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Appropriateness Criteria

Variant 1: Adult. Clinical transient ischemic attack (TIA). Symptoms resolved. Initial imaging
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler carotid artery Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 1 10 2 4
References Study Quality
12 (34024117) 4
38 (16679163) M
MRI head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 1 0 0 1 0 0 3 6 8
References Study Quality
36 (25817629) 4
35 (25813066) 2
34 (24453269) 4
29 (24256197) 2
CT head without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 0 0 1 3 15
References Study Quality
21 (25477216) 2
20 (26747699) 4
19 (24029731) 4
14 (23228203) 2
13 (31662037) 4
CTA head with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 0 1 8 6 3
References Study Quality
23 (35314513) 4
22 (26330567) 2
CTA neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 0 0 0 1 3 11 4
References Study Quality
12 (34024117) 4
24 (10219418) 2
MRA head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 7 9 2 0 0
References Study Quality
25 (23907247) 4
MRA neck without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 7 9 2 0 0
References Study Quality
12 (34024117) 4
26 (18556586) Not Assessed
27 (19164440) 2
MRA neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 9 9 1 0 0
References Study Quality
12 (34024117) 4
26 (18556586) Not Assessed
27 (19164440) 2
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 7 1 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 5 1 0 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 3 0 0 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 7 3 7 1 0 0 1 0 0
References Study Quality
33 (29146719) 2
32 (17200864) 2
31 (11003277) 2
30 (27070836) 2
29 (24256197) 2
28 (15569725) 4
18 (22068990) 2
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 1 6 6 1 0 0 0 0
References Study Quality
34 (24453269) 4
MRV head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 4 4 1 0 1 0 0 0
References Study Quality
37 (21917479) 4
MRV head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 1 6 1 1 0 0 0 0
References Study Quality
37 (21917479) 4
CT head perfusion with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 2 2 6 5 3 1 4 1 1 0 0
References Study Quality
18 (22068990) 2
17 (27939758) 2
16 (34925211) 2
15 (21220677) 2
14 (23228203) 2
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 19 0 2 0 0 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 18 1 2 0 0 0 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 2 1 1 0 0 0 0
Variant 2: Adult. Focal neurologic deficit. Clinically suspected acute ischemic stroke. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 2 0 4 3 4 4 4
References Study Quality
56 (27673305) 2
52 (32668115) 4
49 (36239645) 2
48 (36239644) 1
47 (35138767) 2
46 (29129157) 4
40 (29766770) 2
39 (16339467) 4
CT head without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 1 0 0 0 0 0 20
References Study Quality
58 (10905241) 2
59 (18617663) 2
CTA head with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 0 1 1 6 12
References Study Quality
60 (35342807) 2
57 (29364767) 1
49 (36239645) 2
48 (36239644) 1
46 (29129157) 4
44 (26898852) Not Assessed
CTA neck with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 0 0 1 1 6 12
References Study Quality
12 (34024117) 4
13 (31662037) 4
61 (27092472) 2
US duplex Doppler carotid artery May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 3 3 4 3 6 1 0 0 1
References Study Quality
12 (34024117) 4
63 (10471419) 4
64 (29307510) 2
MRA head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 6 7 3 1 1
References Study Quality
39 (16339467) 4
52 (32668115) 4
56 (27673305) 2
MRA neck without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 14 2 2 0 0
References Study Quality
12 (34024117) 4
39 (16339467) 4
52 (32668115) 4
56 (27673305) 2
MRA neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 16 2 1 0 0
References Study Quality
39 (16339467) 4
52 (32668115) 4
56 (27673305) 2
MRI head perfusion with IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 4 4 3 1 5 1 7 1 0 1 0
References Study Quality
39 (16339467) 4
46 (29129157) 4
57 (29364767) 1
CT head perfusion with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv 6 6 0 1 1 0 8 4 2 1 4
References Study Quality
13 (31662037) 4
46 (29129157) 4
56 (27673305) 2
57 (29364767) 1
US duplex Doppler transcranial Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 1 5 1 1 1 0 0 0
References Study Quality
39 (16339467) 4
Arteriography cervicocerebral Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 4 8 0 0 0 0 0 0
References Study Quality
55 (29075836) 2
54 (35593152) Good
53 (35251309) Good
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 3 2 0 0 0 0 0 0
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 5 8 1 0 0 0 0 0
References Study Quality
62 (29934921) 4
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 3 4 1 1 1 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 3 4 1 2 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 4 1 0 0 0 1 1 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 5 2 0 0 0 0 0 1
