Preoperative and Postoperative Imaging for Bariatric Procedures

Variant: 1 Adult. Bariatric procedure. Routine preprocedure planning.

Procedure	Appropriateness Category	Relative Radiation Level
Fluoroscopy biphasic esophagram	May Be Appropriate	☢☢☢
Fluoroscopy single contrast esophagram	May Be Appropriate	☢☢☢
Fluoroscopy upper GI series	May Be Appropriate	☢☢☢
US abdomen	Usually Not Appropriate	O
Radiography abdomen	Usually Not Appropriate	☢☢
Fluoroscopy small bowel follow-through	Usually Not Appropriate	☢☢☢
MRI abdomen without and with IV contrast	Usually Not Appropriate	O
MRI abdomen without IV contrast	Usually Not Appropriate	O
CT abdomen and pelvis with IV contrast	Usually Not Appropriate	☢☢☢
CT abdomen and pelvis without IV contrast	Usually Not Appropriate	☢☢☢
CT abdomen and pelvis without and with IV contrast	Usually Not Appropriate	☢☢☢☢

Variant: 2 Adult. Bariatric procedure. Routine immediate postprocedure evaluation.

Procedure	Appropriateness Category	Relative Radiation Level
Fluoroscopy upper GI series	May Be Appropriate	☢☢☢
CT abdomen and pelvis with IV contrast	May Be Appropriate	☢☢☢
CT abdomen and pelvis without IV contrast	May Be Appropriate	☢☢☢
US abdomen	Usually Not Appropriate	O
Radiography abdomen	Usually Not Appropriate	☢☢
Fluoroscopy biphasic esophagram	Usually Not Appropriate	☢☢☢
Fluoroscopy single contrast esophagram	Usually Not Appropriate	☢☢☢
Fluoroscopy upper GI series with small bowel follow-through	Usually Not Appropriate	☢☢☢
MRI abdomen without and with IV contrast	Usually Not Appropriate	O
MRI abdomen without IV contrast	Usually Not Appropriate	O
CT abdomen and pelvis without and with IV contrast	Usually Not Appropriate	☢☢☢☢

Variant: 3 Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.

Procedure	Appropriateness Category	Relative Radiation Level
Fluoroscopy upper GI series	May Be Appropriate	☢☢☢
Radiography abdomen and pelvis	May Be Appropriate	☢☢☢
CT abdomen and pelvis with IV contrast	May Be Appropriate	☢☢☢
CT abdomen and pelvis without IV contrast	May Be Appropriate	☢☢☢
US abdomen	Usually Not Appropriate	O
Fluoroscopy biphasic esophagram	Usually Not Appropriate	☢☢☢
Fluoroscopy single contrast esophagram	Usually Not Appropriate	☢☢☢
Fluoroscopy upper GI series with small bowel follow-through	Usually Not Appropriate	☢☢☢
MRI abdomen and pelvis without and with IV contrast	Usually Not Appropriate	O
MRI abdomen and pelvis without IV contrast	Usually Not Appropriate	O
CT abdomen and pelvis without and with IV contrast	Usually Not Appropriate	☢☢☢☢

Variant: 4 Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.

Procedure	Appropriateness Category	Relative Radiation Level
CT abdomen and pelvis with IV contrast	Usually Appropriate	☢☢☢
Fluoroscopy upper GI series	May Be Appropriate	☢☢☢
CT abdomen and pelvis without IV contrast	May Be Appropriate	☢☢☢
US abdomen	Usually Not Appropriate	O
Fluoroscopy biphasic esophagram	Usually Not Appropriate	☢☢☢
Fluoroscopy single contrast esophagram	Usually Not Appropriate	☢☢☢
Fluoroscopy upper GI series with small bowel follow-through	Usually Not Appropriate	☢☢☢
Radiography abdomen and pelvis	Usually Not Appropriate	☢☢☢
MRI abdomen and pelvis without and with IV contrast	Usually Not Appropriate	O
MRI abdomen and pelvis without IV contrast	Usually Not Appropriate	O
CT abdomen and pelvis without and with IV contrast	Usually Not Appropriate	☢☢☢☢

Panel Members

Jason A. Pietryga, MD^a; Cynthia S. Santillan, MD^b; Elena K. Korngold, MD^c; James H. Birkholz, MD^d; Brooks D. Cash, MD^e; Bari Dane, MD^f; Natally Horvat, ^g; Avinash R. Kambadakone, MD^h; Peter S. Liu, MDⁱ; Ann M. Rogers, MD^j; Ashley E. Vorenkamp, MD^k; Chadwick L. Wright, MD, PhD^l; Kathryn J. Fowler, MD^m.

