New recommendations from the American College of Cardiology and the American College of Radiology offer guidance to emergency providers on which imaging tests to use in 20 different clinical scenarios involving chest pain. For each clinical scenario, an expert panel rated the appropriateness of a range of imaging modalities as rarely appropriate (R), may be appropriate (M), or appropriate (A).

  • The guidelines are constructed to flow from the clinician’s judgment as to the probable cause of the chest pain.
  • The recommendations for each clinical scenario are condensed into tables that can be fashioned into notecards or a smartphone app for quick reference.
  • Developers note that the guidelines will need to be revisited when high-sensitivity troponin tests are approved for use in the United States, as these newer-generation blood tests may negate the need for many imaging tests when patients present with chest pain.