Our Appropriate Use Criteria

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At MSK, we have long recognized that the use of medical imaging in cancer care requires guidelines and protocols tailored specifically to the needs of patients with cancer. As part of our commitment to continually optimizing quality, safety and efficiency in all areas of cancer care, we are developing appropriate use criteria (AUC) for advanced imaging services across the patient’s care continuum which we refer to as clinical context for imaging:
 

  • Cancer Screening
  • Neoplasm Detection/Diagnostic Workup
  • Cancer Staging/Restaging
  • Cancer Pre-treatment Assessment
  • Therapeutic Response Assessment
  • Therapeutic Complication Assessment
  • Cancer Complication/Comorbidity Assessment
  • Cancer Surveillance
  • Survivorship
  • Imaging Unrelated to Cancer

Our Appropriate Use Criteria

Our Imaging Disease Management Teams (IDMTs) are charged with defining the AUC for specific clinical domains. While our initial focus is on the Priority Clinical Areas (PCAs) as defined by the Centers for Medicare and Medicaid Services (CMS), it is an on-going process to provide AUC for advanced diagnostic imaging related to the full range of clinical conditions most relevant to patients with cancer.

MSK may modify existing AUC or develop new AUC as our IDMT members deem necessary. The IDMTs may also endorse existing AUC when the evidence provided is consistent with MSK standards of care, clinically relevant, and valid for the cancer patient population. Each IDMT has autonomous governance, decision-making authority and accountability for the AUC developed, modified or endorsed by that team.

Currently, AUC developed at MSK do not meet the definition of “relevant to a priority clinical area” (as defined in paragraph (c)(1)(v) of 42 CFR 414.94, i.e., the criterion or AUC subset must reasonably address the entire clinical scope of the corresponding priority clinical area) due to the focus on special considerations in oncology care and allied diseases.

 

Headache

View Headache AUC

Conditions addressed in this AUC include:

Focal Neurologic Deficit

1. Nontraumatic Headache, Cancer, Focal Neurologic Deficit, Vascular Disease Suspected

2. Nontraumatic Headache, Cancer, Focal Neurologic Deficit, Ischemia Suspected

3. Nontraumatic Headache, Cancer, Focal Neurologic Deficit, Venous Infarct or Sinus Occlusion Suspected

4. Nontraumatic Headache, Cancer, Focal Neurologic Deficit

History of Brain Radiation

5. Nontraumatic Headache, Cancer, History of Brain Radiation 

Hip pain

View Hip Pain AUC

Conditions addressed in this AUC include:

1. Hip pain, cancer, no prior x-ray

2. Hip pain, cancer, prior x-ray

Low back pain

View Low Back Pain AUC

Conditions addressed in this AUC include:

1. Low back pain, cancer

2. Low back pain, cancer, cord compression suspected

3. Low back pain, cancer, hardware failure suspected

4. Low back pain, cancer, metastasis suspected

Shoulder pain

View Shoulder Pain AUC

Conditions addressed in this AUC include:

1. Shoulder pain, cancer, no prior x-ray

2. Shoulder pain, cancer, prior x-ray

Cervical or neck pain

View Cervical or Neck Pain AUC

Conditions addressed in this AUC include:

1. Cervical/neck pain, cancer

2. Cervical/neck pain, cancer, cord compression suspected

3. Cervical/neck pain, cancer, hardware failure suspected

4. Cervical/neck pain, cancer, metastasis suspected

For information about our appropriate use criteria, please contact [email protected]