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 10 5 4 0 1 1 0 0 0
Variant 3: Adult. Recent ischemic infarct; less than 24 hours. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 0 12 3 1
References Study Quality
39 (16339467) 4
52 (32668115) 4
56 (27673305) 2
MRA neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 8 1 8 2 0
References Study Quality
12 (34024117) 4
39 (16339467) 4
52 (32668115) 4
56 (27673305) 2
MRI head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 4 3 5 2 6
References Study Quality
56 (27673305) 2
52 (32668115) 4
49 (36239645) 2
48 (36239644) 1
47 (35138767) 2
46 (29129157) 4
40 (29766770) 2
39 (16339467) 4
CT head without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 1 0 0 0 1 3 16
References Study Quality
59 (18617663) 2
58 (10905241) 2
57 (29364767) 1
49 (36239645) 2
48 (36239644) 1
47 (35138767) 2
46 (29129157) 4
44 (26898852) Not Assessed
CTA head with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 0 1 3 3 13
References Study Quality
60 (35342807) 2
57 (29364767) 1
49 (36239645) 2
48 (36239644) 1
46 (29129157) 4
44 (26898852) Not Assessed
CTA neck with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 0 0 1 4 2 13
References Study Quality
12 (34024117) 4
13 (31662037) 4
61 (27092472) 2
US duplex Doppler carotid artery May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 6 10 2 0 0 0
References Study Quality
63 (10471419) 4
64 (29307510) 2
12 (34024117) 4
MRA neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 13 3 2 0 0
References Study Quality
39 (16339467) 4
52 (32668115) 4
56 (27673305) 2
MRI head perfusion with IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 14 3 0 1 0
References Study Quality
39 (16339467) 4
46 (29129157) 4
57 (29364767) 1
CT head perfusion with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv 6 6 0 0 0 0 8 10 0 0 1
References Study Quality
13 (31662037) 4
46 (29129157) 4
56 (27673305) 2
57 (29364767) 1
US duplex Doppler transcranial Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 9 4 4 1 2 1 0 0 0
References Study Quality
39 (16339467) 4
Arteriography cervicocerebral Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 4 8 0 0 0 0 0 0
References Study Quality
55 (29075836) 2
54 (35593152) Good
53 (35251309) Good
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 1 0 0 0 0 0 0
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 2 4 6 2 0 0 0 0
References Study Quality
62 (29934921) 4
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 5 2 1 1 0 0 1 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 5 1 1 1 0 0 1 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 3 3 0 0 0 1 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 4 2 1 0 0 0 0 1
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 3 4 0 1 1 0 1 0
Variant 4: Adult. Recent ischemic infarct; greater than 24 hours. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 3 3 3 1 8
References Study Quality
79 (35862046) 2
78 (33043760) 2
77 (31479136) 4
76 (23894258) 2
75 (23173645) 4
74 (22367989) 2
13 (31662037) 4
12 (34024117) 4
CT head without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 1 0 0 1 0 4 14
References Study Quality
68 (34921104) 2
67 (24525954) 2
CTA head with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 4 4 6 2 2
References Study Quality
22 (26330567) 2
23 (35314513) 4
69 (35143758) 4
CTA neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 1 0 2 4 5 2 6
References Study Quality
12 (34024117) 4
13 (31662037) 4
US duplex Doppler carotid artery May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 5 11 2 0 0
References Study Quality
80 (29522870) 2
38 (16679163) M
24 (10219418) 2
13 (31662037) 4
12 (34024117) 4
MRA head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 5 3 7 1 1
References Study Quality
22 (26330567) 2
23 (35314513) 4
69 (35143758) 4
MRA neck without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 0 7 9 1 0 1
References Study Quality
70 (15955853) 2
71 (16155164) 2
MRA neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 7 8 2 0 0
References Study Quality
71 (16155164) 2
70 (15955853) 2
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 3 1 1 2 1 0 0 0
Arteriography cervicocerebral Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 6 9 0 0 0 0 0 1
References Study Quality
66 (31649101) 4
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 3 2 0 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 6 4 3 3 3 0 0 0 0
References Study Quality
18 (22068990) 2
73 (21737809) 2
72 (23908062) 2
33 (29146719) 2
32 (17200864) 2
31 (11003277) 2
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 2 4 1 6 0 0 0 0
References Study Quality
62 (29934921) 4
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 3 1 1 0 0 1 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 3 1 1 0 1 0 0
CT head perfusion with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 3 3 4 3 7 1 4 0 0 0 0
References Study Quality
17 (27939758) 2
18 (22068990) 2
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 3 0 0 0 1 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 3 1 0 0 0 1 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 1 1 2 0 0 1 0
