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Sample records for acr appropriateness criteria

  1. ACR Appropriateness Criteria Myelopathy.

    PubMed

    Roth, Christopher J; Angevine, Peter D; Aulino, Joseph M; Berger, Kevin L; Choudhri, Asim F; Fries, Ian Blair; Holly, Langston T; Kendi, Ayse Tuba Karaqulle; Kessler, Marcus M; Kirsch, Claudia F; Luttrull, Michael D; Mechtler, Laszlo L; O'Toole, John E; Sharma, Aseem; Shetty, Vilaas S; West, O Clark; Cornelius, Rebecca S; Bykowski, Julie

    2016-01-01

    Patients presenting with myelopathic symptoms may have a number of causative intradural and extradural etiologies, including disc degenerative diseases, spinal masses, infectious or inflammatory processes, vascular compromise, and vertebral fracture. Patients may present acutely or insidiously and may progress toward long-term paralysis if not treated promptly and effectively. Noncontrast CT is the most appropriate first examination in acute trauma cases to diagnose vertebral fracture as the cause of acute myelopathy. In most nontraumatic cases, MRI is the modality of choice to evaluate the location, severity, and causative etiology of spinal cord myelopathy, and predicts which patients may benefit from surgery. Myelopathy from spinal stenosis and spinal osteoarthritis is best confirmed without MRI intravenous contrast. Many other myelopathic conditions are more easily visualized after contrast administration. Imaging performed should be limited to the appropriate spinal levels, based on history, physical examination, and clinical judgment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26653797

  2. ACR Appropriateness Criteria Crohn Disease.

    PubMed

    Kim, David H; Carucci, Laura R; Baker, Mark E; Cash, Brooks D; Dillman, Jonathan R; Feig, Barry W; Fowler, Kathryn J; Gage, Kenneth L; Noto, Richard B; Smith, Martin P; Yaghmai, Vahid; Yee, Judy; Lalani, Tasneem

    2015-10-01

    Crohn disease is a chronic inflammatory disorder involving the gastrointestinal tract, characterized by episodic flares and times of remission. Underlying structural damage occurs progressively, with recurrent bouts of inflammation. The diagnosis and management of this disease process is dependent on several clinical, laboratory, imaging, endoscopic, and histologic factors. In recent years, with the maturation of CT enterography, and MR enterography, imaging has played an increasingly important role in relation to Crohn Disease. In addition to these specialized examination modalities, ultrasound and routine CT have potential uses. Fluoroscopy, radiography, and nuclear medicine may be less beneficial depending on the clinical scenario. The imaging modality best suited to evaluating this disease may change, depending on the target population, severity of presentation, and specific clinical situation. This document presents seven clinical scenarios (variants) in both the adult and pediatric populations and rates the appropriateness of the available imaging options. They are summarized in a consolidated table, and the underlying rationale and supporting literature are presented in the accompanying narrative. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26435118

  3. ACR Appropriateness Criteria Head Trauma.

    PubMed

    Shetty, Vilaas S; Reis, Martin N; Aulino, Joseph M; Berger, Kevin L; Broder, Joshua; Choudhri, Asim F; Kendi, A Tuba; Kessler, Marcus M; Kirsch, Claudia F; Luttrull, Michael D; Mechtler, Laszlo L; Prall, J Adair; Raksin, Patricia B; Roth, Christopher J; Sharma, Aseem; West, O Clark; Wintermark, Max; Cornelius, Rebecca S; Bykowski, Julie

    2016-06-01

    Neuroimaging plays an important role in the management of head trauma. Several guidelines have been published for identifying which patients can avoid neuroimaging. Noncontrast head CT is the most appropriate initial examination in patients with minor or mild acute closed head injury who require neuroimaging as well as patients with moderate to severe acute closed head injury. In short-term follow-up neuroimaging of acute traumatic brain injury, CT and MRI may have complementary roles. In subacute to chronic traumatic brain injury, MRI is the most appropriate initial examination, though CT may have a complementary role in select circumstances. Advanced neuroimaging techniques are areas of active research but are not considered routine clinical practice at this time. In suspected intracranial vascular injury, CT angiography or venography or MR angiography or venography is the most appropriate imaging study. In suspected posttraumatic cerebrospinal fluid leak, high-resolution noncontrast skull base CT is the most appropriate initial imaging study to identify the source, with cisternography reserved for problem solving. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:27262056

  4. ACR appropriateness criteria on metastatic bone disease.

    PubMed

    Roberts, Catherine C; Daffner, Richard H; Weissman, Barbara N; Bancroft, Laura; Bennett, D Lee; Blebea, Judy S; Bruno, Michael A; Fries, Ian Blair; Germano, Isabelle M; Holly, Langston; Jacobson, Jon A; Luchs, Jonathan S; Morrison, William B; Olson, Jeffrey J; Payne, William K; Resnik, Charles S; Schweitzer, Mark E; Seeger, Leanne L; Taljanovic, Mihra; Wise, James N; Lutz, Stephen T

    2010-06-01

    Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria((R)) Expert Panel on Musculoskeletal Radiology. PMID:20522392

  5. ACR Appropriateness Criteria Breast Cancer Screening.

    PubMed

    Mainiero, Martha B; Lourenco, Ana; Mahoney, Mary C; Newell, Mary S; Bailey, Lisa; Barke, Lora D; D'Orsi, Carl; Harvey, Jennifer A; Hayes, Mary K; Huynh, Phan Tuong; Jokich, Peter M; Lee, Su-Ju; Lehman, Constance D; Mankoff, David A; Nepute, Joshua A; Patel, Samir B; Reynolds, Handel E; Sutherland, M Linda; Haffty, Bruce G

    2013-01-01

    Mammography is the recommended method for breast cancer screening of women in the general population. However, mammography alone does not perform as well as mammography plus supplemental screening in high-risk women. Therefore, supplemental screening with MRI or ultrasound is recommended in selected high-risk populations. Screening breast MRI is recommended in women at high risk for breast cancer on the basis of family history or genetic predisposition. Ultrasound is an option for those high-risk women who cannot undergo MRI. Recent literature also supports the use of breast MRI in some women of intermediate risk, and ultrasound may be an option for intermediate-risk women with dense breasts. There is insufficient evidence to support the use of other imaging modalities, such as thermography, breast-specific gamma imaging, positron emission mammography, and optical imaging, for breast cancer screening. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:23290667

  6. ACR Appropriateness Criteria Renal Cell Carcinoma Staging.

    PubMed

    Vikram, Raghunandan; Beland, Michael D; Blaufox, M Donald; Moreno, Courtney Coursey; Gore, John L; Harvin, Howard J; Heilbrun, Marta E; Liauw, Stanley L; Nguyen, Paul L; Nikolaidis, Paul; Preminger, Glenn M; Purysko, Andrei S; Raman, Steven S; Taffel, Myles T; Wang, Zhen J; Weinfeld, Robert M; Remer, Erick M; Lockhart, Mark E

    2016-05-01

    Renal cell carcinoma accounts for 2%-3% of all visceral malignancies. Preoperative imaging can provide important staging and anatomic information to guide treatment decisions. Size of the primary tumor and degree of local invasion, such as involvement of perinephric fat or renal sinus fat, and tumor thrombus in renal veins and inferior vena cava are important detriments to local staging of primary tumor. Both kidneys are assessed for presence of other synchronous lesions. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and application by the panel of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:27016804

  7. ACR Appropriateness Criteria Osteonecrosis of the Hip.

    PubMed

    Murphey, Mark D; Roberts, Catherine C; Bencardino, Jenny T; Appel, Marc; Arnold, Erin; Chang, Eric Y; Dempsey, Molly E; Fox, Michael G; Fries, Ian Blair; Greenspan, Bennett S; Hochman, Mary G; Jacobson, Jon A; Mintz, Douglas N; Newman, Joel S; Rosenberg, Zehava S; Rubin, David A; Small, Kirstin M; Weissman, Barbara N

    2016-02-01

    Osteonecrosis of the hip (Legg-Calvé-Perthes) is a common disease, with 10,000-20,000 symptomatic cases annually in the United States. The disorder affects both adults and children and is most frequently associated with trauma and corticosteroid usage. The initial imaging evaluation of suspected hip osteonecrosis is done using radiography. MRI is the most sensitive and specific imaging modality for diagnosis of osteonecrosis of the hip. The clinical significance of hip osteonecrosis is dependent on its potential for articular collapse. The likelihood of articular collapse is significantly increased with involvement of greater than 30%-50% of the femoral head area, which is optimally evaluated by MRI, often in the sagittal plane. Contrast-enhanced MRI may be needed to detect early osteonecrosis of the hip in pediatric patients, revealing hypoperfusion. In patients with a contraindication for MRI, use of either CT or bone scintigraphy with SPECT (single-photon emission CT) are alternative radiologic methods of assessment. Imaging helps guide treatment, which may include core decompression, osteotomy, and ultimately, need for joint replacement. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26846390

  8. ACR appropriateness Criteria® infertility.

    PubMed

    Wall, Darci J; Javitt, Marcia C; Glanc, Phyllis; Bhosale, Priyadarshani R; Harisinghani, Mukesh G; Harris, Robert D; Khati, Nadia J; Mitchell, Donald G; Nyberg, David A; Pandharipande, Pari V; Pannu, Harpreet K; Shipp, Thomas D; Siegel, Cary Lynn; Simpson, Lynn; Wong-You-Cheong, Jade J; Zelop, Carolyn M

    2015-03-01

    Appropriate imaging for women undergoing infertility workup depends upon the clinician's suspicion for potential causes of infertility. Transvaginal US is the preferred modality to assess the ovaries for features of polycystic ovary syndrome (PCOS), the leading cause of anovulatory infertility. For women who have a history or clinical suspicion of endometriosis, which affects at least one third of women with infertility, both MRI and pelvic US can provide valuable information. If tubal occlusion is suspected, whether due to endometriosis, previous pelvic inflammatory disease, or other cause, hysterosalpingogram (HSG) is the preferred method of evaluation. To assess for anatomic causes of recurrent pregnancy loss (RPL) such as Müllerian anomalies, synechiae, and leiomyomas, saline infusion sonohysterography, MRI and 3-D US are most appropriate. Up to 10% of women suffering recurrent pregnancy loss have a congenital Müllerian anomaly. When assessment of the pituitary gland is indicated, MRI is the imaging exam of choice.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:25706363

  9. ACR Appropriateness Criteria Review ACR Appropriateness Criteria® Occupational Lung Diseases.

    PubMed

    Bacchus, Leon; Shah, Rakesh D; Chung, Jonathan H; Crabtree, Traves P; Heitkamp, Darel E; Iannettoni, Mark D; Johnson, Geoffrey B; Jokerst, Clinton; McComb, Barbara L; Saleh, Anthony G; Steiner, Robert M; Mohammed, Tan-Lucien H; Ravenel, James G

    2016-01-01

    Occupational lung disease is a category of disease entities characterized by a reaction of the lung parenchyma to inhaled aerosolized particles found in the environment. This document summarizes the imaging appropriateness data for silicosis, coal worker pneumoconiosis, and asbestosis. The main points of the document are that computed tomography is more sensitive than radiography, computed tomography without contrast generally suffices for evaluation, and fluorodeoxyglucose-positron emission tomography may have utility in patients with mesothelioma. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26656194

  10. ACR Appropriateness Criteria Clinically Suspected Pulmonary Arteriovenous Malformation.

    PubMed

    Hanley, Michael; Ahmed, Osmanuddin; Chandra, Ankur; Gage, Kenneth L; Gerhard-Herman, Marie D; Ginsburg, Michael; Gornik, Heather L; Johnson, Pamela T; Oliva, Isabel B; Ptak, Thomas; Steigner, Michael L; Strax, Richard; Rybicki, Frank J; Dill, Karin E

    2016-07-01

    Pulmonary arteriovenous malformations are often included in the differential diagnosis of common clinical presentations, including hypoxemia, hemoptysis, brain abscesses, and paradoxical stroke, as well as affecting 30% to 50% of patients with hereditary hemorrhagic telangiectasia (HHT). Various imaging studies are used in the diagnostic and screening settings, which have been reviewed by the ACR Appropriateness Criteria Vascular Imaging Panel. Pulmonary arteriovenous malformation screening in patients with HHT is commonly performed with transthoracic echocardiographic bubble study, followed by CT for positive cases. Although transthoracic echocardiographic bubble studies and radionuclide perfusion detect right-to-left shunts, they do not provide all of the information needed for treatment planning and may remain positive after embolization. Pulmonary angiography is appropriate for preintervention planning but not as an initial test. MR angiography has a potential role in younger patients with HHT who may require lifelong surveillance, despite lower spatial resolution compared with CT. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:27209598

  11. ACR Appropriateness Criteria Acute Trauma to the Foot.

    PubMed

    Bancroft, Laura W; Kransdorf, Mark J; Adler, Ronald; Appel, Marc; Beaman, Francesca D; Bernard, Stephanie A; Bruno, Michael A; Dempsey, Molly E; Fries, Ian B; Khoury, Viviane; Khurana, Bharti; Mosher, Timothy J; Roberts, Catherine C; Tuite, Michael J; Ward, Robert J; Zoga, Adam C; Weissman, Barbara N

    2015-06-01

    This ACR Appropriateness Criteria article offers imaging triage guidance for several variants of patients presenting with acute foot trauma. Patients meeting inclusion criteria for the Ottawa Rules should undergo a 3-view radiographic series. Diabetic patients with peripheral neuropathy should undergo radiography, even though they do not meet the Ottawa Rules inclusion criteria. Patients with suspected midfoot and/or Lisfranc injury should undergo 3-view radiographs with weight bearing on at least the anterior-posterior view. Patients with suspected Lisfranc injury and normal radiographs should be considered for MRI and CT on a case-by-case basis. MRI or ultrasound could confirm cases of suspected acute tendon rupture. Radiography is the initial imaging modality for suspected plantar plate injury after metatarsal-phalangeal joint injury. Weight-bearing anterior-posterior, lateral, and sesamoid axial views may detect proximal migration of the hallux sesamoids. Ultrasound or MRI can directly evaluate the capsuloligamentous complex, specifically the plantar plate. Radiography can detect radiopaque penetrating foreign bodies, and ultrasound can be helpful in detecting those that are nonradiopaque. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures, by the panel. In instances in which evidence is lacking or is not definitive, expert opinion may be used to recommend imaging and treatment. PMID:25935824

  12. ACR Appropriateness Criteria Radiologic Management of Hepatic Malignancy.

    PubMed

    Kouri, Brian E; Abrams, Ross A; Al-Refaie, Waddah B; Azad, Nilofer; Farrell, James; Gaba, Ron C; Gervais, Debra A; Gipson, Matthew G; Kolbeck, Kenneth J; Marshalleck, Francis E; Pinchot, Jason W; Small, William; Ray, Charles E; Hohenwalter, Eric J

    2016-03-01

    Management of primary and secondary hepatic malignancy is a complex problem. Achieving optimal care for this challenging population often requires the involvement of multiple medical and surgical disciplines. Because of the wide variety of potential therapies, treatment protocols for various malignancies continue to evolve. Consequently, development of appropriate therapeutic algorithms necessitates consideration of medical options, such as systemic chemotherapy; surgical options, such as resection or transplantation; and loco-regional therapies, such as thermal ablation and transarterial embolization techniques. This article provides a review of treatment strategies for the three most common subtypes of hepatic malignancy treated with loco-regional therapies: hepatocellular carcinoma, neuroendocrine metastases, and colorectal metastases. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26944037

  13. ACR Appropriateness Criteria Low Back Pain.

    PubMed

    Patel, Nandini D; Broderick, Daniel F; Burns, Judah; Deshmukh, Tejaswini K; Fries, Ian Blair; Harvey, H Benjamin; Holly, Langston; Hunt, Christopher H; Jagadeesan, Bharathi D; Kennedy, Tabassum A; O'Toole, John E; Perlmutter, Joel S; Policeni, Bruno; Rosenow, Joshua M; Schroeder, Jason W; Whitehead, Matthew T; Cornelius, Rebecca S; Corey, Amanda S

    2016-09-01

    Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. PMID:27496288

  14. ACR appropriateness Criteria® second and third trimester bleeding.

    PubMed

    Podrasky, Ann E; Javitt, Marcia C; Glanc, Phyllis; Dubinsky, Theodore; Harisinghani, Mukesh G; Harris, Robert D; Khati, Nadia J; Mitchell, Donald G; Pandharipande, Pari V; Pannu, Harpreet K; Shipp, Thomas D; Siegel, Cary Lynn; Simpson, Lynn; Wall, Darci J; Wong-You-Cheong, Jade J; Zelop, Carolyn M