Summary of Literature Review

Introduction/Background

Special Imaging Considerations

Discussion of Procedures by Variant

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
A. CT abdomen and pelvis with IV contrast

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
B. CT abdomen and pelvis without and with IV contrast

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
C. CT abdomen and pelvis without IV contrast

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
D. Fluoroscopy biphasic esophagram

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
E. Fluoroscopy single contrast esophagram

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
F. Fluoroscopy small bowel follow-through

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
G. Fluoroscopy upper GI series

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
H. MRI abdomen without and with IV contrast

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
I. MRI abdomen without IV contrast

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
J. Radiography abdomen

Variant 1: Adult. Bariatric procedure. Routine preprocedure planning.
K. US abdomen

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
A. CT abdomen and pelvis with IV contrast

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
B. CT abdomen and pelvis without and with IV contrast

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
C. CT abdomen and pelvis without IV contrast

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
D. Fluoroscopy biphasic esophagram

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
E. Fluoroscopy single contrast esophagram

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
F. Fluoroscopy upper GI series

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
G. Fluoroscopy upper GI series with small bowel follow-through

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
H. MRI abdomen without and with IV contrast

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
I. MRI abdomen without IV contrast

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
J. Radiography abdomen

Variant 2: Adult. Bariatric procedure. Routine immediate postprocedure evaluation.
K. US abdomen

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
A. CT abdomen and pelvis with IV contrast

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
B. CT abdomen and pelvis without and with IV contrast

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
C. CT abdomen and pelvis without IV contrast

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
D. Fluoroscopy biphasic esophagram

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
E. Fluoroscopy single contrast esophagram

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
F. Fluoroscopy upper GI series

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
G. Fluoroscopy upper GI series with small bowel follow-through

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
H. MRI abdomen and pelvis without and with IV contrast

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
I. MRI abdomen and pelvis without IV contrast

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
J. Radiography abdomen and pelvis

Variant 3: Adult. Less-invasive bariatric procedure. Suspected complication. Postprocedure evaluation.
K. US abdomen

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
A. CT abdomen and pelvis with IV contrast

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
B. CT abdomen and pelvis without and with IV contrast

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
C. CT abdomen and pelvis without IV contrast

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
D. Fluoroscopy biphasic esophagram

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
E. Fluoroscopy single contrast esophagram

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
F. Fluoroscopy upper GI series

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
G. Fluoroscopy upper GI series with small bowel follow-through

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
H. MRI abdomen and pelvis without and with IV contrast

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
I. MRI abdomen and pelvis without IV contrast

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
J. Radiography abdomen and pelvis

Variant 4: Adult. Bariatric procedure. Suspected complication. Postprocedure evaluation.
K. US abdomen

Summary of Highlights

Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Gender Equality and Inclusivity Clause

The ACR acknowledges the limitations in applying inclusive language when citing research studies that predates the use of the current understanding of language inclusive of diversity in sex, intersex, gender, and gender-diverse people. The data variables regarding sex and gender used in the cited literature will not be changed. However, this guideline will use the terminology and definitions as proposed by the National Institutes of Health.

Appropriateness Category Names and Definitions

Appropriateness Category Name	Appropriateness Rating	Appropriateness Category Definition
Usually Appropriate	7, 8, or 9	The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.
May Be Appropriate	4, 5, or 6	The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.
May Be Appropriate (Disagreement)	5	The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.
Usually Not Appropriate	1, 2, or 3	The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.

Relative Radiation Level Information

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria^® Radiation Dose Assessment Introduction document.

Relative Radiation Level Designations
Relative Radiation Level*	Adult Effective Dose Estimate Range	Pediatric Effective Dose Estimate Range
O	0 mSv	0 mSv
☢	<0.1 mSv	<0.03 mSv
☢☢	0.1-1 mSv	0.03-0.3 mSv
☢☢☢	1-10 mSv	0.3-3 mSv
☢☢☢☢	10-30 mSv	3-10 mSv
☢☢☢☢☢	30-100 mSv	10-30 mSv
*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.”