Variant 5: Adult. Prior ischemic infarct. Surveillance imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT head without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 1 0 1 0 1 1 2 5 8
References Study Quality
67 (24525954) 2
68 (34921104) 2
US duplex Doppler carotid artery May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 3 10 4 1 0 0
References Study Quality
12 (34024117) 4
13 (31662037) 4
38 (16679163) M
MRA head without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 1 0 8 6 1 1 0 1
References Study Quality
22 (26330567) 2
23 (35314513) 4
69 (35143758) 4
MRA neck without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 1 0 6 8 1 0 1 1
References Study Quality
12 (34024117) 4
13 (31662037) 4
85 (26077590) 2
84 (26077583) 4
83 (22498329) 2
MRA neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 1 0 5 9 2 0 0 1
References Study Quality
85 (26077590) 2
84 (26077583) 4
83 (22498329) 2
MRI head without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 0 2 5 2 6 2 1
References Study Quality
79 (35862046) 2
78 (33043760) 2
77 (31479136) 4
76 (23894258) 2
75 (23173645) 4
74 (22367989) 2
13 (31662037) 4
12 (34024117) 4
CTA head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 0 0 1 14 1 1 0 0
References Study Quality
22 (26330567) 2
23 (35314513) 4
69 (35143758) 4
CTA neck with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 0 1 14 2 1 0 0
References Study Quality
12 (34024117) 4
13 (31662037) 4
24 (10219418) 2
81 (25721945) 1
82 (33004431) 4
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 1 2 3 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 2 5 3 1 1 0 0 0
References Study Quality
66 (31649101) 4
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 1 0 2 1 1 0 0
MRI head perfusion with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 7 3 7 0 2 0 0 0 0
References Study Quality
18 (22068990) 2
33 (29146719) 2
32 (17200864) 2
31 (11003277) 2
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 2 6 4 0 1 0 0 0
References Study Quality
62 (29934921) 4
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 4 0 1 0 1 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 3 0 2 0 0 0 1
CT head perfusion with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 2 2 6 5 8 0 0 0 0 0 0
References Study Quality
17 (27939758) 2
18 (22068990) 2
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 3 2 0 0 1 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 4 0 0 0 1 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 2 0 2 0 1 0 0
Variant 6: Adult. Known intraparenchymal hemorrhage. No history of trauma. Follow-up imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 2 1 3 6 6
References Study Quality
98 (20733299) 2
97 (10800260) 2
96 (21761271) 1
MRI head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 2 4 4 4 4
References Study Quality
97 (10800260) 2
98 (20733299) 2
CT head without IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 0 0 2 3 1 12
CTA head with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 1 0 1 4 5 7
References Study Quality
5 (34794589) 4
95 (19910545) 3
94 (24136645) 2
93 (25177839) 2
92 (19342546) 1
91 (30193811) 2
Arteriography cervicocerebral May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 9 6 2 0 0
References Study Quality
90 (9836762) 4
89 (26553142) 1
88 (9227692) 2
MRA head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 10 7 1 0 1
References Study Quality
93 (25177839) 2
95 (19910545) 3
MRV head without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 15 3 0 1 0
MRV head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 14 2 1 0 0
CTV head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 15 2 1 0 0
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 1 0 0 0 0 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 2 1 0 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 4 8 0 0 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 4 3 1 1 0 0 1 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 4 5 0 1 0 0 0 1
MRI head perfusion with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 1 7 0 3 1 0 0 0
References Study Quality
5 (34794589) 4
CT head perfusion with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 7 4 7 0 1 0 0 0 0
References Study Quality
5 (34794589) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 1 2 2 0 1 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 6 2 2 0 0 0 0 0
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 5 7 0 0 0 0 0 0
Variant 7: Adult. Suspected venous sinus thrombosis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 1 0 0 1 0 3 5 8
References Study Quality
103 (26670082) 2
102 (11237970) 4
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 0 6 7 5
References Study Quality
103 (26670082) 2
102 (11237970) 4
MRV head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 0 0 2 16
References Study Quality
104 (25938564) 2
MRV head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 0 1 4 4 9
References Study Quality
104 (25938564) 2
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 0 0 3 6 10
References Study Quality
99 (21293023) 4