    2013-12-01

    Vaginal bleeding occurring in the second or third trimesters of pregnancy can variably affect perinatal outcome, depending on whether it is minor (i.e. a single, mild episode) or major (heavy bleeding or multiple episodes.) Ultrasound is used to evaluate these patients. Sonographic findings may range from marginal subchorionic hematoma to placental abruption. Abnormal placentations such as placenta previa, placenta accreta and vasa previa require accurate diagnosis for clinical management. In cases of placenta accreta, magnetic resonance imaging is useful as an adjunct to ultrasound and is often appropriate for evaluation of the extent of placental invasiveness and potential involvement of adjacent structures. MRI is useful for preplanning for cases of complex delivery, which may necessitate a multi-disciplinary approach for optimal care.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:24263752

  15. ACR Appropriateness Criteria® Intensive Care Unit Patients.

    PubMed

    Suh, Robert D; Genshaft, Scott J; Kirsch, Jacobo; Kanne, Jeffrey P; Chung, Jonathan H; Donnelly, Edwin F; Ginsburg, Mark E; Heitkamp, Darel E; Henry, Travis S; Kazerooni, Ella A; Ketai, Loren H; McComb, Barbara L; Ravenel, James G; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Mohammed, Tan-Lucien H

    2015-11-01

    Portable chest radiography is a fundamental and frequently utilized examination in the critically ill patient population. The chest radiograph often represents a timely investigation of new or rapidly evolving clinical findings and an evaluation of proper positioning of support tubes and catheters. Thoughtful consideration of the use of this simple yet valuable resource is crucial as medical cost containment becomes even more mandatory. This review addresses the role of chest radiography in the intensive care unit on the basis of the existing literature and as formed by a consensus of an expert panel on thoracic imaging through the American College of Radiology. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26439890

  16. ACR Appropriateness Criteria Follow-Up of Malignant or Aggressive Musculoskeletal Tumors.

    PubMed

    Roberts, Catherine C; Kransdorf, Mark J; Beaman, Francesca D; Adler, Ronald S; Amini, Behrang; Appel, Marc; Bernard, Stephanie A; Fries, Ian Blair; Germano, Isabelle M; Greenspan, Bennett S; Holly, Langston T; Kubicky, Charlotte D; Shek-Man Lo, Simon; Mosher, Timothy J; Sloan, Andrew E; Tuite, Michael J; Walker, Eric A; Ward, Robert J; Wessell, Daniel E; Weissman, Barbara N

    2016-04-01

    Appropriate imaging modalities for the follow-up of malignant or aggressive musculoskeletal tumors include radiography, MRI, CT, (18)F-2-fluoro-2-deoxy-D-glucose PET/CT, (99m)Tc bone scan, and ultrasound. Clinical scenarios reviewed include evaluation for metastatic disease to the lung in low- and high-risk patients, for osseous metastatic disease in asymptomatic and symptomatic patients, for local recurrence of osseous tumors with and without significant hardware present, and for local recurrence of soft tissue tumors. The timing for follow-up of pulmonary metastasis surveillance is also reviewed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26922595

  17. ACR appropriateness criteria asymptomatic patient at risk for coronary artery disease.

    PubMed

    Earls, James P; Woodard, Pamela K; Abbara, Suhny; Akers, Scott R; Araoz, Philip A; Cummings, Kristopher; Cury, Ricardo C; Dorbala, Sharmila; Hoffmann, Udo; Hsu, Joe Y; Jacobs, Jill E; Min, James K

    2014-01-01

    Atherosclerotic cardiovascular disease is the leading cause of death for both men and women in the United States. Coronary artery disease has a long asymptomatic latent period and early targeted preventive measures can reduce mortality and morbidity. It is important to accurately classify individuals at elevated risk in order to identify those who might benefit from early intervention. Imaging advances have made it possible to detect subclinical coronary atherosclerosis. Coronary artery calcium score correlates closely with overall atherosclerotic burden and provides useful prognostic information for patient management. Our purpose is to discuss use of diagnostic imaging in asymptomatic patients at elevated risk for future cardiovascular events. The goal for these patients is to further refine targeted preventative efforts based on risk. The following imaging modalities are available for evaluating asymptomatic patients at elevated risk: radiography, fluoroscopy, multidetector CT, ultrasound, MRI, cardiac perfusion scintigraphy, echocardiography, and PET. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:24316232

  18. ACR Appropriateness Criteria chronic chest pain-low to intermediate probability of coronary artery disease.

    PubMed

    Woodard, Pamela K; White, Richard D; Abbara, Suhny; Araoz, Philip A; Cury, Ricardo C; Dorbala, Sharmila; Earls, James P; Hoffmann, Udo; Hsu, Joe Y; Jacobs, Jill E; Javidan-Nejad, Cylen; Krishnamurthy, Rajesh; Mammen, Leena; Martin, Edward T; Ryan, Thomas; Shah, Amar B; Steiner, Robert M; Vogel-Claussen, Jens; White, Charles S

    2013-05-01

    Chronic chest pain can arise from a variety of etiologies. However, of those potential causes, the most life-threatening include cardiac disease. Chronic cardiac chest pain may be caused either by ischemia or atherosclerotic coronary artery disease or by other cardiac-related etiologies, such as pericardial disease. To consider in patients, especially those who are at low risk for coronary artery disease, are etiologies of chronic noncardiac chest pain. Noncardiac chest pain is most commonly related to gastroesophageal reflux disease or other esophageal diseases. Alternatively, it may be related to costochondritis, arthritic or degenerative diseases, old trauma, primary or metastatic tumors, or pleural disease. Rarely, noncardiac chest pain may be referred pain from organ systems below the diaphragm, such as the gallbladder. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:23542027

  19. ACR Appropriateness Criteria Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease.

    PubMed

    Hoffmann, Udo; Akers, Scott R; Brown, Richard K J; Cummings, Kristopher W; Cury, Ricardo C; Greenberg, S Bruce; Ho, Vincent B; Hsu, Joe Y; Min, James K; Panchal, Kalpesh K; Stillman, Arthur E; Woodard, Pamela K; Jacobs, Jill E

    2015-12-01

    Primary imaging options in patients at low risk for coronary artery disease (CAD) who present with undifferentiated chest pain and without signs of ischemia are functional testing with exercise or pharmacologic stress-based electrocardiography, echocardiography, or myocardial perfusion imaging to exclude myocardial ischemia after rule-out of myocardial infarction and early cardiac CT because of its high negative predictive value to exclude CAD. Although possible, is not conclusive whether triple-rule-out CT (CAD, pulmonary embolism, and aortic dissection) might improve the efficiency of patient management. More advanced noninvasive tests such as cardiac MRI and invasive imaging with transesophageal echocardiography or coronary angiography are rarely indicated. With increased likelihood of noncardiac causes, a number of diagnostic tests, among them ultrasound of the abdomen, MR angiography of the aorta with or without contrast, x-ray rib views, x-ray barium swallow, and upper gastrointestinal series, can also be appropriate. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. This recommendation is based on excellent evidence, including several randomized comparative effectiveness trials and blinded observational cohort studies. PMID:26653833

  20. ACR Appropriateness Criteria Fever Without Source or Unknown Origin-Child.

    PubMed

    Westra, Sjirk J; Karmazyn, Boaz K; Alazraki, Adina L; Dempsey, Molly E; Dillman, Jonathan R; Garber, Matthew; Moore, Sheila G; Raske, Molly E; Rice, Henry E; Rigsby, Cynthia K; Safdar, Nabile; Simoneaux, Stephen F; Strouse, Peter J; Trout, Andrew T; Wootton-Gorges, Sandra L; Coley, Brian D

    2016-08-01

    The cause of fever in a child can often be determined from history, physical examination, and laboratory tests; infections account for the majority of cases. Yet in 20%, no apparent cause can be found, designated as fever without source (FWS). The yield of chest radiography in children with FWS is low, and it is usually not appropriate. However, in children with respiratory signs, high fever (>39°C), or marked leukocytosis (≥20,000/mm(3)), chest radiography is usually appropriate, as it has a higher yield in detecting clinically occult pneumonia. In newborns with FWS, there is higher risk for serious bacterial infection, and the routine use of chest radiography is controversial. In children with neutropenia, fever is a major concern. In some clinical circumstances, such as after hematopoietic stem cell transplantation, chest CT scan may be appropriate even if the results of chest radiography are negative or nonspecific, as it has higher sensitivity and can demonstrate specific findings (such as lung nodule and "halo sign") that can guide management. In a child with prolonged fever of unknown origin despite extensive medical workup (fever of unknown origin), diagnosis is usually dependent on clinical and laboratory studies, and imaging tests have low yield. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or

  1. ACR Appropriateness Criteria® Hodgkin Lymphoma-Unfavorable Clinical Stage I and II.

    PubMed

    Roberts, Kenneth B; Younes, Anas; Hodgson, David C; Advani, Ranjana; Dabaja, Bouthaina S; Dhakal, Sughosh; Flowers, Christopher R; Ha, Chul S; Hoppe, Bradford S; Mendenhall, Nancy P; Metzger, Monika L; Plastaras, John P; Shapiro, Ronald; Smith, Sonali M; Terezakis, Stephanie A; Winkfield, Karen M; Constine, Louis S

    2016-08-01

    These guidelines review the historical evolution of treatment for early-stage Hodgkin lymphoma (HL) with current standards that rely on prognostic factors to risk stratify and direct current treatment schemes that includes differentiation of favorable and unfavorable presentations. The major clinical trials for unfavorable early-stage HL are reviewed. Patients in this heterogenous subgroup of classic HL are best managed with sequential chemotherapy and radiotherapy. The role of imaging response assessment as a means to modify therapy is a strategy under investigation. Tailoring the radiation treatment volume and radiation dose prescription along with selective use of modern conformal techniques is expected to help reduce long-term toxicities. Many patients are well served receiving involved-site radiotherapy to 30 Gy after appropriate systemic therapy intensity; but, there are nuances for which some variations in the chemotherapy and radiotherapy specifics are appropriately individualized. Following a discussion of the current evidence-based treatment algorithms, several different example cases are reviewed to help physicians make appropriate treatment decisions. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:27299425

  2. ACR Appropriateness Criteria® Pre-Irradiation Evaluation and Management of Brain Metastases

    PubMed Central

    Gore, Elizabeth M.; Bradley, Jeffrey D.; Buatti, John M.; Germano, Isabelle; Ghafoori, A. Paiman; Henderson, Mark A.; Murad, Gregory J.A.; Patchell, Roy A.; Patel, Samir H.; Robbins, Jared R.; Robins, H. Ian; Vassil, Andrew D.; Wippold, Franz J.; Yunes, Michael J.; Videtic, Gregory M.M.

    2014-01-01

    Abstract Pretreatment evaluation is performed to determine the number, location, and size of the brain metastases and magnetic resonance imaging (MRI) is the recommended imaging technique, particularly in patients being considered for surgery or stereotactic radiosurgery. A contiguous thin-cut volumetric MRI with gadolinium with newer gadolinium-based agents can improve detection of small brain metastases. A systemic workup and medical evaluation are important, given that subsequent treatment for the brain metastases will also depend on the extent of the extracranial disease and on the age and performance status of the patient. Patients with hydrocephalus or impending brain herniation should be started on high doses of corticosteroids and evaluated for possible neurosurgical intervention. Patients with moderate symptoms should receive approximately 4–8 mg/d of dexamethasone in divided doses. The routine use of corticosteroids in patients without neurologic symptoms is not necessary. There is no proven benefit of anticonvulsants in patient without seizures. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:24971478

  3. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group.

    PubMed

    Andreotti, Rochelle F; Lee, Susanna I; Dejesus Allison, Sandra O; Bennett, Genevieve L; Brown, Douglas L; Dubinsky, Theodore; Glanc, Phyllis; Javitt, Marcia C; Mitchell, Donald G; Podrasky, Ann E; Shipp, Thomas D; Siegel, Cary Lynn; Wong-You-Cheong, Jade J; Zelop, Carolyn M

    2011-09-01

    Premenopausal women who present with acute pelvic pain frequently pose a diagnostic dilemma, exhibiting nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. Diagnostic considerations encompass multiple organ systems, including obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The selection of imaging modality is determined by the clinically suspected differential diagnosis. Thus, a careful evaluation of such a patient should be performed and diagnostic considerations narrowed before a modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice when an obstetric or gynecologic abnormality is suspected, and computed tomography is more useful when gastrointestinal or genitourinary pathology is more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies because of the lack of ionizing radiation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:21873877

  4. ACR Appropriateness Criteria Retreatment of Recurrent Head and Neck Cancer After Prior Definitive Radiation

    SciTech Connect

    McDonald, Mark W.; Lawson, Joshua; Garg, Madhur Kumar; Quon, Harry; Ridge, John A.; Saba, Nabil; Salama, Joseph K.; Smith, Richard V.; Yeung, Anamaria Reyna; Yom, Sue S.; Beitler, Jonathan J.

    2011-08-01

    Recurrent and second primary head-and-neck squamous cell carcinomas arising within or in close proximity to previously irradiated fields are a common clinical challenge. Whereas surgical salvage therapy is recommended for resectable disease, randomized data support the role of postoperative reirradiation in high-risk patients. Definitive reirradiation is an established approach for patients with recurrent disease who are medically or technically inoperable or decline radical surgery. The American College of Radiology Expert Panel on Head and Neck Cancer reviewed the relevant literature addressing re-treatment after prior definitive radiation and developed appropriateness criteria for representative clinical scenarios. Examples of unresectable recurrent disease and microscopic residual disease after salvage surgery were addressed. The panel evaluated the appropriateness of reirradiation, the integration of concurrent chemotherapy, radiation technique, treatment volume, dose, and fractionation. The panel emphasized the importance of patient selection and recommended evaluation and treatment at tertiary-care centers with a head-and-neck oncology team equipped with the resources and experience to manage the complexities and toxicities of re-treatment.

  5. ACR Appropriateness Criteria® Diffuse Large B-Cell Lymphoma.

    PubMed

    Dabaja, Bouthaina S; Advani, Ranjana; Hodgson, David C; Dhakal, Sughosh; Flowers, Christopher R; Ha, Chul S; Hoppe, Bradford S; Mendenhall, Nancy P; Metzger, Monika L; Plastaras, John P; Roberts, Kenneth B; Shapiro, Ronald; Smith, Sonali M; Terezakis, Stephanie A; Winkfield, Karen M; Younes, Anas; Constine, Louis S

    2015-12-01

    The management of diffuse large B-cell lymphoma depends on the initial diagnosis including molecular and immunophenotypic characteristics, Ann Arbor staging, and International Prognostic Index (IPI score). Treatment approaches with different chemotherapy regimens used is discussed in detail. The role of radiation as a consolidation is discussed including: (1) the prerituximab randomized trials that challenged the role of radiation, (2) recent prospective studies (UNFOLDER/RICOVER-60), and (3) retrospective studies; the last 2 showed a potential benefit of radiation both for early and advanced stage. The document also discusses the role of positron emission tomography/computed tomography for predicting outcome and potentially guiding therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26583344

  6. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group.

    PubMed

    Bhosale, Priyadarshani R; Javitt, Marcia C; Atri, Mostafa; Harris, Robert D; Kang, Stella K; Meyer, Benjamin J; Pandharipande, Pari V; Reinhold, Caroline; Salazar, Gloria M; Shipp, Thomas D; Simpson, Lynn; Sussman, Betsy L; Uyeda, Jennifer; Wall, Darci J; Zelop, Carolyn M; Glanc, Phyllis

    2016-06-01

    Acute pelvic pain in premenopausal women frequently poses a diagnostic dilemma. These patients may exhibit nonspecific signs and symptoms such as nausea, vomiting and leukocytosis. The cause of pelvic pain includes a myriad of diagnostic possibilities such as obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The choice of the imaging modality is usually determined by a suspected clinical differential diagnosis. Thus the patient should undergo careful evaluation and the suspected differential diagnosis should be narrowed before an optimal imaging modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice, to assess for pelvic pain, when an obstetric or gynecologic etiology is suspected and computed tomography is often more useful when gastrointestinal or genitourinary pathology is thought to be more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies owing to its lack of ionizing radiation.The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26588104

  7. ACR Appropriateness Criteria® Local Excision in Early Stage Rectal Cancer.

    PubMed

    Russo, Suzanne; Blackstock, A William; Herman, Joseph M; Abdel-Wahab, May; Azad, Nilofer; Das, Prajnan; Goodman, Karyn A; Hong, Theodore S; Jabbour, Salma K; Jones, William E; Konski, Andre A; Koong, Albert C; Kumar, Rachit; Rodriguez-Bigas, Miguel; Small, William; Thomas, Charles R; Suh, W Warren

    2015-10-01

    Low anterior resection or abdominoperineal resection are considered standard treatments for early rectal cancer but may be associated with morbidity in selected patients who are candidates for early distal lesions amenable to local excision (LE). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The panel recognizes the importance of accurate staging to identify patients who may be candidates for a LE approach. Patients who may be candidates for LE alone include those with small, low-lying T1 tumors, without adverse pathologic features. Several surgical approaches can be utilized for LE however none include lymph node evaluation. Adjuvant radiation±chemotherapy may be warranted depending on the risk of nodal metastases. Patients with high-risk T1 tumors, T2 tumors not amenable to radical surgery may also benefit from adjuvant treatment; however, patients with positive margins or T3 lesions should be offered abdominoperineal resection or low anterior resection. Neoadjuvant radiation±chemotherapy followed by LE in higher risk patients results in excellent local control, but it is not clear if this approach reduces recurrence rates over surgery alone. PMID:26371522

  8. ACR Appropriateness Criteria on Induction and Adjuvant Therapy for Stage N2 Non-Small-Cell Lung Cancer: Expert Panel on Radiation Oncology-Lung

    SciTech Connect

    Gopal, Ramesh S.; Dubey, Sarita; Rosenzweig, Kenneth E.; Chang, Joe Yujiao; Decker, Roy; Gewanter, Richard M.; Kong Fengming; Lally, Brian E.; Langer, Corey J.; Lee, Hoon Ku; Movsas, Benjamin M.D.