References

1.	World Health Organization. Obesity and overweight. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
2.	Centers for Disease Control and Prevention. Adult Obesity Facts. Available at: https://www.cdc.gov/obesity/data/adult.html.
3.	Kawai T, Autieri MV, Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell Physiol 2021;320:C375-C91.
4.	Mechanick JI, Apovian C, Brethauer S, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists - Executive Summary. Endocr Pract 2019;25:1346-59.
5.	Clayton RD, Carucci LR. Imaging following bariatric surgery: roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and sleeve gastrectomy. [Review]. British Journal of Radiology. 91(1089):20180031, 2018 Sep.
6.	De Simone B, Ansaloni L, Sartelli M, et al. The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon's point of view. World Journal Of Emergency Surgery. 15(1):2, 2020 01 06.
7.	Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 2022;18:1345-56.
8.	International Federation for Surgery for Obesity and Metabolic Disorders. IFSO 8TH GLOBAL REGISTRY REPORT. Available at: https://www.ifso.com/pdf/8th-ifso-registry-report-2023.pdf.
9.	American Society for Metabolic and Bariatric Surgery. Obesity in America. Available at: https://asmbs.org/resources/obesity-in-america/.
10.	Lesourd R, Greilsamer T, de Montrichard M, et al. Lack of benefit of routine abdominal CT-scan before bariatric surgery. Journal of visceral surgery. 158(5):390-394, 2021 10.J Visc Surg. 158(5):390-394, 2021 10.
11.	Schneider R, Lazaridis I, Kraljevic M, Beglinger C, Wolnerhanssen B, Peterli R. The impact of preoperative investigations on the management of bariatric patients; results of a cohort of more than 1200 cases. Surg Obes Relat Dis 2018;14:693-99.
12.	Sharaf RN, Weinshel EH, Bini EJ, Rosenberg J, Ren CJ. Radiologic assessment of the upper gastrointestinal tract: does it play an important preoperative role in bariatric surgery? Obes Surg 2004;14:313-7.
13.	Abou Hussein BM, Khammas A, Makki M, et al. Role of Routine Abdominal Ultrasound Before Bariatric Surgery: Review of 937 Patients. Obesity Surgery. 28(9):2696-2699, 2018 09.
14.	Almazeedi S, Al-Sabah S, Alshammari D. Routine trans-abdominal ultrasonography before laparoscopic sleeve gastrectomy: the findings. Obes Surg. 24(3):397-9, 2014 Mar.
15.	Diaz Vico T, Elli EF. Utility of Immediate Postoperative Upper Gastrointestinal Contrast Study in Bariatric Surgery. Obesity Surgery. 29(4):1130-1133, 2019 04.
16.	Kim J, Azagury D, Eisenberg D, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis 2015;11:739-48.
17.	Lainas P, Triantafyllou E, Chague P, et al. Routine Early Computed Tomography Scanner After Laparoscopic Sleeve Gastrectomy in High-Risk Severely Obese Patients Is Effective for Bleeding or Hematoma Diagnosis but not for Staple-Line Leak Detection: a Prospective Study. Obesity Surgery. 32(5):1624-1630, 2022 05.
18.	Mbadiwe T, Prevatt E, Duerinckx A, Cornwell E 3rd, Fullum T, Davis B. Assessing the value of routine upper gastrointestinal contrast studies following bariatric surgery: a systematic review and meta-analysis. [Review]. American Journal of Surgery. 209(4):616-22, 2015 Apr.
19.	Mittermair R, Sucher R, Perathoner A, Wykypiel H. Routine upper gastrointestinal swallow studies after laparoscopic sleeve gastrectomy are unnecessary. American Journal of Surgery. 207(6):897-901, 2014 Jun.
20.	Quartararo G, Facchiano E, Scaringi S, Liscia G, Lucchese M. Upper gastrointestinal series after Roux-en-Y gastric bypass for morbid obesity: effectiveness in leakage detection. a systematic review of the literature. [Review]. Obesity Surgery. 24(7):1096-101, 2014 Jul.
21.	Lainas P, Tranchart H, Gaillard M, Ferretti S, Donatelli G, Dagher I. Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy. Surgery for Obesity & Related Diseases. 12(8):1483-1490, 2016 Sep - Oct.
22.	Wahby M, Salama AF, Elezaby AF, et al. Is routine postoperative gastrografin study needed after laparoscopic sleeve gastrectomy? Experience of 712 cases. Obesity Surgery. 23(11):1711-7, 2013 Nov.
23.	Gnecchi M, Bella G, Pino AR, et al. Usefulness of x-ray in the detection of complications and side effects after laparoscopic sleeve gastrectomy. Obesity Surgery. 23(4):456-9, 2013 Apr.
24.	Burt JR, Kocher MR, Snider L, et al. Computed Tomography Assessment of Gastric Band Slippage. Visc Med 2022;38:288-94.
25.	Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. [Review]. Radiology. 270(2):327-41, 2014 Feb.