CTV head with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 0 1 1 2 14
References Study Quality
101 (9393193) 3
CT head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 4 2 2 6 4 1 0 0 0
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 1 0 0 0 0 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 0 0 1 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 3 2 1 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 3 2 0 1 0 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 2 2 0 1 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 2 0 1 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 2 0 1 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 3 4 3 3 0 0 0 0
References Study Quality
100 (24172883) 3
CT head perfusion with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 6 3 6 2 1 1 0 0 0
References Study Quality
100 (24172883) 3
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 1 5 2 4 0 0 1 0
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 3 3 4 3 1 0 0 0
References Study Quality
5 (34794589) 4
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 5 3 0 1 0 0 0 0
Variant 8: Adult. Known venous sinus thrombosis. Surveillance imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 0 7 5 5
References Study Quality
102 (11237970) 4
103 (26670082) 2
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 0 6 7 4
References Study Quality
102 (11237970) 4
103 (26670082) 2
MRV head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 1 1 1 4 11
References Study Quality
104 (25938564) 2
MRV head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 1 1 3 7 6
References Study Quality
104 (25938564) 2
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 0 1 0 0 7 6 5
References Study Quality
99 (21293023) 4
CTV head with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 0 3 9 6
References Study Quality
101 (9393193) 3
106 (17114562) 2
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 2 1 0 0 0 0 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 2 0 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 8 1 2 2 4 1 1 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 2 1 1 0 0 0 0 0
MRA head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 3 2 1 1 0 0 0 0
References Study Quality
5 (34794589) 4
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 0 1 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 0 1 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 3 4 3 1 0 0 0 0
References Study Quality
100 (24172883) 3
CT head perfusion with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 8 2 5 4 0 0 0 0 0
References Study Quality
100 (24172883) 3
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 5 1 5 4 2 2 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 1 3 6 1 1 1 0 0
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 1 7 2 2 0 0 0 0
References Study Quality
5 (34794589) 4
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 2 0 0 1 0 0 0 0
Variant 9: Adult. Asymptomatic cervical bruit. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler carotid artery Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 1 3 2 12
References Study Quality
120 (15944595) M
112 (35412377) 4
111 (25355838) 4
MRA neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 1 0 3 6 8
References Study Quality
27 (19164440) 2
119 (24008170) 1
118 (23988640) 4
117 (32877415) 2
114 (30378455) 4
113 (29896980) 2
MRA neck without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 1 10 1 5
References Study Quality
27 (19164440) 2
119 (24008170) 1
118 (23988640) 4
117 (32877415) 2
114 (30378455) 4
113 (29896980) 2
CTA neck with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 1 0 1 3 4 4 6
References Study Quality
24 (10219418) 2
116 (24343701) 2
115 (28251333) 2
114 (30378455) 4
113 (29896980) 2
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 4 2 1 1 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 4 2 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 0 1 2 1 1 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 2 8 0 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 3 3 1 3 0 0 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 4 2 1 1 0 0 1 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 5 4 2 0 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 4 2 0 0 0 1 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 5 1 0 0 1 0 0 0
CT head perfusion with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 3 2 0 1 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 3 1 0 0 0 1 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 3 1 0 0 1 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 6 3 10 0 0 0 0 0 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 5 8 0 0 0 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 3 1 0 1 0 0 0 0
Variant 10: Adult. Asymptomatic carotid stenosis. Surveillance imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler carotid artery Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 1 4 6 7
References Study Quality
120 (15944595) M
MRA neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 1 1 3 7 6
References Study Quality