    2010-11-15

    'The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply society endorsement of the final document.'

  9. ACCF/ACR/AIUM/ASE/ASN/ICAVL/SCAI/SCCT/SIR/SVM/SVS 2012 appropriate use criteria for peripheral vascular ultrasound and physiological testing part I: Arterial ultrasound and physiological testing

    PubMed Central

    Mohler, Emile R.; Gornik, Heather L.; Gerhard-Herman, Marie; Misra, Sanjay; Olin, Jeffrey W.; Zierler, R. Eugene

    2015-01-01

    The American College of Cardiology Foundation (ACCF), in partnership with key specialty and subspecialty societies, conducted a review of common clinical scenarios where noninvasive vascular testing (ultrasound and physiological testing) is frequently considered. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC). The 159 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). A total of 255 indications (with the inclusion of surveillance timeframes) were rated. One hundred and seventeen indications were rated as appropriate, 84 were rated as uncertain, and 54 were rated as inappropriate. The AUC for peripheral vascular disease have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID:22694919

  10. ACCF/ACR/AIUM/ASE/ASN/ICAVL/SCAI/SCCT/SIR/SVM/SVS 2012 Appropriate Use Criteria for Peripheral Vascular Ultrasound and Physiological Testing Part I: Arterial Ultrasound and Physiological Testing

    PubMed Central

    Mohler, Emile R.; Gornik, Heather L.; Gerhard-Herman, Marie; Misra, Sanjay; Olin, Jeffrey W.; Zierler, R. Eugene; Wolk, Michael J.; Mohler, Emile R.; Dixon, Bradley S.; Driver, Vickie R.; Fail, Peter S.; Fazel, Reza; Findeiss, Laura; Fuchs, Richard; Gillespie, John; Hughes, Joseph P.; Jaigobin, Cheryl; Leers, Steven A.; Moore, Colleen; Pellerito, John S.; Robbin, Michelle L.; Shugart, Rita E.; Weaver, Fred A.; White, Christopher J.; Yevzlin, Alexander S.; Wolk, Michael J.; Bailey, Steven R.; Douglas, Pamela S.; Hendel, Robert C.; Kramer, Christopher M.; Min, James K.; Patel, Manesh R.; Shaw, Leslee; Stainback, Raymond F.; Allen, Joseph M.

    2015-01-01

    The American College of Cardiology Foundation (ACCF), in partnership with key specialty and subspecialty societies, conducted a review of common clinical scenarios where noninvasive vascular testing (ultrasound and physiological testing) is frequently considered. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC). The 159 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). A total of 255 indications (with the inclusion of surveillance timeframes) were rated. One hundred and seventeen indications were rated as appropriate, 84 were rated as uncertain, and 54 were rated as inappropriate. The AUC for peripheral vascular disease have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID:22694840

  11. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine.

    PubMed

    Hendel, Robert C; Berman, Daniel S; Di Carli, Marcelo F; Heidenreich, Paul A; Henkin, Robert E; Pellikka, Patricia A; Pohost, Gerald M; Williams, Kim A

    2009-06-01

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac radionuclide imaging (RNI) is frequently considered. This document is a revision of the original Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI) Appropriateness Criteria, published 4 years earlier, written to reflect changes in test utilization and new clinical data, and to clarify RNI use where omissions or lack of clarity existed in the original criteria. This is in keeping with the commitment to revise and refine appropriate use criteria (AUC) on a frequent basis. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Sixty-seven clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of cardiac RNI for diagnosis and risk assessment in intermediate- and high-risk patients with coronary artery disease (CAD) was viewed favorably, while testing in low-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Additionally, use for perioperative testing was found to be inappropriate except for high selected groups of patients. It is anticipated that these results will have a significant impact on physician decision making, test performance, and reimbursement policy, and will help guide future research. PMID:19451357

  12. Appropriate Use Criteria for Amyloid PET

    PubMed Central

    Johnson, Keith A.; Minoshima, Satoshi; Bohnen, Nicolaas I.; Donohoe, Kevin J.; Foster, Norman L.; Herscovitch, Peter; Karlawish, Jason H.; Rowe, Christopher C.; Carrillo, Maria C.; Hartley, Dean M.; Hedrick, Saima; Mitchell, Kristi; Pappas, Virginia; Thies, William H.

    2013-01-01

    Positron Emission Tomography (PET) of brain amyloid-beta is a technology that is becoming more available, but its clinical utility in medical practice requires careful definition. In order to provide guidance to dementia care practitioners, patients and caregivers, the Alzheimer Association and the Society of Nuclear Medicine and Molecular Imaging convened the Amyloid Imaging Taskforce (AIT). The AIT considered a broad range of specific clinical scenarios in which amyloid PET could potentially be appropriately used. Peer-reviewed, published literature was searched to ascertain available evidence relevant to these scenarios, and the AIT developed a consensus of expert opinion. While empirical evidence of impact on clinical outcomes is not yet available, a set of specific Appropriate Use Criteria (AUC) were agreed upon that define the types of patients and clinical circumstances in which amyloid PET could be used. Both appropriate and inappropriate uses were considered and formulated, and are reported and discussed here. Because both dementia care and amyloid PET technology are in active development, these AUC will require periodic reassessment. Future research directions are also outlined, including diagnostic utility and patient-centered outcomes. PMID:23360977

  13. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D

    2010-11-23

    The American College of Cardiology Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:20975004

  14. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D; Kramer, Christopher M; Berman, Daniel; Brown, Alan; Chaudhry, Farooq A; Cury, Ricardo C; Desai, Milind Y; Einstein, Andrew J; Gomes, Antoinette S; Harrington, Robert; Hoffmann, Udo; Khare, Rahul; Lesser, John; McGann, Christopher; Rosenberg, Alan; Schwartz, Robert; Shelton, Marc; Smetana, Gerald W; Smith, Sidney C

    2010-11-23

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:21087721

  15. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D

    2010-01-01

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:21232696

  16. Developing a Formal Representation for Medication Appropriateness Criteria

    PubMed Central

    Salmasian, Hojjat; Tran, Tran H; Friedman, Carol

    2014-01-01

    Inappropriate medications use (IMU) is a serious issue of global concern that leads to a waste of resources and potentially harms the patients. IMU can usually be identified by extracting information about the patient’s conditions and treatments, and comparing them with “medication appropriateness criteria”. To enable automation of these criteria, we developed a formal representation for them, which we called Objective Medication Appropriateness Criteria (OMAC). OMAC represents four aspects of the criteria: trigger, rules, action and metadata. Our evaluation showed that OMAC can completely represent explicitly defined medication appropriateness criteria using links to external knowledge sources. OMAC is the first formal representation for medication appropriateness criteria, and will enable development of structured rules for appropriate use of medications that can be implemented using standards for clinical decision support. PMID:25954464

  17. Development and validation of a simple lupus severity index using ACR criteria for classification of SLE

    PubMed Central

    Bello, Ghalib A; Brown, Michael A; Kelly, Jennifer A; Thanou, Aikaterini; James, Judith A; Montgomery, Courtney G

    2016-01-01

    Objective To develop a simple systemic lupus erythematosus (SLE) severity index that requires knowledge of only American College of Rheumatology (ACR) criteria and subcriteria. Methods This study used demographic, mortality and medical records data of 1915 patients with lupus from the Lupus Family Registry and Repository. The data were randomly split (2:1 ratio) into independent training and validation sets. A logistic regression with ridge penalty was used to model the probability of being prescribed major immunosuppressive drugs—a surrogate indicator of lupus severity. ACR criteria and subcriteria were used as predictor variables in this model, and the resulting regression coefficient estimates obtained from the training data were used as item weightings to construct the severity index. Results The resulting index was tested on the independent validation dataset and was found to have high predictive accuracy for immunosuppressive use and early mortality. The index was also found to be strongly correlated with a previously existing severity score for lupus. In addition, demographic factors known to influence lupus severity (eg, age of onset, gender and ethnicity) all showed robust associations with our severity index that were consistent with observed clinical trends. Conclusions This new index can be easily computed using ACR criteria, which may be among the most readily available data elements from patient medical records. This tool may be useful in lupus research, especially large dataset analyses to stratify patients by disease severity, an important prognostic indicator in SLE. PMID:27026812

  18. The Features of the Synovium in Early Rheumatoid Arthritis According to the 2010 ACR/EULAR Classification Criteria

    PubMed Central

    van de Sande, Marleen G. H.; de Hair, Maria J. H.; Schuller, Yvonne; van de Sande, Gijs P. M.; Wijbrandts, Carla A.; Dinant, Huib J.; Gerlag, Danielle M.; Tak, Paul P.

    2012-01-01

    Objectives It has been shown in early arthritis cohorts that the 2010 ACR/EULAR criteria for rheumatoid arthritis (RA) enable an earlier diagnosis, perhaps at the cost of a somewhat more heterogeneous patient population. We describe the features of synovial inflammation in RA patients classified according to these new criteria. Methods At baseline, synovial tissue biopsy samples were obtained from disease-modifying antirheumatic drug (DMARD)-naïve early RA patients (clinical signs and symptoms <1 year). Synovial tissue was analyzed for cell infiltration, vascularity, and expression of adhesion molecules. Stained sections were evaluated by digital image analysis. Patients were classified according to the two different sets of classification criteria, autoantibody status, and outcome. Findings Synovial tissue of 69 RA patients according to 2010 ACR/EULAR criteria was analyzed: 56 patients who fulfilled the criteria for RA at baseline and 13 who were initially diagnosed as undifferentiated arthritis but fulfilled criteria for RA upon follow up. The synovium at baseline was infiltrated by plasma cells, macrophages, and T cells as well as other cells, and findings were comparable to those when patients were selected based on the 1987 ACR criteria for RA. There was no clear cut difference in the characteristics of the synovium between RA patients initially diagnosed as undifferentiated arthritis and those who already fulfilled classification criteria at baseline. Conclusion The features of synovial inflammation are similar when the 2010 ACR/EULAR classification criteria are used compared to the 1987 ACR criteria. PMID:22574210

  19. Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method

    PubMed Central

    Basger, Benjamin Joseph; Chen, Timothy Frank; Moles, Rebekah Jane

    2012-01-01

    Objective To further develop and validate previously published national prescribing appropriateness criteria to assist in identifying drug-related problems (DRPs) for commonly occurring medications and medical conditions in older (≥65 years old) Australians. Design RAND/UCLA appropriateness method. Participants A panel of medication management experts were identified consisting of geriatricians/pharmacologists, clinical pharmacists and disease management advisors to organisations that produce Australian evidence-based therapeutic publications. This resulted in a round-one panel of 15 members, and a round-two panel of 12 members. Main outcome measure Agreement on all criteria. Results Forty-eight prescribing criteria were rated. In the first rating round via email, there was disagreement regarding 17 of the criteria according to median panel ratings. During a face-to-face second round meeting, discussion resulted in retention of 25 criteria after amendments, agreement for 14 criteria with no changes required and deletion of 9 criteria. Two new criteria were added, resulting in a final validated list of 41 prescribing appropriateness criteria. Agreement after round two was reached for all 41 criteria, measured by median panel ratings and the amount of dispersion of panel ratings, based on the interpercentile range. Conclusions A set of 41 Australian prescribing appropriateness criteria were validated by an expert panel. Use of these criteria, together with clinical judgement and other medication review processes such as patient interview, is intended to assist in improving patient care by efficiently detecting potential DRPs related to commonly occurring medicines and medical conditions in older Australians. These criteria may also contribute to the medication management education of healthcare professionals. PMID:22983875

  20. Development of appropriateness explicit criteria for cataract extraction by phacoemulsification

    PubMed Central

    Ma Quintana, José; Escobar, Antonio; Aróstegui, Inmaculada

    2006-01-01

    Background Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cataract extraction. We developed a new appropriateness of indications tool for cataract following the RAND method. We tested the validity of our panel results. Methods Criteria were developed using a modified Delphi panel judgment process. A panel of 12 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the influence of all variables on the final panel score using linear and logistic regression models. The explicit criteria developed were summarized by classification and regression tree analysis. Results Of the 765 indications evaluated by the main panel in the second round, 32.9% were found appropriate, 30.1% uncertain, and 37% inappropriate. Agreement was found in 53% of the indications and disagreement in 0.9%. Seven variables were considered to create the indications and divided into three groups: simple cataract, with diabetic retinopathy, or with other ocular pathologies. The preoperative visual acuity in the cataractous eye and visual function were the variables that best explained the panel scoring. The panel results were synthesized and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel original criteria, was 5.3%. Conclusion The parameters tested showed acceptable validity for an evaluation tool. These results support the use of this indication algorithm as a screening tool for assessing the appropriateness of cataract extraction in field studies and for the development of practice guidelines. PMID:16512906

  1. Applying appropriate-use criteria to cardiac revascularisation in India

    PubMed Central

    Sood, Neeraj; Ugargol, Allen P; Barnes, Kayleigh; Mahajan, Anish

    2016-01-01

    Objectives The high prevalence of coronary heart disease and dramatic growth of cardiac interventions in India motivate an evaluation of the appropriateness of coronary revascularisation procedures in India. Although, appropriate-use criteria (AUC) have been used to analyse the appropriateness of cardiovascular care in the USA, they are yet to be applied to care in India. In our study, we apply AUC to cardiac care in Karnataka, India, compare our results to international applications of AUC, and suggest ways to improve the appropriateness of care in India. Setting Data were collected from the Vajpayee Arogyashree Scheme, a government-sponsored health insurance scheme in Karnataka, India. These data were collected as part of the preauthorisation process for cardiac procedures. Participants The final data included a random sample of 600 patients from 28 hospitals in Karnataka, who obtained coronary artery bypass grafting or percutaneous coronary intervention between 1 October 2014 and 31 December 2014. Primary and secondary outcome measures We obtained our primary baseline results using a random imputation simulation to fill in missing data. Our secondary outcome measure was a best case–worst case scenario where missing data were filled to give the lowest or highest number of appropriate cases. Results Of the cases, 86.7% (CI 0.837% to 0.892%) were deemed appropriate, 3.65% (CI 0.023% to 0.055%) were inappropriate and 9.63% (CI 0.074% to 0.123%) were uncertain. Conclusions The vast majority of cardiac revascularisation procedures performed on beneficiaries of a government-sponsored insurance programme in India were found to be appropriate. These results meet or exceed levels of appropriate use of cardiac care in the USA. PMID:27029773

  2. Performance of the new 2011 ACR/EULAR remission criteria with tocilizumab using the phase IIIb study TAMARA as an example and their comparison with traditional remission criteria

    PubMed Central

    Iking-Konert, Christof; Aringer, Martin; Wollenhaupt, Jürgen; Mosch, Thomas; Tuerk, Stefan; Feist, Eugen; Burmester, Gerd R