26.	Lall C, Cruz AA, Bura V, Rudd AA, Bosemani T, Chang KJ. What the radiologist needs to know about gastrointestinal endoscopic surgical procedures. [Review]. Abdominal Radiology. 43(6):1482-1493, 2018 06.
27.	Swenson DW, Pietryga JA, Grand DJ, Chang KJ, Murphy BL, Egglin TK. Gastric band slippage: a case-controlled study comparing new and old radiographic signs of this important surgical complication. AJR Am J Roentgenol 2014;203:10-6.
28.	Francica G, Giardiello C, Scarano F, Cristiano S, Iodice G, Delle Cave M. Ultrasound diagnosis of intragastric balloon complications in obese patients. Radiologia Medica. 108(4):380-4, 2004 Oct.Radiol Med (Torino). 108(4):380-4, 2004 Oct.
29.	Haddad D, David A, Abdel-Dayem H, Socci N, Ahmed L, Gilet A. Abdominal imaging post bariatric surgery: predictors, usage and utility. Surgery for Obesity & Related Diseases. 13(8):1327-1336, 2017 Aug.
30.	Morandeira C, Barcena MV, Bilbao A, et al. Studying the complications of bariatric surgery with intravenous contrast-enhanced multidetector computed tomography. Radiologia. 60(2):143-151, 2018 Mar - Apr.
31.	Dupree A, de Heer J, Tichby M, et al. The value of CT imaging and CRP quotient for detection of postbariatric complications. Langenbecks Archives of Surgery. 406(1):181-187, 2021 Feb.
32.	Bingham J, Shawhan R, Parker R, Wigboldy J, Sohn V. Computed tomography scan versus upper gastrointestinal fluoroscopy for diagnosis of staple line leak following bariatric surgery. American Journal of Surgery. 209(5):810-4; discussion 814, 2015 May.
33.	Musella M, Cantoni V, Green R, et al. Efficacy of Postoperative Upper Gastrointestinal Series (UGI) and Computed Tomography (CT) Scan in Bariatric Surgery: a Meta-analysis on 7516 Patients. Obesity Surgery. 28(8):2396-2405, 2018 08.
34.	Dilauro M, McInnes MD, Schieda N, et al. Internal Hernia after Laparoscopic Roux-en-Y Gastric Bypass: Optimal CT Signs for Diagnosis and Clinical Decision Making. Radiology. 282(3):752-760, 2017 03.
35.	Goudsmedt F, Deylgat B, Coenegrachts K, Van De Moortele K, Dillemans B. Internal hernia after laparoscopic Roux-en-Y gastric bypass: a correlation between radiological and operative findings. Obesity Surgery. 25(4):622-7, 2015 Apr.
36.	Altieri MS, Pryor AD, Telem DA, Hall K, Brathwaite C, Zawin M. Algorithmic approach to utilization of CT scans for detection of internal hernia in the gastric bypass patient. Surgery for Obesity & Related Diseases. 11(6):1207-11, 2015 Nov-Dec.
37.	Frokjaer JB, Jensen WN, Holt G, Omar HK, Olesen SS. The diagnostic performance and interrater agreement of seven CT findings in the diagnosis of internal hernia after gastric bypass operation. Abdominal Radiology. 43(12):3220-3226, 2018 12.
38.	Ederveen JC, Nienhuijs SW, Jol S, Robben SGF, Nederend J. Structured CT reporting improves accuracy in diagnosing internal herniation after laparoscopic Roux-en-Y gastric bypass. European Radiology. 30(6):3448-3454, 2020 Jun.
39.	Zaigham H, Ekelund M, Lee D, Ekberg O, Regner S. Intussusception After Roux-en-Y Gastric Bypass: Correlation Between Radiological and Operative Findings. Obesity Surgery. 33(2):475-481, 2023 02.
40.	Patel P, Bhogal R, Rajput A, et al. Post Roux-en-Y gastric bypass complications: A comparative study assessing the clinical effectiveness of oesophagogastroduodenoscopy and oral-contrast swallow. Surgeon Journal of the Royal Colleges of Surgeons of Edinburgh & Ireland. 15(4):196-201, 2017 Aug.
41.	Krishna S, McInnes MDF, Schieda N, Narayanasamy S, Sheikh A, Kielar A. Diagnostic Accuracy of MRI for Diagnosis of Internal Hernia in Pregnant Women With Prior Roux-en-Y Gastric Bypass. AJR. American Journal of Roentgenology. 211(4):755-759, 2018 10.
42.	Van Berkel B, Gillardin P, Sneyers V, et al. Diagnostic accuracy of a fast MRI T2-sequence for the diagnosis of internal herniation after Roux-and-Y gastric bypass during pregnancy: A retrospective single center study. European Journal of Radiology. 151:110318, 2022 Jun.
43.	Bonouvrie DS, van Beek HC, Taverne SBM, et al. Pregnant Women After Bariatric Surgery: Diagnostic Accuracy of Magnetic Resonance Imaging for Small Bowel Obstruction. Obesity Surgery. 32(2):245-255, 2022 02.
44.	National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022.
45.	American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf.

Disclaimer

The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.