27 (19164440) 2
85 (26077590) 2
119 (24008170) 1
118 (23988640) 4
117 (32877415) 2
114 (30378455) 4
113 (29896980) 2
MRA neck without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 0 1 10 3 4
References Study Quality
27 (19164440) 2
85 (26077590) 2
119 (24008170) 1
118 (23988640) 4
117 (32877415) 2
114 (30378455) 4
113 (29896980) 2
CTA neck with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 1 1 1 1 3 5 7
References Study Quality
80 (29522870) 2
116 (24343701) 2
115 (28251333) 2
114 (30378455) 4
113 (29896980) 2
MRI head without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 0 0 5 6 4 0 0 1
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 3 1 0 0 1 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 1 3 1 4 1 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 4 1 0 0 1 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 3 8 0 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 4 7 1 0 0 1 0 0
References Study Quality
124 (28255464) 2
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 1 5 0 2 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 3 1 0 1 0 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 3 2 0 0 0 0 0 0
CT head perfusion with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 9 2 4 2 2 0 0 0 0
References Study Quality
124 (28255464) 2
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 3 3 0 0 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 5 2 0 1 0 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 7 2 8 1 0 1 0 0 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 2 10 0 0 0 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 3 2 0 0 0 0 0 0
Variant 11: Adult. Suspected cervical vascular dissection or injury. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 1 1 5 6 5
References Study Quality
129 (29853818) 4
132 (24384680) 2
MRA neck without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 1 10 5 3
References Study Quality
129 (29853818) 4
132 (24384680) 2
CT head without IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 0 0 6 3 8 0 2
CTA neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 0 0 0 0 5 13
References Study Quality
131 (27767400) 4
130 (18635617) 2
129 (29853818) 4
MRA head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 0 3 2 11 2 0 0 0
MRI head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 1 0 13 3 1 0 1
CTA head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 13 3 1 1 0
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 4 1 0 0 0 0 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 2 1 0 0 1 0 0 0
Arteriography cervicocerebral Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 4 6 0 0 0 0 0 0
References Study Quality
128 (26478890) 4
127 (22198988) 2
126 (10568710) 2
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 2 0 0 2 0 2 0 0
MRI head perfusion with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 4 1 1 0 0 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 2 4 0 0 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 4 1 0 0 0 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 1 0 0 0 0 0 0
CT head perfusion with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 2 4 0 0 1 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 3 3 0 0 0 0 1 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 3 2 1 0 0 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 4 0 0 2 0 0 0 0
Variant 12: Adult. Known cervical vascular dissection or injury. Surveillance imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 3 11 3 2
References Study Quality
129 (29853818) 4
132 (24384680) 2
MRA neck without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 0 1 0 3 12 0 2
References Study Quality
129 (29853818) 4
132 (24384680) 2
CTA neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 0 0 1 2 2 13
References Study Quality
131 (27767400) 4
130 (18635617) 2
129 (29853818) 4
Arteriography cervicocerebral May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 0 1 9 6 2 0 0 0
MRA head without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 2 0 9 2 3 0 0 0
CTA head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 1 1 9 5 2 0 0 0
US duplex Doppler carotid artery Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 9 6 2 2 0 0 0 0 0
References Study Quality
137 (20962286) 2
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 2 0 1 2 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 4 1 0 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 3 3 1 0 1 0 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 1 1 2 2 0 0 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 1 3 9 0 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 0 0 1 0 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 1 0 0 0 0 0 0
CT head perfusion with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 3 4 1 0 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 4 1 0 0 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 3 2 0 0 0 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 7 2 5 0 4 1 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 3 0 0 0 0 0 0
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.