    2011-01-01

    Background Remission is the established goal in rheumatoid arthritis (RA) treatment. Although originally defined by a disease activity score in 28 joints (DAS28) <2.6, more stringent criteria may imply the absence of disease activity. The 2011 ACR/EULAR remission criteria provide the newest and most stringent definition of remission. Objectives To evaluate post hoc the remission by ACR/EULAR criteria and compare the criteria with the conventional DAS28 in TAMARA, an open-label phase IIIb tocilizumab (TCZ) trial including patients with active RA receiving inadequate disease-modifying antirheumatic drugs (DMARDs) or tumour necrosis factor α (TNFα) inhibitor treatment. Results 286 patients were enrolled, 99.7% of patients were receiving a conventional DMARD and 41.6% had TNFα inhibitor pretreatment. Baseline mean DAS28 of 6.0 ± 1.0 fell to 2.6 ± 1.5 at week 24. DAS28 <2.6 was achieved by 47.6% at week 24. Remission rates with the new ACR/EULAR Boolean-based criteria for clinical studies were 15.0% after 12 weeks and 20.3% after 24 weeks. Of note, 13.5% of patients with previous TNFα blocker inadequate response still achieved remission according to the new ACR/EULAR criteria after 24 weeks. Clinical Disease Activity Index and Simplified Disease Activity Index remission rates were 24.1% and 25.2%, respectively. Conclusions Under the definition of the new stringent 2011 ACR/EULAR remission criteria, patients with active RA despite DMARD treatment and even after inadequate response to TNFα inhibitors, receiving TCZ showed significant rates of remission. Similar remission rates were achieved, when clinical practice criteria, not inclusive of acute phase reactants, were used. PMID:21875873

  3. ACR Appropriateness Criteria on acute pelvic pain in the reproductive age group.

    PubMed

    Andreotti, Rochelle F; Lee, Susanna I; Choy, Garry; DeJesus Allison, Sandra O; Bennett, Genevieve L; Brown, Douglas L; Glanc, Phyllis; Horrow, Mindy M; Javitt, Marcia C; Lev-Toaff, Anna S; Podrasky, Ann E; Scoutt, Leslie M; Zelop, Carolyn

    2009-04-01

    Premenopausal women who present with acute pelvic pain frequently pose a diagnostic dilemma, exhibiting nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. Diagnostic considerations encompass multiple organ systems, including obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The selection of imaging modality is determined by the clinically suspected differential diagnosis. Thus, a careful evaluation of such a patient should be performed and diagnostic considerations narrowed before a modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice when an obstetric or gynecologic abnormality is suspected, and computed tomography is more useful when gastrointestinal or genitourinary pathology is more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies because of the lack of ionizing radiation. PMID:19327655

  4. Teacher Criteria for Evaluating and Selecting Developmentally Appropriate Computer Software

    ERIC Educational Resources Information Center

    Ntuli, Esther; Kyei-Blankson, Lydia

    2011-01-01

    Although many teacher training programs and school districts offer courses and workshops on technology integration in instruction, research shows that teachers still face major challenges especially as it relates to selecting and using developmentally appropriate technology to meet the needs of diverse learners. The current study examines the…

  5. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Criteria for establishing appropriated fund wage areas. 532.211 Section 532.211 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS Prevailing Rate Determinations § 532.211 Criteria for establishing appropriated fund wage areas. (a)...

  6. Selective involvement of ERK and JNK mitogen-activated protein kinases in early rheumatoid arthritis (1987 ACR criteria compared to 2010 ACR/EULAR criteria): a prospective study aimed at identification of diagnostic and prognostic biomarkers as well as therapeutic targets

    PubMed Central

    de Launay, Daphne; van de Sande, Marleen GH; de Hair, Maria JH; Grabiec, Aleksander M; van de Sande, Gijs PM; Lehmann, K Aad; Wijbrandts, Carla A; van Baarsen, Lisa GM; Gerlag, Danielle M; Tak, Paul P; Reedquist, Kris A

    2012-01-01

    Objectives To investigate the expression and activation of mitogen-activated protein kinases in patients with early arthritis who are disease-modifying antirheumatic drug (DMARD) naïve. Methods A total of 50 patients with early arthritis who were DMARD naïve (disease duration <1 year) were prospectively followed and diagnosed at baseline and after 2 years for undifferentiated arthritis (UA), rheumatoid arthritis (RA) (1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism (EULAR) criteria), or spondyloarthritis (SpA). Synovial biopsies obtained at baseline were examined for expression and phosphorylation of p38, extracellular signal regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) by immunohistochemistry and digital analysis. Synovial tissue mRNA expression was measured by quantitative PCR (qPCR). Results ERK and JNK activation was enhanced at inclusion in patients meeting RA criteria compared to other diagnoses. JNK activation was enhanced in patients diagnosed as having UA at baseline who eventually fulfilled 1987 ACR RA criteria compared to those who remained UA, and in patients with RA fulfilling 2010 ACR/EULAR criteria at baseline. ERK and JNK activation was enhanced in patients with RA developing progressive joint destruction. JNK activation in UA predicted 1987 ACR RA classification criteria fulfilment (R2=0.59, p=0.02) after follow-up, and disease progression in early arthritis (R2=0.16, p<0.05). Enhanced JNK activation in patients with persistent disease was associated with altered synovial expression of extracellular matrix components and CD44. Conclusions JNK activation is elevated in RA before 1987 ACR RA classification criteria are met and predicts development of erosive disease in early arthritis, suggesting JNK may represent an attractive target in treating RA early in the disease process. PMID:21953337

  7. Towards Tailored Patient's Management Approach: Integrating the Modified 2010 ACR Criteria for Fibromyalgia in Multidimensional Patient Reported Outcome Measures Questionnaire

    PubMed Central

    El Miedany, Yasser; El Gaafary, Maha; Youssef, Sally; Ahmed, Ihab

    2016-01-01

    Objectives. To assess the validity, reliability, and responsiveness to change of a patient self-reported questionnaire combining the Widespread Pain Index and the Symptom Severity Score as well as construct outcome measures and comorbidities assessment in fibromyalgia patients. Methods. The PROMs-FM was conceptualized based on frameworks used by the WHO Quality of Life tool and the PROMIS. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction were achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented. The questionnaire included the modified ACR criteria main items (Symptom Severity Score and Widespread Pain Index), in addition to assessment of functional disability, quality of life (QoL), review of the systems, and comorbidities. Every patient completed HAQ and EQ-5D questionnaires. Results. A total of 146 fibromyalgia patients completed the questionnaire. The PROMs-FM questionnaire was reliable as demonstrated by a high standardized alpha (0.886–0.982). Content construct assessment of the functional disability and QoL revealed significant correlation (p < 0.01) with both HAQ and EQ-5D. Changes in functional disability and QoL showed significant (p < 0.01) variation with diseases activity status in response to therapy. There was higher prevalence of autonomic symptoms, CVS risk, sexual dysfunction, and falling. Conclusions. The developed PROMs-FM questionnaire is a reliable and valid instrument for assessment of fibromyalgia patients. A phased treatment regimen depending on the severity of FMS as well as preferences and comorbidities of the patient is the best approach to tailored patient management. PMID:27190648

  8. Appropriate use criteria in clinical routine practice: implications in a nuclear cardiology lab.

    PubMed

    Gimelli, Alessia; Rovai, Ilaria; Liga, Riccardo; Pasanisi, Emilio Maria; Marzullo, Paolo

    2016-06-01

    The efforts for a broad application of the appropriate use criteria to reduce inappropriate nuclear stress testing have frequently been unsuccessful and the reported rates of inappropriateness have varied widely between studies. We sought to analyze the criteria of clinical appropriateness of a cohort of consecutive patients referred to our nuclear cardiology laboratory to perform stress myocardial perfusion imaging (MPI) and to assess the relationships between test appropriateness and the evaluation of ischaemia. A cohort of 251 consecutive patients, admitted to our Institute from January to March 2015, who underwent stress/rest MPI on a dedicated cardiac camera equipped with cadmium-zinc-telluride detectors, was selected. The level of clinical appropriateness of each MPI test was categorized in each patient according to the AUC criteria. According to the accepted criteria, the majority of the MPI stress-tests could be classified as clinically appropriate (218 of 251, 87 % of the tests), while only 16 (6 %) and 17 (7 %) resulted of uncertain appropriateness or clearly inappropriate, respectively. Of the 251 appropriate tests, 22 (10 %), 65 (30 %), and 131 (60 %) showed the presence of a mild (SDS < 4), moderate (4 ≥ SDS < 7), and severe (SDS ≥ 7) ischemic burden, respectively, while none of the inappropriate test showed moderate-to-severe ischaemia (P < 0.001 for comparisons). The rate of inappropriate MPI tests is considerably low in a high-volume laboratory. Appropriate and inappropriate studies identify patients at high and low probability of significant ischemia, respectively, providing insights on the effects of the level of appropriateness on stress-test results. PMID:26961179

  9. A method for discovering and inferring appropriate eligibility criteria in clinical trial protocols without labeled data

    PubMed Central

    2013-01-01

    Background We consider the user task of designing clinical trial protocols and propose a method that discovers and outputs the most appropriate eligibility criteria from a potentially huge set of candidates. Each document d in our collection D is a clinical trial protocol which itself contains a set of eligibility criteria. Given a small set of sample documentsD′,|D′|≪|D|, a user has initially identified as relevant e.g., via a user query interface, our scoring method automatically suggests eligibility criteria from D, D ⊃ D', by ranking them according to how appropriate they are to the clinical trial protocol currently being designed. The appropriateness is measured by the degree to which they are consistent with the user-supplied sample documents D'. Method We propose a novel three-step method called LDALR which views documents as a mixture of latent topics. First, we infer the latent topics in the sample documents using Latent Dirichlet Allocation (LDA). Next, we use logistic regression models to compute the probability that a given candidate criterion belongs to a particular topic. Lastly, we score each criterion by computing its expected value, the probability-weighted sum of the topic proportions inferred from the set of sample documents. Intuitively, the greater the probability that a candidate criterion belongs to the topics that are dominant in the samples, the higher its expected value or score. Results Our experiments have shown that LDALR is 8 and 9 times better (resp., for inclusion and exclusion criteria) than randomly choosing from a set of candidates obtained from relevant documents. In user simulation experiments using LDALR, we were able to automatically construct eligibility criteria that are on the average 75% and 70% (resp., for inclusion and exclusion criteria) similar to the correct eligibility criteria. Conclusions We have proposed LDALR, a practical method for discovering and inferring appropriate eligibility criteria in clinical

  10. Do water quality criteria based on nonnative species provide appropriate protection for native species?

    PubMed

    Jin, Xiaowei; Wang, Zijian; Wang, Yeyao; Lv, Yibing; Rao, Kaifeng; Jin, Wei; Giesy, John P; Leung, Kenneth M Y

    2015-08-01

    The potential use of toxicity data for nonnative species to derive water quality criteria is controversial because it is sometimes questioned whether criteria based on species from one geographical region provide appropriate protection for species in a different region. However, this is an important concept for the development of Chinese water quality criteria or standards. Data were assembled on 38 chemicals for which values were available for both native and nonnative species. Sensitivities of these organisms were compared based on the 5% hazardous concentration values and the species sensitivity distribution from a literature review. Results of the present study's analysis showed that there is approximately 74% certainty that use of nonnative species to generate water quality criteria would be sufficiently protective of aquatic ecosystems in China. Without applying any assessment factor to the water quality criteria generated from nonnative species, the uncertainty would be 26% when the native Chinese species might be under protection. Applying an assessment factor of 10 would offer adequate protection to native Chinese species for approximately 90% of tested chemicals and thus reduce the uncertainty from 26% to 10%. PMID:25761401

  11. Effect of coenzyme Q10 evaluated by 1990 and 2010 ACR Diagnostic Criteria for Fibromyalgia and SCL-90-R: four case reports and literature review.

    PubMed

    Alcocer-Gómez, Elísabet; Cano-García, Francisco Javier; Cordero, Mario D

    2013-01-01

    Recently, Coenzyme Q10 (CoQ10) deficiency has been implicated in the pathophysiology of fibromyalgia (FM). It is our objective to present the findings of the FM evaluation before and after oral CoQ10 treatment using the American College of Rheumatology (ACR) Diagnostic Criteria of 1990 and 2010, and Symptom Checklist-Revised (Scl-90-R). Four patients with FM were examined using the trigger points, the Fibromyalgia Impact Questionnaire, visual analog scale (pain, fatigue, and sleep), Widespread Pain Index, symptom severity scale, and Scl-90-R. Previously, CoQ10 contents from patients were analyzed by high-performance liquid chromatography. All patients showed CoQ10 deficiency. All patients meet the ACR 1990 and 2010 criteria. After treatment, all patients showed an important improvement in clinical symptoms in all evaluation methods. According to our results, and evaluated by three methods, patients with FM are candidates for treatment with CoQ10. However, more controlled clinical trials and investigations are needed to clarify the precise mechanism(s) by which CoQ10 may contribute in pathological and therapeutic processes of FM and to provide data on its effectiveness in FM. PMID:24103521

  12. Health Disparities Research Among Small Tribal Populations: Describing Appropriate Criteria for Aggregating Tribal Health Data.

    PubMed

    Van Dyke, Emily R; Blacksher, Erika; Echo-Hawk, Abigail L; Bassett, Deborah; Harris, Raymond M; Buchwald, Dedra S

    2016-07-01

    In response to community concerns, we used the Tribal Participatory Research framework in collaboration with 5 American-Indian communities in Washington, Idaho, and Montana to identify the appropriate criteria for aggregating health data on small tribes. Across tribal sites, 10 key informant interviews and 10 focus groups (n = 39) were conducted between July 2012 and April 2013. Using thematic analysis of focus group content, we identified 5 guiding criteria for aggregating tribal health data: geographic proximity, community type, environmental exposures, access to resources and services, and economic development. Preliminary findings were presented to focus group participants for validation at each site, and a culminating workshop with representatives from all 5 tribes verified our final results. Using this approach requires critical assessment of research questions and study designs by investigators and tribal leaders to determine when aggregation or stratification is appropriate and how to group data to yield robust results relevant to local concerns. At project inception, tribal leaders should be consulted regarding the validity of proposed groupings. After regular project updates, they should be consulted again to confirm that findings are appropriately contextualized for dissemination. PMID:27268030

  13. The disconnect between the guidelines, the appropriate use criteria, and reimbursement coverage decisions: the ultimate dilemma.

    PubMed

    Fogel, Richard I; Epstein, Andrew E; Mark Estes, N A; Lindsay, Bruce D; DiMarco, John P; Kremers, Mark S; Kapa, Suraj; Brindis, Ralph G; Russo, Andrea M

    Recently, the American College of Cardiology Foundation in collaboration with the Heart Rhythm Society published appropriate use criteria (AUC) for implantable cardioverter-defibrillators and cardiac resynchronization therapy. These criteria were developed to critically review clinical situations that may warrant implantation of an implantable cardioverter-defibrillator or cardiac resynchronization therapy device, and were based on a synthesis of practice guidelines and practical experience from a diverse group of clinicians. When the AUC was drafted, the writing committee recognized that some of the scenarios that were deemed "appropriate" or "may be appropriate" were discordant with the clinical requirements of many payers, including the Medicare National Coverage Determination (NCD). To charge Medicare for a procedure that is not covered by the NCD may be construed as fraud. Discordance between the guidelines, the AUC, and the NCD places clinicians in the difficult dilemma of trying to do the "right thing" for their patients, while recognizing that the "right thing" may not be covered by the payer or insurer. This commentary addresses these issues. Options for reconciling this disconnect are discussed, and recommendations to help clinicians provide the best care for their patients are offered. PMID:23916934

  14. The Ann Arbor Criteria for Appropriate Urinary Catheter Use in Hospitalized Medical Patients: Results Obtained by Using the RAND/UCLA Appropriateness Method.

    PubMed

    Meddings, Jennifer; Saint, Sanjay; Fowler, Karen E; Gaies, Elissa; Hickner, Andrew; Krein, Sarah L; Bernstein, Steven J

    2015-05-01

    Interventions to reduce urinary catheter use involve lists of "appropriate" indications developed from limited evidence without substantial multidisciplinary input. Implementing these lists, however, is challenging given broad interpretation of indications, such as "critical illness." To refine criteria for appropriate catheter use-defined as use in which benefits outweigh risks-the RAND/UCLA Appropriateness Method was applied. After reviewing the literature, a 15-member multidisciplinary panel of physicians, nurses, and specialists in infection prevention rated scenarios for catheter use as appropriate, inappropriate, or of uncertain appropriateness by using a standardized, multiround rating process. The appropriateness of Foley catheters, intermittent straight catheters (ISCs), and external condom catheters for hospitalized adults on medical services was assessed in 299 scenarios, including urinary retention, incontinence, wounds, urine volume measurement, urine sample collection, and comfort. The scenarios included patient-specific issues, such as difficulty turning and catheter placement challenges. The panel rated 105 Foley scenarios (43 appropriate, 48 inappropriate, 14 uncertain), 97 ISC scenarios (15 appropriate, 66 inappropriate, 16 uncertain), and 97 external catheter scenarios (30 appropriate, 51 inappropriate, 16 uncertain). The refined criteria clarify that Foley catheters are appropriate for measuring and collecting urine only when fluid status or urine cannot be assessed by other means; specify that patients in the intensive care unit (ICU) need specific medical indications for catheters because ICU location alone is not an appropriate indication; and recognize that Foley and external catheters may be pragmatically appropriate to manage urinary incontinence in select patients. These new appropriateness criteria can inform large-scale collaborative and bedside efforts to reduce inappropriate urinary catheter use. PMID:25938928

  15. The 1995 forum on appropriate criteria and methods for seismic design of nuclear piping

    SciTech Connect

    Slagis, G.C.

