dallas, Texas. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Syncope Although there is conflicting data regarding its utility, multisociety guidelines suggest a resting 12-lead electrocardiogram (ECG) for all patients to detect arrhythmias or abnormality indicative of higher risk for arrhythmia (eg, prolonged QT interval) [7-9,11]. Although additional laboratory, physiologic, and image-based testing can be performed, it is recommended that testing be limited to select patients based on clinical assessment. In most instances, nonfocused additional testing in a patient with syncope or presyncope does not improve diagnostic yield, however, it does increase the hospitalization rate and significantly increases cost, and therefore is not endorsed by any major medical society [3,8,9,20,24]. All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. Syncope Discussion of Procedures by Variant Variant 1: Presyncope or syncope. Clinical suspicion for cardiovascular etiology based on history, physical examination, and ECG findings. Initial imaging. CT Head Serial studies of patients with syncope or presyncope have shown that head CT does not influence treatment management in this clinical scenario [15-19].