    1996-12-01

    A record of the 1995 Forum on Appropriate Criteria and Methods for Seismic Design of Nuclear Piping is provided. The focus of the forum was the earthquake experience data base and whether the data base demonstrates that seismic inertia loads will not cause failure in ductile piping systems. This was a follow-up to the 1994 Forum when the use of earthquake experience data, including the recent Northridge earthquake, to justify a design-by-rule method was explored. Two possible topics for the next forum were identified--inspection after an earthquake and design for safe-shutdown earthquake only.

  16. Cost Savings Associated With Implementation of Peer-Reviewed Appropriate Use Criteria for Percutaneous Coronary Interventions.

    PubMed

    Puri, Pranav; Carroll, Jennifer; Patterson, Bobette

    2016-04-15

    Appropriate use criteria (AUC) for coronary revascularization have been developed to provide a practical standard to assess the quality of patient selection for percutaneous coronary interventions (PCI). However, the economic impact of AUC implementation has yet to be quantified. A peer-reviewed AUC process was implemented at UnityPoint Trinity in February 2012. Volumes of PCI cases were measured in 12-month intervals for 2 years after AUC implementation and compared with volumes from the corresponding 12-month intervals in the 2 years preceding implementation of AUC. Hospital reimbursement was averaged based on each year's payer mix and reimbursement contracts. In the 2 years preceding AUC implementation, PCI volumes were similar (1,414 in 2010 and 1,411 in 2011). After AUC implementation, volumes of PCI decreased by 17% in both 2012 and 2013. From 2012 to 2013, the relative ratio of elective to acute interventions decreased from 1.36 to 1.02. In the same time frame, the proportion of appropriate PCI significantly increased from 76% to 84% (p <0.001). Total hospital reimbursement for PCI decreased by 36% after AUC implementation. In conclusion, implementation of a peer-reviewed AUC process at the UnityPoint Trinity led to significant cost savings through a large decrease in volume of PCI with concurrent improvement in PCI appropriateness. PMID:26899491

  17. Aggressive rheumatoid arthritis registry in Italy. Characteristics of the early rheumatoid arthritis subtype among patients classified according to the ACR criteria.

    PubMed

    2003-01-01

    The Italian Society of Rheumatology in the year 2000 decided to sponsor the creation of a data base (Registry) of consecutive patients who fulfilled the diagnosis of rheumatoid arthritis (RA) according to the American College of Rheumatology (ACR) criteria. The registry is designed to collect data on the "aggressive" type of RA all over the country in order to determine the percentage of patients who satisfy the established criteria among incident cases of RA and to define the therapeutic approach according to the characteristics of the enrolled patients. Predefined criteria set up by eight recognized opinion leaders on the disease were used by all the centers to create the database. The GIARA registry (Gruppo Italiano Artrite Reumatoide Aggressiva) has now enrolled 706 patients who will be followed up for 24 months. They have been divided into two major subsets--patients with early (< 4 months' disease duration) and late (> 4 months) RA--with the aim of establishing whether differences in clinical, serological, radiographic and therapeutic (DMARDs: disease modifying antirheumatic drugs) parameters may distinguish the two subsets. The major conclusion of this preliminary analysis is that an overall tendency to undertreatment is discernable. PMID:14969064

  18. Indications for TEE before cardioversion for atrial fibrillation: implications for appropriateness criteria.

    PubMed

    Grewal, Gaganpreet K; Klosterman, Tristan B; Shrestha, Kevin; Yarmohammadi, Hirad; Zurick, Andrew O; Varr, Brandon C; Tang, W H Wilson; Lindsay, Bruce D; Klein, Allan L

    2012-06-01

    The purpose of this study was to evaluate appropriateness of transesophageal echocardiography (TEE) before direct current cardioversion (DCC), investigate indications for TEE, and analyze if indications are predictive of outcome. According to American College of Cardiology Foundation/American Society of Echocardiography 2011 Appropriateness Criteria, TEE is appropriate in the evaluation of patients with atrial fibrillation (AF) to facilitate clinical decision making with regards to anticoagulation and/or DCC. However, it is unclear in which instances physicians utilize TEE. We reviewed 671 TEE studies in 604 AF patients (age 66 ± 13 years, 67% male) in which TEE was performed before DCC for left atrial thrombus (LAT)/sludge. Studies were divided by the main indication for TEE into the following 8 categories: 1) congestive heart failure (CHF)/hemodynamic compromise; 2) symptomatic; 3) new onset AF; 4) hospitalized and symptomatic; 5) high stroke risk; 6) subtherapeutic anticoagulation; 7) miscellaneous; and 8) inappropriate for TEE. The main indications for TEE before DCC were symptomatic (26.4%) and CHF/hemodynamic compromise (26.1%). We deemed 2.7% of the studies as inappropriate. LAT/sludge was found in 8.2% of studies. Incidence of LAT/sludge differed significantly between indications (p = 0.0021) and the highest incidences occurred in the high stroke risk (17.6%) and hospitalized and symptomatic (14.1%) categories. No LAT/sludge was found in the miscellaneous or inappropriate groups. Stroke occurred in 2.5% (n = 15) of all patients and in all groups except for miscellaneous and inappropriate (p = 0.3). TEE is appropriately used prior to DCC for patients with the main indications of symptomatic and CHF/hemodynamic compromise. In a minority of studies, TEE utilization was inappropriate. Incidence of LAT/sludge differed between indications. PMID:22698535

  19. EACVI appropriateness criteria for the use of cardiovascular imaging in heart failure derived from European National Imaging Societies voting.

    PubMed

    Garbi, Madalina; Edvardsen, Thor; Bax, Jeroen; Petersen, Steffen E; McDonagh, Theresa; Filippatos, Gerasimos; Lancellotti, Patrizio

    2016-07-01

    This paper presents the first European appropriateness criteria for the use of cardiovascular imaging in heart failure, derived from voting of the European National Imaging Societies representatives. The paper describes the development process and discusses the results. PMID:27129538

  20. Application of appropriate use criteria for percutaneous coronary intervention in Japan

    PubMed Central

    Inohara, Taku; Kohsaka, Shun; Ueda, Ikuko; Yagi, Takashi; Numasawa, Yohei; Suzuki, Masahiro; Maekawa, Yuichiro; Fukuda, Keiichi

    2016-01-01

    The aim of this review was to summarize the concept of appropriate use criteria (AUC) regarding percutaneous coronary intervention (PCI) and document AUC use and impact on clinical practice in Japan, in comparison with its application in the United States. AUC were originally developed to subjectively evaluate the indications and performance of various diagnostic and therapeutic modalities, including revascularization techniques. Over the years, application of AUC has significantly impacted patient selection for PCI in the United States, particularly in non-acute settings. After the broad implementation of AUC in 2009, the rate of inappropriate PCI decreased by half by 2014. The effect was further accentuated by incorporation of financial incentives (e.g., restriction of reimbursement for inappropriate procedures). On the other hand, when the United States-derived AUC were applied to Japanese patients undergoing elective PCI from 2008 to 2013, about one-third were classified as inappropriate, largely due to the perception gap between American and Japanese experts. For example, PCI for low-risk non-left atrial ascending artery lesion was more likely to be classified as appropriate by Japanese standards, and anatomical imaging with coronary computed tomography angiography was used relatively frequently in Japan, but no scenario within the current AUC includes this modality. To extrapolate the current AUC to Japan or any other region outside of the United States, these local discrepancies must be taken into consideration, and scenarios should be revised to reflect contemporary practice. Understanding the concept of AUC as well as its perception gap between different counties will result in the broader implementation of AUC, and lead to the quality improvement of patients’ care in the field of coronary intervention. PMID:27621773

  1. Application of appropriate use criteria for percutaneous coronary intervention in Japan.

    PubMed

    Inohara, Taku; Kohsaka, Shun; Ueda, Ikuko; Yagi, Takashi; Numasawa, Yohei; Suzuki, Masahiro; Maekawa, Yuichiro; Fukuda, Keiichi

    2016-08-26

    The aim of this review was to summarize the concept of appropriate use criteria (AUC) regarding percutaneous coronary intervention (PCI) and document AUC use and impact on clinical practice in Japan, in comparison with its application in the United States. AUC were originally developed to subjectively evaluate the indications and performance of various diagnostic and therapeutic modalities, including revascularization techniques. Over the years, application of AUC has significantly impacted patient selection for PCI in the United States, particularly in non-acute settings. After the broad implementation of AUC in 2009, the rate of inappropriate PCI decreased by half by 2014. The effect was further accentuated by incorporation of financial incentives (e.g., restriction of reimbursement for inappropriate procedures). On the other hand, when the United States-derived AUC were applied to Japanese patients undergoing elective PCI from 2008 to 2013, about one-third were classified as inappropriate, largely due to the perception gap between American and Japanese experts. For example, PCI for low-risk non-left atrial ascending artery lesion was more likely to be classified as appropriate by Japanese standards, and anatomical imaging with coronary computed tomography angiography was used relatively frequently in Japan, but no scenario within the current AUC includes this modality. To extrapolate the current AUC to Japan or any other region outside of the United States, these local discrepancies must be taken into consideration, and scenarios should be revised to reflect contemporary practice. Understanding the concept of AUC as well as its perception gap between different counties will result in the broader implementation of AUC, and lead to the quality improvement of patients' care in the field of coronary intervention. PMID:27621773

  2. Toward appropriate criteria in medication adherence assessment in older persons: Position Paper.

    PubMed

    Giardini, Anna; Martin, Maria Teresa; Cahir, Caitriona; Lehane, Elaine; Menditto, Enrica; Strano, Maria; Pecorelli, Sergio; Monaco, Alessandro; Marengoni, Alessandra

    2016-06-01

    Nonadherence to medication regimens is a worldwide challenge; adherence rates range from 38 to 57 % in older populations with an average rate of less than 45 % and nonadherence contributes to adverse drug events, increased emergency visits and hospitalisations. Accurate measurement of medication adherence is important in terms of both research and clinical practice. However, the identification of an objective approach to measure nonadherence is still an ongoing challenge. The aim of this Position Paper is to describe the advantages and disadvantages of the known medication adherence tools (self-report, pill count, medication event monitoring system (MEMS) and electronic monitoring devices, therapeutic drug monitoring, pharmacy records based on pharmacy refill and pharmacy claims databases) to provide the appropriate criteria to assess medication adherence in older persons. To the best of our knowledge, no gold standard has been identified in adherence measurement and no single method is sufficiently reliable and accurate. A combination of methods appears to be the most suitable. Secondly, adherence assessment should always consider tools enabling polypharmacy adherence assessment. Moreover, it is increasingly evident that adherence, as a process, has to be assessed over time and not just at one evaluation time point (drug discontinuation). When cognitive deficits or functional impairments may impair reliability of adherence assessment, a comprehensive geriatric assessment should be performed and the caregiver involved. Finally, studies considering the possible implementation in clinical practice of adherence assessment tools validated in research are needed. PMID:26630945

  3. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false What criteria will Reclamation apply to determine whether it is appropriate to recommend that a feasibility study be conducted? 404.44 Section 404.44 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR RECLAMATION RURAL WATER...

  4. 45 CFR 400.81 - Criteria for appropriate employability services and employment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the State in its work and training programs for TANF recipients. (5) The service or work site to which... safety standards. (6) Assignments must not be made which are discriminatory in terms of age, sex, race, creed, color, or national origin. (7) Appropriate work may be temporary, permanent, full-time,...

  5. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... establishing appropriated fund wage areas. (a) Each wage area shall consist of one or more survey areas along with nonsurvey areas, if any. (1) Survey area: A survey area is composed of the counties, parishes, cities, or townships in which survey data are collected. Except in very unusual circumstances, a...

  6. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... establishing appropriated fund wage areas. (a) Each wage area shall consist of one or more survey areas along with nonsurvey areas, if any. (1) Survey area: A survey area is composed of the counties, parishes, cities, or townships in which survey data are collected. Except in very unusual circumstances, a...

  7. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... establishing appropriated fund wage areas. (a) Each wage area shall consist of one or more survey areas along with nonsurvey areas, if any. (1) Survey area: A survey area is composed of the counties, parishes, cities, or townships in which survey data are collected. Except in very unusual circumstances, a...

  8. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... establishing appropriated fund wage areas. (a) Each wage area shall consist of one or more survey areas along with nonsurvey areas, if any. (1) Survey area: A survey area is composed of the counties, parishes, cities, or townships in which survey data are collected. Except in very unusual circumstances, a...

  9. Assessment of Children's Digital Courseware in Light of Developmentally Appropriate Courseware Criteria

    ERIC Educational Resources Information Center

    Ihmeideh, Fathi Mahmoud

    2015-01-01

    Developmentally appropriate courseware can play a crucial role in enhancing children's learning and development. Research studies have demonstrated that early childhood educators face major challenges in selecting and updating developmental courseware that supports young children's development. The primary purpose of this study was to assess…

  10. Evaluation of Posttreatment Follow-Up of Patients With Prostate Cancer Relative to the American College of Radiology’s Appropriateness Criteria

    PubMed Central

    McDonald, Jennifer S.; Carter, Rickey E.; Karnes, R. Jeffrey; Port, John D.; Kawashima, Akira; Carlson, Stephanie K.; Bender, Claire E.

    2016-01-01

    OBJECTIVE The American College of Radiology (ACR) Appropriateness Criteria panel has recommended that patients with prostate cancer who have received treatment undergo imaging only after suspected cancer recurrence. We examined whether local physicians followed this recommendation and what types of imaging examinations were ordered in a cohort of patients with local prostate cancer. MATERIALS AND METHODS The Rochester Epidemiology Project, a research consortium that collects, links, and stores medical record information of Olmsted County, Minnesota, residents, was used to capture the complete medical history of treated patients with prostate cancer from 2000 through 2011. Clinical information and imaging examinations performed were retrieved by chart review. Suspected recurrence was defined as treatment-specific prostate-specific antigen level elevations, bone pain, or abnormal digital rectal examination findings. RESULTS Of the 670 treated patients with prostate cancer who were included in the final analysis, 129 (19%) underwent posttreatment imaging. After excluding imaging related to retreatment or another cancer, 13 patients (i.e., 2% of the entire cohort and 10% of imaged patients) underwent imaging in the absence of suspected recurrence. A total of 90 patients (70% of imaged patients) underwent imaging after suspected recurrence. Of these 90 patients, 62 (69%) underwent a bone scan as their first imaging modality either alone or in combination with other imaging modalities. Of the providers who ordered a bone scan first, 27% were urologists, 23% were radiation oncologists, and 24% were primary care physicians. CONCLUSION Most patients in this study did not undergo imaging in the absence of suspected recurrence. Various types of imaging examinations were ordered for patients with suspected recurrence. PMID:26496548

  11. Appropriate Use Criteria in Echocardiography: An Observational Institutional Study with the Perspective of a Quality Improvement Project

    PubMed Central

    Rameh, Vanessa; Kossaify, Antoine

    2016-01-01

    BACKGROUND Appropriate use criteria (AUC) in echocardiography are essential tools for aligning the indications of echocardiography with the best clinical standards, improving clinical outcome, restraining abuse, and preserving health-care resources. OBJECTIVES The aim of this study was to ascertain the AUC for transthoracic echocardiography in a university hospital and create a quality improvement project (QIP). METHODS The assessment of 501 inpatients who received transthoracic cardiac echo was conducted according to the 2011 AUC report. Indications were classified as appropriate, uncertain, or inappropriate, and patients not matching any of the abovementioned divisions were grouped in the nonfitting category. RESULTS Of the 501 eligible patients, 374 patients (74.66%) were in the appropriate group, 85 patients (16.96%) in the inappropriate group, 20 patients (3.99%) in the uncertain group, and 22 patients (4.39%) in the nonfitting category. DISCUSSION Interpretation and analysis of the obtained results are presented, along with the results of many comparable studies; moreover, a QIP was set up accordingly. CONCLUSION AUC are useful to assess local practice, preserve health-care resources, and improve clinical outcome. PMID:26917982

  12. Appropriate criteria for identification of near-miss maternal morbidity in tertiary care facilities: A cross sectional study

    PubMed Central

    Souza, JP; Cecatti, JG; Parpinelli, MA; Serruya, SJ; Amaral, E

    2007-01-01

    Background The study of severe maternal morbidity survivors (near miss) may be an alternative or a complement to the study of maternal death events as a health care indicator. However, there is still controversy regarding the criteria for identification of near-miss maternal morbidity. This study aimed to characterize the near miss maternal morbidity according to different sets of criteria. Methods A descriptive study in a tertiary center including 2,929 women who delivered there between July 2003 and June 2004. Possible cases of near miss were daily screened by checking different sets of criteria proposed elsewhere. The main outcome measures were: rate of near miss and its primary determinant factors, criteria for its identification, total hospital stay, ICU stay, and number and kind of special procedures performed. Results There were two maternal deaths and 124 cases of near miss were identified, with 102 of them admitted to the ICU (80.9%). Among the 126 special procedures performed, the most frequent were central venous access, echocardiography and invasive mechanical ventilation. The mean hospital stay was 10.3 (± 13.24) days. Hospital stay and the number of special procedures performed were significantly higher when the organ dysfunction based criteria were applied. Conclusion The adoption of a two level screening strategy may lead to the development of a consistent severe maternal morbidity surveillance system but further research is needed before worldwide near miss criteria can be assumed. PMID:17848189

  13. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... sufficient to supply the proposed service area, including all practicable water sources such as lower quality... health and safety; (3) Will meet water demand, including projected future needs; (4)...

  14. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... sufficient to supply the proposed service area, including all practicable water sources such as lower quality... health and safety; (3) Will meet water demand, including projected future needs; (4)...

  15. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... sufficient to supply the proposed service area, including all practicable water sources such as lower quality... health and safety; (3) Will meet water demand, including projected future needs; (4)...

  16. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... sufficient to supply the proposed service area, including all practicable water sources such as lower quality... health and safety; (3) Will meet water demand, including projected future needs; (4)...

  17. 75 FR 58448 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... participation in ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269... Designs The ACRS Subcommittee on Future Plant Designs will hold a meeting on October 21, 2010, at 11545... Subcommittee will review current Design Acceptance Criteria associated with Digital Instrumentation and...

  18. Neonatal Near Miss: the need for a standard definition and appropriate criteria and the rationale for a prospective surveillance system

    PubMed Central

    Santos, Juliana P; Cecatti, José G; Serruya, Suzanne J; Almeida, Paulo V; Duran, Pablo; de Mucio, Bremen; Pileggi-Castro,, Cynthia

    2015-01-01

    In Latin American, there is currently a regional action with the main purposes of putting the concept of severe neonatal morbidity in practice and formulating proposals for interventions. A general overview of neonatal health conditions, including morbidity and mortality, is provided to update regional knowledge on the topic. An example of the development and implementation of the concept of maternal near miss is also provided, followed by results from a systematic review covering all previously published studies on Neonatal Near Miss. Finally, some proposals for building a common concept on the topic and for launching a prospective surveillance study are presented. A Neonatal Near Miss is a neonate who had a severe morbidity (organ dysfunction or failure) but who survived this condition within the first 27 days of life. The pragmatic criteria recommended to be used are as follows: birth weight below 1700 g, Apgar score below 7 at 5 minutes of life and gestational age below 33 weeks. As a proxy for organ dysfunction, the following management criteria are also confirmed: parenteral therapeutic antibiotics; nasal continuous positive airway pressure; any intubation during the first 27 days of life; phototherapy within the first 24 h of life; cardiopulmonary resuscitation; the use of vasoactive drugs, anticonvulsants, surfactants, blood products and steroids for refractory hypoglycemia and any surgical procedure. Although this study starts from a regional perspective, this topic is clearly globally relevant. All nations, especially low and middle-income countries, could benefit from the proposed standardization. PMID:26735223

  19. Praise Acres Project

    ERIC Educational Resources Information Center

    Hayes, Carolyn

    2004-01-01

    In this article, the author presents the "Praise Acres Project," which was initiated from a letter written by a local resident. The resident wrote about an idea to develop a wetlands and outdoor lab facility on his property for students. Thus, a plan was conceived that would not only benefit the owner, but also enhance high school science…

  20. ACR process for ethylene

    SciTech Connect

    Baldwin, R.L.; Kamm, G.R.

    1983-01-01

    Describes how the advanced cracking reactor process, which is ready for a logical commercial application, offers total liquids feedstock flexibility from light naphthenes through vacuum gas oils in the same production unit. Several processes are presently being developed which are aimed at maintaining olefin selectivity when cracking the heaviest feeds. Addresses the problems posed by such heavy feedstocks. The following trends favor the ACR process in the 1980s: natural gas price decontrol; limited natural gas reserves; few new domestic LPG-based ethylene plants will be built; an economic recovery will create the need for more ethylene capacity; modest increases in ''real'' crude oil prices; plentiful supplies of vacuum gas oil at prices making it an attractive ethylene feedstock; and increasing supplies of light naphtha at prices making it an attractive ethylene feedstock as well. Predicts that these factors will swing the preferred feedstocks for ethylene manufacture back to crude oil distillates before the end of the decade. Argues that in this environment, the ACR process can deliver the lowest cost ethylene in the industry. ACR has full-range feedstock flexibility, high selectivity to ethylene, and less sensitivity to feedstock costs and co-product credits.

  1. Appropriate use criteria for amyloid PET: a report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer's Association.

    PubMed

    Johnson, Keith A; Minoshima, Satoshi; Bohnen, Nicolaas I; Donohoe, Kevin J; Foster, Norman L; Herscovitch, Peter; Karlawish, Jason H; Rowe, Christopher C; Carrillo, Maria C; Hartley, Dean M; Hedrick, Saima; Pappas, Virginia; Thies, William H

    2013-03-01

    Positron emission tomography (PET) of brain amyloid β is a technology that is becoming more available, but its clinical utility in medical practice requires careful definition. To provide guidance to dementia care practitioners, patients, and caregivers, the Alzheimer's Association and the Society of Nuclear Medicine and Molecular Imaging convened the Amyloid Imaging Taskforce (AIT). The AIT considered a broad range of specific clinical scenarios in which amyloid PET could potentially be used appropriately. Peer-reviewed, published literature was searched to ascertain available evidence relevant to these scenarios, and the AIT developed a consensus of expert opinion. Although empirical evidence of impact on clinical outcomes is not yet available, a set of specific appropriate use criteria (AUC) were agreed on that define the types of patients and clinical circumstances in which amyloid PET could be used. Both appropriate and inappropriate uses were considered and formulated, and are reported and discussed here. Because both dementia care and amyloid PET technology are in active development, these AUC will require periodic reassessment. Future research directions are also outlined, including diagnostic utility and patient-centered outcomes. PMID:23359661

  2. Validation of the appropriate use criteria for percutaneous coronary intervention in patients with stable coronary artery disease (from the COURAGE trial).

    PubMed

    Bradley, Steven M; Chan, Paul S; Hartigan, Pamela M; Nallamothu, Brahmajee K; Weintraub, William S; Sedlis, Steven P; Dada, Marcin; Maron, David J; Kostuk, William J; Berman, Daniel S; Teo, Koon K; Mancini, G B John; Boden, William E; Spertus, John A

    2015-07-15

    Establishing the validity of appropriate use criteria (AUC) for percutaneous coronary intervention (PCI) in the setting of stable ischemic heart disease can support their adoption for quality improvement. We conducted a post hoc analysis of 2,287 Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial patients with stable ischemic heart disease randomized to PCI with optimal medical therapy (OMT) or OMT alone. Within appropriateness categories, we compared rates of death, myocardial infarction, revascularization subsequent to initial therapy, and angina-specific health status as determined by the Seattle Angina Questionnaire in patients randomized to PCI + OMT to those randomized to OMT alone. A total of 1,987 patients (87.9%) were mapped to the 2012 publication of the AUC, with 1,334 (67.1%) classified as appropriate, 551 (27.7%) uncertain, and 102 (5.1%) as inappropriate. There were no significant differences between PCI and OMT alone in the rate of mortality and myocardial infarction by appropriateness classification. Rates of revascularization were significantly lower in patients initially receiving PCI + OMT who were classified as appropriate (hazard ratio 0.65; 95% confidence interval 0.53 to 0.80; p <0.001) or uncertain (hazard ratio 0.49; 95% confidence interval 0.32 to 0.76; p = 0.001). Furthermore, among patients classified as appropriate by the AUC, Seattle Angina Questionnaire scores at 1 month were better in the PCI-treated group compared with the medical therapy group (80 ± 23 vs 75 ± 24 for angina frequency, 73 ± 24 vs 68 ± 24 for physical limitations, and 68 ± 23 vs 60 ± 24 for quality of life; all p <0.01), with differences generally persisting through 12 months. In contrast, health status scores were similar throughout the first year of follow-up in PCI + OMT patients compared with OMT alone in patients classified as uncertain or inappropriate. In conclusion, these findings support the validity of the AUC in

  3. Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)

    PubMed Central

    Cardona-Morrell, Magnolia; Hillman, Ken

    2015-01-01

    Objective To develop a screening tool to identify elderly patients at the end of life and quantify the risk of death in hospital or soon after discharge for to minimise prognostic uncertainty and avoid potentially harmful and futile treatments. Design Narrative literature review of definitions, tools and measurements that could be combined into a screening tool based on routinely available or obtainable data at the point of care to identify elderly patients who are unavoidably dying at the time of admission or at risk of dying during hospitalisation. Main measurements Variables and thresholds proposed for the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL screening tool) were adopted from existing scales and published research findings showing association with either in-hospital, 30-day or 3-month mortality. Results Eighteen predictor instruments and their variants were examined. The final items for the new CriSTAL screening tool included: age ≥65; meeting ≥2 deterioration criteria; an index of frailty with ≥2 criteria; early warning score >4; presence of ≥1 selected comorbidities; nursing home placement; evidence of cognitive impairment; prior emergency hospitalisation or intensive care unit readmission in the past year; abnormal ECG; and proteinuria. Conclusions An unambiguous checklist may assist clinicians in reducing uncertainty patients who are likely to die within the next 3 months and help initiate transparent conversations with families and patients about end-of-life care. Retrospective chart review and prospective validation will be undertaken to optimise the number of prognostic items for easy administration and enhanced generalisability. Development of an evidence-based tool for defining and identifying the dying patient in hospital: CriSTAL. PMID:25613983

  4. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A; Masoudi, Frederick A; Dehmer, Gregory J; Patel, Manesh R; Smith, Peter K; Chambers, Charles E; Ferguson, T Bruce; Garcia, Mario J; Grover, Frederick L; Holmes, David R; Klein, Lloyd W; Limacher, Marian C; Mack, Michael J; Malenka, David J; Park, Myung H; Ragosta, Michael; Ritchie, James L; Rose, Geoffrey A; Rosenberg, Alan B; Russo, Andrea M; Shemin, Richard J; Weintraub, William S; Wolk, Michael J; Bailey, Steven R; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Shaw, Leslee; Stainback, Raymond F; Allen, Joseph M

    2012-04-01

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD

  5. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A

    2012-02-28

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD

  6. Licensing the ACR in the USA - A Status Report

    SciTech Connect

    Snell, Victor; Langman, Vince; Ion, Robert; Reid, Calvin

    2004-07-01

    The ACR-700 (ACR) is an evolutionary reactor design, which incorporates the inherent safety features of the Candu products, as well as the successful operating experience of the current Candu 6 reactors. The improvements to the ACR from Candu 6 result in significant reductions in capital and operating costs as well as enhanced safety. AECL Technologies (AECLT, a wholly owned US subsidiary of Atomic Energy of Canada Limited) is the proponent for the ongoing pre-application review of the ACR with the US Nuclear Regulatory Commission (NRC) in the United States. This pre-application review will be completed shortly and will support an application to the USNRC for Standard Design Certification (SDC). AECL Technologies' overall objective for the pre-application review of the ACR is to obtain an understanding of the scope, cost, and the schedule to obtain a Standard Design Certification for the ACR. The pre-application review will address licensing issues associated with the Candu reactor technologies in ACR that depart from the light water reactor, pressure-vessel based regulatory framework in the USA. Therefore, during the course of the ACR pre-application review, major USNRC issues with the ACR design will be identified early and the scope of the work required to address these concerns, along with associated completion schedules, will be formulated and ultimately agreed upon with the USNRC. AECLT has been informed by the NRC staff that the results of their pre-application review will be documented in a Safety Assessment Report (SAR), which will state whether there are any major impediments to licensing the ACR in the United States. In particular, the SAR should provide confirmation of the licensing criteria applicable to the ACR, provide an assessment of the completeness of AECL's Research and Development (R and D) programs that exist or are planned in support of the ACR, provide an assessment of the suitability for purpose of the computer codes used in the safety

  7. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians.

    PubMed

    Douglas, Pamela S; Garcia, Mario J; Haines, David E; Lai, Wyman W; Manning, Warren J; Patel, Ayan R; Picard, Michael H; Polk, Donna M; Ragosta, Michael; Parker Ward, R; Weiner, Rory B

    2011-03-01

    The American College of Cardiology Foundation (ACCF), in partnership with the American Society of Echocardiography (ASE) and along with key specialty and subspecialty societies, conducted a review of common clinical scenarios where echocardiography is frequently considered. This document combines and updates the original transthoracic and transesophageal echocardiography appropriateness criteria published in 2007 (1) and the original stress echocardiography appropriateness criteria published in 2008 (2). This revision reflects new clinical data, reflects changes in test utilization patterns,and clarifies echocardiography use where omissions or lack of clarity existed in the original criteria.The indications (clinical scenarios)were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC).The 202 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9,to designate appropriate use(median 7 to 9), uncertain use(median 4 to 6), and inappropriate use (median 1 to 3). Ninety-seven indications were rated as appropriate, 34 were rated as uncertain, and 71 were rated as inappropriate. In general,the use of echocardiography for initial diagnosis when there is a change in clinical status or when the results of the echocardiogram are anticipated to change patient management were rated appropriate. Routine testing when there was no change in clinical status or when results of testing were unlikely to modify management were more likely to be inappropriate than appropriate/uncertain.The AUC for echocardiography have the potential to impact physician decision making,healthcare delivery, and reimbursement policy. Furthermore,recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID

  8. AcrS/EnvR Represses Expression of the acrAB Multidrug Efflux Genes in Escherichia coli▿

    PubMed Central

    Hirakawa, Hidetada; Takumi-Kobayashi, Asuka; Theisen, Ulrike; Hirata, Takahiro; Nishino, Kunihiko; Yamaguchi, Akihito

    2008-01-01

    The acrS regulatory gene is located upstream of the acrEF multidrug efflux system genes. However, the roles of AcrS in regulation of drug efflux pumps have not been clearly understood. Here we show that AcrS represses other multidrug efflux genes, acrAB, which encode a major efflux system in Escherichia coli. PMID:18567659

  9. 75 FR 1831 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on AP1000...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-13

    ... October 14, 2009 (74 FR 58268-58269). Detailed ACRS meeting agendas and meeting transcripts are available... prior to the meeting, if possible, so that appropriate arrangements can be made. Thirty-five hard copies... compact disk containing each presentation at least 30 minutes before the meeting. Electronic...

  10. 75 FR 57536 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ABWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ABWR The ACRS... Safeguards. BILLING CODE 7590-01-P...

  11. 78 FR 79020 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  12. 78 FR 70597 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-26

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  13. 78 FR 70598 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-26

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  14. ACR CT Accreditation Program and the Lung Cancer Screening Program Designation.

    PubMed

    Kazerooni, Ella A; Armstrong, Mark R; Amorosa, Judith K; Hernandez, Dina; Liebscher, Lawrence A; Nath, Hrudaya; McNitt-Gray, Michael F; Stern, Eric J; Wilcox, Pamela A

    2016-02-01

    The ACR recognizes that low-dose CT for lung cancer screening has the potential to significantly reduce mortality from lung cancer in the appropriate high-risk population. The ACR supports the recommendations of the US Preventive Services Task Force and the National Comprehensive Cancer Network for screening patients. To be effective, lung cancer screening should be performed at sites providing high-quality low-dose CT examinations overseen and interpreted by qualified physicians using a structured reporting and management system. The ACR has developed a set of tools necessary for radiologists to take the lead on the front lines of lung cancer screening. The ACR Lung Cancer Screening Center designation is built upon the ACR CT accreditation program and requires use of Lung-RADS or a similar structured reporting and management system. This designation provides patients and referring providers with the assurance that they will receive high-quality screening with appropriate follow-up care. PMID:26846533

  15. Appropriate drinking water treatment processes for organic micropollutants removal based on experimental and model studies - a multi-criteria analysis study.

    PubMed

    Sudhakaran, Sairam; Lattemann, Sabine; Amy, Gary L

    2013-01-01

    The presence of organic micropollutants (OMPs), pharmaceuticals and personal care products (PPCPs) in potable water is of great environmental and public health concern. OMPs are included in the priority list of contaminants in United States EPA and European framework directives. Advanced treatment processes such as reverse osmosis, nanofiltration, ozonation and adsorption are the usual industry-recommended processes for OMPs removal, however, natural systems, e.g., riverbank filtration and constructed wetlands, are also potentially efficient options for OMPs removal. In this study, a decision support system (DSS) based on multi-criteria analysis (MCA) was created to compare processes for OMPs removal under various criteria. Multi-criteria analysis (MCA), a transparent and reliable procedure, was adopted. Models were built for both experimental and predicted percent-removals for a range of OMPs reflecting different physicochemical properties. The experimental percent-removals for several processes (riverbank filtration (RBF), ozonation, advanced oxidation, adsorption, reverse osmosis, and nanofiltration) were considered. The predicted percent-removals were taken from validated quantitative structure activity relationship (QSAR) models. Analytical methods to detect OMPs in water are very laborious, thus a modeling approach such as QSAR is an attractive option. A survey among two groups of participants including academics (PhD students and post-doctoral research associates) and industry (managers and operators) representatives was conducted to assign weights for the following criteria: treatability, costs, technical considerations, sustainability and time. The process rankings varied depending on the contaminant species and personal preferences (weights). The results indicated that RBF and oxidation were preferable over adsorption and membranes processes. The results also suggest that the use of a hybrid treatment process, e.g., combining a natural system with an

  16. 78 FR 24441 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-25

    ... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S....

  17. 76 FR 32240 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-03

    ... ACRS meetings ] were published in the Federal Register on October 21, 2010, (75 FR 65038-65039... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital Instrumentation and Control Systems; Notice of Meeting The ACRS Subcommittee on Digital Instrumentation...

  18. 76 FR 52715 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ... ACRS meetings were published in the Federal Register on October 21, 2010 (75 FR 65038-65039). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital Instrumentation and Control Systems; Notice of Meeting The ACRS Subcommittee on Digital Instrumentation...

  19. 77 FR 60480 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-03

    ... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital Instrumentation and Control Systems; Notice of Meeting The ACRS Subcommittee on Digital Instrumentation...

  20. 78 FR 17944 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147). Detailed... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  1. 75 FR 27841 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-18

    ... ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR 58268-58269). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials The ACRS Subcommittee on Radiation Protection and Nuclear Materials...

  2. 76 FR 36160 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-21

    ... ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  3. 76 FR 27101 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  4. 75 FR 27840 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-18

    ... participation in ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR 58268-58269... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials The ACRS Subcommittee on Radiation Protection and Nuclear Materials...

  5. 78 FR 20959 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-08

    ... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor The ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR) will hold a...

  6. 78 FR 37595 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-21

    ... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor...

  7. 76 FR 34276 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-13

    ... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor...

  8. 77 FR 45699 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... participation in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on August 14, 2012, Room...

  9. 78 FR 51752 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on September 18, 2013, Room...

  10. 77 FR 28903 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-16

    ... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on May 22, 2012, Room...

  11. 77 FR 59676 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ... in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on October 3, 2012, Room...

  12. 78 FR 2694 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-14

    ... the Federal Register on Monday, December 17, 2012, (77 FR 74697-74698). Information regarding this... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Fukushima; Cancellation of the January 18, 2013, ACRS Subcommittee Meeting The ACRS Subcommittee meeting on...

  13. 77 FR 74697 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-17

    ... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on January 18, 2013, Room...

  14. 77 FR 28637 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-15

    ... participation in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126- 64127... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on May 22- 23, 2012, Room...

  15. 77 FR 45700 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126- 64127... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on August 15, 2012, Room...

  16. TU-A-18C-01: ACR Accreditation Updates in CT, Ultrasound, Mammography and MRI

    SciTech Connect

    Price, R; Berns, E; Hangiandreou, N; McNitt-Gray, M

    2014-06-15

    A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, the ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up-to-date as the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, mammography, ultrasound, and computed tomography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements. Learning Objectives: To understand the requirements of the ACR MR accreditation program. The discussion will include accreditation of whole-body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program. To understand the new requirements of the ACR ultrasound accreditation program, and roles the physicist can play in annual equipment surveys and setting up and supervising the routine QC program. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process.

  17. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    PubMed

    Ronan, Grace; Wolk, Michael J; Bailey, Steven R; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Rosenbaum, Lisa; Shaw, Leslee J; Stainback, Raymond F; Allen, Joseph M; Brindis, Ralph G; Kramer, Christopher M; Shaw, Leslee J; Cerqueira, Manuel D; Chen, Jersey; Dean, Larry S; Fazel, Reza; Hundley, W Gregory; Itchhaporia, Dipti; Kligfield, Paul; Lockwood, Richard; Marine, Joseph Edward; McCully, Robert Benjamin; Messer, Joseph V; O'Gara, Patrick T; Shemin, Richard J; Wann, L Samuel; Wong, John B; Patel, Manesh R; Kramer, Christopher M; Bailey, Steven R; Brown, Alan S; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Lindsay, Bruce D; Min, James K; Shaw, Leslee J; Stainback, Raymond F; Wann, L Samuel; Wolk, Michael J; Allen, Joseph M

    2014-02-01

    The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting. The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1-9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology. The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram (ECG

  18. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    PubMed

    Wolk, Michael J; Bailey, Steven R; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Rosenbaum, Lisa; Shaw, Leslee J; Stainback, Raymond F; Allen, Joseph M

    2014-02-01

    The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting. The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1 to 9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology. The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram

  19. ASCI 2010 appropriateness criteria for cardiac magnetic resonance imaging: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group

    PubMed Central

    Choi, Byoung Wook; Chan, Carmen; Jinzaki, Masahiro; Tsai, I-Chen; Yong, Hwan Seok; Yu, Wei

    2010-01-01

    There has been a growing need for standard Asian population guidelines for cardiac CT and cardiac MR due to differences in culture, healthcare system, ethnicity and disease prevalence. The Asian Society of Cardiovascular Imaging, as the only society dedicated to cardiovascular imaging in Asia, formed a cardiac CT and cardiac MR guideline working group in order to help Asian practitioners to establish cardiac CT and cardiac MR services. In this ASCI cardiac MR appropriateness criteria report, 23 Technical Panel members representing various Asian countries were invited to rate 50 indications that can frequently be encountered in clinical practice in Asia. Indications were rated on a scale of 1–9 to be categorized into ‘appropriate’ (7–9), ‘uncertain’ (4–6), or ‘inappropriate’ (1–3). According to median scores of the 23 members, the final ratings for indications were 24 appropriate, 18 uncertain and 8 inappropriate with 22 ‘highly-agreed’ (19 appropriate and 3 inappropriate) indications. This report is expected to have a significant impact on the cardiac MR practices in many Asian countries by promoting the appropriate use of cardiac MR. Electronic supplementary material The online version of this article (doi:10.1007/s10554-010-9687-z) contains supplementary material, which is available to authorized users. PMID:20734234

  20. 75 FR 30077 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ESBWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-28

    ... Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ESBWR The... Reactor Safeguards. BILLING CODE 7590-01-P...

  1. 76 FR 55717 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... and Probabilistic Risk Assessment The ACRS Subcommittee on Reliability and PRA will hold a meeting... ACRS meetings were published in the Federal Register on October 21, 2010 (75 FR 65038-65039)....

  2. 75 FR 66803 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-29

    ... Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on ABWR will hold a meeting on... ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039)....

  3. 76 FR 11524 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... Boiling Water Reactors (ABWR); Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactors... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-...

  4. 78 FR 79019 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... participation in ACRS meetings were published in the Federal Register on November 8, 2013 (78 FR 67205-67206..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  5. 75 FR 58448 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... participation in ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR 58268- 58269... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability... Safety Branch B, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  6. 76 FR 44377 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-25

    ... events at the Fukushima Dai-Ichi reactor site in Japan. The Subcommittee will hear presentations by and... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on...

  7. 78 FR 65008 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-30

    ... published in the Federal Register on October 18, 2012 (77 FR 64146- 64147). Detailed meeting agendas and... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S....

  8. 75 FR 82093 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant License Renewal; Notice of Meeting The ACRS Subcommittee on Plant License Renewal will hold a meeting on January 12, 2011, Room T-2B1, 11545 Rockville...

  9. 75 FR 25303 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-07

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Regulatory Policies and Practices The ACRS Subcommittee on Regulatory Policies and Practices will hold a meeting on May 19, 2010, Room T-2B1, 11545 Rockville...

  10. 78 FR 20958 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-08

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory Policies and Practices The ACRS Subcommittee on Regulatory Policies and Practices will hold a meeting on April 23, 2013, Room T-2B1, 11545...

  11. 77 FR 5063 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-01

    ... October 17, 2011, (76 FR 64127- 64128). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Thermal-Hydraulics Phenomena; Notice of Meeting The ACRS Subcommittee on Thermal-Hydraulics Phenomena will hold...

  12. 75 FR 82092 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  13. 77 FR 56240 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-12

    ..., (76 FR 64126-64127). Detailed meeting agendas and meeting transcripts are available on the NRC Web... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  14. 77 FR 31044 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-24

    ..., (76 FR 64127-64128). Detailed meeting agendas and meeting transcripts are available on the NRC Web... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  15. 76 FR 34779 - Advisory Committee On Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-14

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee On Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on June...

  16. 76 FR 55717 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on...

  17. 77 FR 68161 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on December...

  18. 75 FR 16874 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-02

    ... Register on October 14, 2009, (74 FR 52829-52830). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  19. 75 FR 82093 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... were published in the Federal Register on October 21, 2010 (75 FR 65038-65039). Detailed meeting... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  20. 76 FR 44964 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  1. 77 FR 38099 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-26

    ... October 17, 2011, (76 FR 64126-64127). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  2. 75 FR 58447 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials The ACRS Subcommittee on Radiation Protection and Nuclear Materials...

  3. 78 FR 66967 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommitte on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-07

    ..., 2012, (77 FR 64146- 64147). Detailed meeting agendas and meeting transcripts are available on the NRC... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommitte on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  4. 75 FR 4881 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-29

    ... Register on October 14, 2009, (74 FR 52829-52830). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  5. 76 FR 55716 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of The ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of The ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on...

  6. 76 FR 61119 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  7. 76 FR 5218 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-28

    ... Register on October 21, 2010 (75 FR 65038- 65039). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water...

  8. 77 FR 76089 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-26

    ... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor...

  9. 76 FR 27102 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic Simplified Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Economic Simplified...

  10. 77 FR 59678 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ... October 17, 2011, (76 FR 64126-64127). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor...

  11. 75 FR 52999 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On ESBWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-30

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On ESBWR The ACRS Subcommittee on Economic Simplified Boiling Water Reactor (ESBWR) will hold a meeting on September 23-24, 2010, Room T-2B1, 11545 Rockville...

  12. 78 FR 51752 - Advisory Committee On Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... COMMISSION Advisory Committee On Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory..., September 16, 2013--8:30 a.m. Until 5 p.m. The Subcommittee will review the State-of-the-Art Reactor... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147)....

  13. 77 FR 33004 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-04

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Reliability... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126- 64127... White Flint North building, 11555 Rockville Pike, Rockville, MD. After registering with security,...

  14. 78 FR 12800 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Plant License... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... White Flint North building, 11555 Rockville Pike, Rockville, MD. After registering with security,...

  15. 78 FR 27442 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147). Detailed meeting... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on May 23, Room T-2B1,...

  16. 78 FR 17945 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... Register on October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on April 10, 2013, Room...

  17. 77 FR 31676 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-29

    ... October 17, 2011, (76 FR 64126- 64127). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on June 20, 2012, Room...

  18. 77 FR 68161 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... Register on October 18, 2012 (77 FR 64146- 64147). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on December 4, 2012, Room...

  19. 78 FR 50457 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-19

    ... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on September 4, 2013, Room...

  20. 78 FR 65008 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-30

    ... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on November 5, 2013, Room...

  1. 77 FR 64147 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-18

    ... published in the Federal Register on October 17, 2011 (76 FR 64126- 64127). Detailed meeting agendas and... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on October 31, 2012, Room...

  2. 77 FR 68161 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... Register on October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on December 5, 2012, Room...

  3. 77 FR 52371 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-29

    ... Register on October 17, 2011, (76 FR 64126- 64127). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on September 5, 2012, Room...

  4. 75 FR 57536 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... were published in the Federal Register on October 14, 2009 (74 FR 58268- 58269). Detailed meeting... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Regulatory Policies and Practices The ACRS Subcommittee on Regulatory Policies and Practices will hold a meeting...

  5. Appropriateness of diagnostics tests.

    PubMed

    Cappelletti, P

    2016-05-01

    The evolution of the concept of 'appropriateness', in the three past decades, from 'no harm' and 'no waste' to 'medical decision-making' and 'determining outcomes' highlights two main points: its foundation is evidence-based medicine, and it is a quality of every phase of the total testing process, not only for the selection of tests. Nevertheless, appropriateness in Laboratory Hematology, as well as in Laboratory Medicine, is an elusive concept: 'Appropriateness' interplays with 'patient's safety', 'healthcare costs', 'clinical decision-making', and 'effectiveness', and the criteria for appropriateness, mainly adherence to clinical guidelines, are often not evidence-based and not always consensus-based. Moreover, practising appropriateness is a complex issue because of the ambiguity of the criteria and targets, the never-ending work of implementing guidelines and their audit, and the uniqueness of the clinical situation of the individual patient. Authors agree on some practical rules: establishing a multidisciplinary and multiprofessional team, choosing carefully clinical targets, finding or building evidences, sharing guidelines with clinicians, choosing adequate tools for changing, working hard on implementation, identifying the 'right' laboratory methods and processes, checking progress indefinitely, providing information, interpretations, and consultations, and promoting feedback and audits. The success depends on the 'right' combination of educational, operative, and reinforcing interventions. Competences in organization, in implementation science, and in interpersonal relationship management are essential as well as knowledge and experience in Hematology, not only in Laboratory Hematology. PMID:27161094

  6. ARM Cloud Retrieval Ensemble Data Set (ACRED)

    SciTech Connect

    Zhao, C; Xie, S; Klein, SA; McCoy, R; Comstock, JM; Delanoë, J; Deng, M; Dunn, M; Hogan, RJ; Jensen, MP; Mace, GG; McFarlane, SA; O’Connor, EJ; Protat, A; Shupe, MD; Turner, D; Wang, Z

    2011-09-12

    This document describes a new Atmospheric Radiation Measurement (ARM) data set, the ARM Cloud Retrieval Ensemble Data Set (ACRED), which is created by assembling nine existing ground-based cloud retrievals of ARM measurements from different cloud retrieval algorithms. The current version of ACRED includes an hourly average of nine ground-based retrievals with vertical resolution of 45 m for 512 layers. The techniques used for the nine cloud retrievals are briefly described in this document. This document also outlines the ACRED data availability, variables, and the nine retrieval products. Technical details about the generation of ACRED, such as the methods used for time average and vertical re-grid, are also provided.

  7. The Automated Conflict Resolution System (ACRS)

    NASA Technical Reports Server (NTRS)

    Kaplan, Ted; Musliner, Andrew; Wampler, David

    1993-01-01

    The Automated Conflict Resolution System (ACRS) is a mission-current scheduling aid that predicts periods of mutual interference when two or more orbiting spacecraft are scheduled to communicate with the same Tracking and Data Relay Satellite (TDRS) at the same time. The mutual interference predicted has the potential to degrade or prevent communications. Thus the ACRS system is a useful tool for aiding in the scheduling of Space Network (SN) communications.

  8. 78 FR 79019 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels... materials and metallurgy. The Subcommittee will hear presentations by and hold discussions with the...

  9. 75 FR 58447 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant License... Branch A, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  10. 75 FR 52556 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-26

    ..., (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available on the NRC Web... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory..., 2010. Cayetano Santos, Chief, Reactor Safety Branch A, Advisory Committee on Reactor...

  11. 75 FR 61781 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-06

    ... representatives of the NRC staff, the Nuclear Energy Institute (NEI), and other interested persons regarding this... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability... October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available...

  12. 75 FR 71154 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-22

    ... would result in a major inconvenience. Dated: November 15, 2010. Antonio Dias, Chief, Reactor Safety... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability... were published in the Federal Register on October 21, 2010, (75 FR 65038- 65039). Detailed...

  13. 76 FR 27103 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... Subcommittee will review recent events at the Fukushima site in Japan. The Subcommittee will hear presentations... were published in the Federal Register on October 21, 2010 (75 FR 65038-65039). Detailed meeting... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on...

  14. 76 FR 34778 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-14

    ... Subcommittee will review recent events at the Fukushima site in Japan. The Subcommittee will hear presentations..., (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on the NRC Web... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on...

  15. 76 FR 22934 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-25

    ... and Probabilistic Risk Assessment; Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on May 11, 2011, Room T-2B3, 11545 Rockville Pike... ACRS meetings were published in the Federal Register on October 21, 2010 (75 FR 65038- 65039)....

  16. 76 FR 71609 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-18

    ... and Probabilistic Risk Assessment; Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on December 14, 2011, Room T-2B3, 11545 Rockville Pike... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64127-...

  17. 76 FR 55717 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... and Probabilistic Risk Assessment The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on September 20, 2011, Room T-2B1, 11545 Rockville Pike, Rockville... ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-...

  18. 78 FR 2695 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-14

    ... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... Operations and Fire Protection; Notice of Meeting The ACRS Subcommittee on Plant Operations and Fire... onsite emergency response capabilities such as Emergency Operating Procedures (EOPs), Severe...

  19. 78 FR 27442 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Plant License... October 18, 2012, (77 FR 64146- 64147). Detailed meeting agendas and meeting transcripts are available on..., Rockville, MD. After registering with security, please contact Mr. Theron Brown (Telephone 240-888-9835)...

  20. 78 FR 27443 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability... were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147). Detailed meeting... Flint North building, 11555 Rockville Pike, Rockville, MD. After registering with security,...

  1. 77 FR 36582 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-19

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory... October 17, 2011, (76 FR 64127-64128). Detailed meeting agendas and meeting transcripts are available on..., Rockville, MD. After registering with security, please contact Mr. Theron Brown (240-888-9835) to...

  2. 77 FR 18873 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory... Subcommittee will review the Draft NUREG Report on the State- of-the-Art Reactor Consequence Analyses (SOARCA... were published in the Federal Register on October 17, 2011, (76 FR 64127-64128). Detailed...

  3. 76 FR 63329 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-12

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant License... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on..., Rockville, MD. After registering with security, please contact Mr. Theron Brown (240-888-9835) to...

  4. 78 FR 59074 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on..., Rockville, MD. After registering with security, please contact Mr. Theron Brown (Telephone 240-888-9835)...

  5. 78 FR 31988 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-28

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant... Register on October 18, 2012, (77 FR 64146- 64147). Detailed meeting agendas and meeting transcripts are... Rockville Pike, Rockville, MD. After registering with security, please contact Mr. Theron Brown...

  6. 75 FR 51499 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C Systems The ACRS Subcommittee on Digital Instrumentation and Controls (I&C) Systems will hold a meeting...

  7. 75 FR 51501 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and Procedures The ACRS Subcommittee on Planning and Procedures will hold a meeting on September 8, 2010,...

  8. The Expanding Significance of One Acre.

    ERIC Educational Resources Information Center

    Gilbert, Daniel R., Jr.

    2003-01-01

    A management class assignment requires students to study the history and complexity of one acre of land. The intent is to develop connections between the natural environment and human acts of management, focusing on the concept of privilege. (Contains 15 references.) (SK)

  9. 7 CFR 760.632 - Payment acres.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 7 2011-01-01 2011-01-01 false Payment acres. 760.632 Section 760.632 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE... considered the same as a planting of an initial crop in tropical regions as defined in part 1437, subpart...

  10. 7 CFR 760.632 - Payment acres.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Payment acres. 760.632 Section 760.632 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE... considered the same as a planting of an initial crop in tropical regions as defined in part 1437, subpart...

  11. Small Break LOCA Analysis of ACR-700 NPP

    SciTech Connect

    Limin Zheng; Sen Shen; Wright, David

    2006-07-01

    A small break loss of coolant accident (SB-LOCA) analysis to assess a preliminary conceptual design of the ACR-700 PHWR nuclear power plant (NPP) developed by AECL has been performed with CATHENA MOD 3.5d, a PHWR system thermal-hydraulic analysis code. The limiting break size has been found by performing a sensitivity study for three different break locations [i.e. reactor inlet header (RIH), HTS pump suction (PS) pipe and reactor outlet head (ROH)] under the limiting case (i.e. SB-LOCA with subsequent loss of class IV power with all safety systems available). The analysis results indicate that the SB-LOCA acceptance criteria are satisfied. (authors)

  12. 75 FR 16203 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Power...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-31

    ....'' This supplement extends the GEH/GNF computational methods to include GNF-2 fuel design. The... participation in ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR...

  13. 77 FR 59677 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ... participation in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127... p.m. The Subcommittee will review and discuss SECY-12-0110, ``Consideration of Economic...

  14. 77 FR 68160 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... develop a revision to the Station Blackout Rule. The Subcommittee will hear presentations by and hold... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147)....

  15. 77 FR 64563 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-22

    ... efforts to develop a revision to the Station Blackout Rule. The Subcommittee will hear presentations by... participation in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR...

  16. 75 FR 65036 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-21

    ... protection program transition to National Fire Protection Association (NFPA) Standard 805. The Subcommittee... participation in ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR...

  17. 76 FR 44378 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-25

    ... ACRS meetings were published in the Federal Register on October 21, 2010 (75 FR 65038-65039). Detailed... for Nuclear Power Plants''; NUREG/CR-4461, Revision 2, ``Tornado Climatology of the Contiguous...

  18. 76 FR 16458 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on ABWR will hold a meeting on April... Register on October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts...

  19. 77 FR 64148 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-18

    ... Reactors,'' Revision 2 and RG 1.79.1, ``Initial Test Program of Emergency Core Cooling Systems for Boiling... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64127-64128)....

  20. 76 FR 18585 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

    ... Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor... October 21, 2010, (75 FR 65038- 65039). Detailed meeting agendas and meeting transcripts are available...

  1. 77 FR 24745 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-25

    ... October 17, 2011, (76 FR 64126- 64127). Detailed meeting agendas and meeting transcripts are available on... Hydraulic Phenomena; Notice of Meeting The ACRS Subcommittee on Thermal Hydraulic Phenomena will hold...

  2. 75 FR 51499 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... October 14, 2009, (74 FR 58268- 58269). Detailed meeting agendas and meeting transcripts are available on... Hydraulics Phenomena The ACRS Subcommittee on Thermal Hydraulics Phenomena will hold a meeting on September...

  3. 77 FR 47680 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittees on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-09

    ... published in the Federal Register on Wednesday, August 1, 2012 (77 FR 45698-45699). Further information... and PRA and Fukushima; Revision to Notice of Meetings The (ACRS) Subcommittee on Fukushima...

  4. 78 FR 29159 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-17

    ... published in the Federal Register on October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  5. 76 FR 55718 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on the NRC Web..., Metallurgy & Reactor Fuels The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels will hold a...

  6. 76 FR 72451 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-23

    ... October 17, 2011, (76 FR 64127- 64128). Detailed meeting agendas and meeting transcripts are available on..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  7. 78 FR 56756 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-13

    ... were published in the Federal Register on October 18, 2012, (77 FR 64146-64147). Detailed meeting..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  8. 76 FR 34778 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-14

    ..., (75 FR 65038- 65039). Detailed meeting agendas and meeting transcripts are available on the NRC Web..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  9. 77 FR 74698 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-17

    ... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  10. 78 FR 34677 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the Acrs Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-10

    ... Register on October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  11. 78 FR 31987 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-28

    ... Register on October 18, 2012, (77 FR 64146- 64147). Detailed meeting agendas and meeting transcripts are..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  12. 75 FR 58449 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are..., Metallurgy & Reactor Fuels The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels will hold a...

  13. 78 FR 3474 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-16

    ... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  14. 76 FR 16016 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of The ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on..., Metallurgy And Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy and...

  15. Radiology practice models: the 2008 ACR Forum.

    PubMed

    Gunderman, Richard B; Weinreb, Jeffrey C; Van Moore, Arl; Hillman, Bruce J; Neiman, Harvey L; Thrall, James H

    2008-09-01

    The 2008 ACR Forum brought together a diverse group of participants from clinical radiology, radiology leadership and practice management, managed care, economics, law, and entrepreneurship in Washington, DC, in January 2008 to discuss current models of radiology practice and anticipate new ones. It addressed what forces shape the practice of radiology, how these forces are changing, and how radiology practices can most effectively respond to them in the future. PMID:18755435

  16. 7 CFR 1412.44 - Notification of base acres.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Notification of base acres. 1412.44 Section 1412.44... through 2012 § 1412.44 Notification of base acres. The operator and owners of record of a farm will be notified in writing of the number of base acres eligible for enrollment in a contract, unless such...

  17. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Election of base acres. 1412.21 Section 1412.21... CROP REVENUE ELECTION PROGRAM FOR THE 2008 AND SUBSEQUENT CROP YEARS Establishment of Base Acres for a Farm for Covered Commodities § 1412.21 Election of base acres. (a) Subject to adjustments in...

  18. 76 FR 44964 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039.... Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor...

  19. 76 FR 5220 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-28

    ... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039... Designs The ACRS Subcommittee on Future Plant Designs will hold a meeting on February 9, 2011, at...

  20. 76 FR 16016 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... ACRS meetings were published in the Federal Register on October 21, 2010 (75 FR 65038-65039). Detailed... Designs The ACRS Subcommittee on Future Plant Designs will hold a meeting on April 5, 2011, at...

  1. 75 FR 74103 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on AP1000...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-30

    ... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038- 65039... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on AP1000; Notice... exception of portions that may be closed to protect unclassified safeguards information, pursuant to 5...

  2. 75 FR 55366 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning And...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-10

    ... ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning And... Branch A, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  3. 75 FR 81318 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of The ACRS Subcommittee on AP1000...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-27

    ... ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of The ACRS Subcommittee on AP1000; Notice... Safety Branch B, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  4. 76 FR 27102 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on U.S. Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor... follows: Friday, May 27, 2011--8:30 a.m. Until 5 p.m. The Subcommittee will review Chapter 5,...

  5. 76 FR 23630 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-27

    ..., Reactor Safety Branch B, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR...

  6. 75 FR 82094 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR); Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR) will hold a meeting on January...

  7. 76 FR 16458 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR); Notice of Meeting The ACRS Subcommittee on U.S. EPR will hold a meeting on April 5, 2011, Room T-2B3, 11545...

  8. 78 FR 50457 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-19

    ... identification of digital system failure modes and use of hazard analysis methods for digital safety systems. The... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital...

  9. 75 FR 16203 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on EPR; Notice...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-31

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on EPR; Notice of Meeting The ACRS Subcommittee on the U.S. Evolutionary Power Reactor (EPR) will hold a meeting on April 20-21, 2010, at 11545 Rockville Pike, T2-...

  10. 76 FR 7882 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C Systems The ACRS Subcommittee on Digital Instrumentation & Control (DI&C) Systems will hold a meeting on February 23, 2011, Room T-2B3, 11545...

  11. 75 FR 67783 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-03

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and Procedures The ACRS Subcommittee on Planning and Procedures will hold a meeting on December 1, 2010, in Room... conduct of the meeting, persons planning to attend should check with these references if such...

  12. 78 FR 12800 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Planning and... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... security, please contact Mr. Theron Brown (240-888-9835) to be escorted to the meeting room....

  13. 78 FR 31987 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-28

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147... security, please contact Mr. Theron Brown (240-888-9835) to be escorted to the meeting room. Dated: May...

  14. 77 FR 67688 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-13

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C... Instrumentation and Control of the Babcock & Wilcox (B&W) mPower reactor. The Subcommittee will hear presentations... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR...

  15. 77 FR 10784 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-23

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor... were published in the Federal Register on October 17, 2011, (76 FR 64127-64128). Detailed...

  16. 77 FR 36581 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-19

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor... October 17, 2011, (76 FR 64127-64128). Detailed meeting agendas and meeting transcripts are available...

  17. 77 FR 36583 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-19

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Planning and... participation in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126- 64127... security, please contact Mr. Theron Brown (240-888-9835) to be escorted to the meeting room. Dated: June...

  18. 77 FR 33003 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-04

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital I&C... for reviewing the mPower reactor. The Subcommittee will hear presentations by and hold discussions... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127)....

  19. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    PubMed

    Patel, Manesh R; Bailey, Steven R; Bonow, Robert O; Chambers, Charles E; Chan, Paul S; Dehmer, Gregory J; Kirtane, Ajay J; Wann, L Samuel; Ward, R Parker

    2012-05-29

    The American College of Cardiology Foundation, in collaboration with the Society for Cardiovascular Angiography and Interventions and key specialty and subspecialty societies, conducted a review of common clinical scenarios where diagnostic catheterization is frequently considered. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of noninvasive imaging appropriate use criteria. The 166 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). Diagnostic catheterization may include several different procedure components. The indications developed focused primarily on 2 aspects of diagnostic catheterization. Many indications focused on the performance of coronary angiography for the detection of coronary artery disease with other procedure components (e.g., hemodynamic measurements, ventriculography) at the discretion of the operator. The majority of the remaining indications focused on hemodynamic measurements to evaluate valvular heart disease, pulmonary hypertension, cardiomyopathy, and other conditions, with the use of coronary angiography at the discretion of the operator. Seventy-five indications were rated as appropriate, 49 were rated as uncertain, and 42 were rated as inappropriate. The appropriate use criteria for diagnostic catheterization have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID:22578925

  20. 75 FR 44818 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ESBWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-29

    ... Racks,'' NEDC- 33374P, ``Safety Analysis Report for Fuel Storage Racks Criticality Analysis for ESBWR... ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed... Subcommittee will discuss Chapters 2, 10, 12, 14, 15, 16, 18, 20, and 21 of the final Safety Evaluation...

  1. 76 FR 11525 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... and Probabilistic Risk Assessment (PRA); Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA), Room T-2B1, 11545 Rockville Pike, Rockville, Maryland. The entire meeting... published in the Federal Register on October 21, 2010, (75 FR 65038- 65039). Detailed meeting agendas...

  2. 76 FR 18586 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

    ... and Probabilistic Risk Assessment (PRA); Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on April 20, 2011, Room T-2B1, 11545 Rockville Pike... published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas...

  3. 75 FR 66803 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-29

    ... ACRS meetings were ] published in the Federal Register on October 14, 2009, (74 FR 58268- 58269... with the NRC staff, AREVA, UniStar, and other interested persons. The Subcommittee will gather... rescheduling would result in a major inconvenience. Dated: October 21, 2010. Antonio F. Dias, Chief,...

  4. 75 FR 55365 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-10

    ..., (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available on the NRC Web... Operations and Fire Protection The ACRS Subcommittee on Plant Operations and Fire Protection will hold a..., October 6, 2010--8:30 a.m. until 12 p.m. The subcommittee will discuss the construction, inspection,...

  5. 76 FR 38212 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-29

    ... published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and... Operations and Fire Protection; Notice of Meeting The ACRS Subcommittee on Plant Operations and Fire... Region II to discuss the construction inspection program at the Vogtle site and discuss other items...

  6. 77 FR 45699 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Economic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127). Detailed... and/or written comments should notify the Designated Federal Official (DFO), Christopher Brown (Telephone 301-415-7111 or Email: Christopher.Brown@nrc.gov ) five days prior to the meeting, if possible,...

  7. 75 FR 28824 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on APWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-24

    .... Detailed procedures for the conduct of and participation in ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are... From the Federal Register Online via the Government Publishing Office NUCLEAR...

  8. 75 FR 57536 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and... Hydraulic Phenomena The ACRS Subcommittee on Thermal Hydraulic Phenomena will hold a meeting on October 18... 5 p.m. The Subcommittee will review the thermal-hydraulic research activities in the Office...

  9. 76 FR 62866 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-11

    ..., (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on the NRC Web... Simplified Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Economic Simplified Boiling Water Reactor (ESBWR) will hold a meeting on October 21, 2011, Room T-2B1, 11545 Rockville...

  10. 76 FR 68793 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-07

    ... published in the Federal Register on October 17, 2011, (76 FR 64127-64128). Detailed meeting agendas and... Simplified Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Economic Simplified Boiling Water Reactor (ESBWR) will hold a meeting on November 30, 2011, Room T-2B1, 11545 Rockville...