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Inflammatory Ear Disease
Variant: 1
Adult. Otitis externa, uncomplicated. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography skull | Usually Not Appropriate | ☢ |
| MRI head and internal auditory canal with IV contrast | Usually Not Appropriate | O |
| MRI head and internal auditory canal without and with IV contrast | Usually Not Appropriate | O |
| MRI head and internal auditory canal without IV contrast | Usually Not Appropriate | O |
| MRI head with IV contrast | Usually Not Appropriate | O |
| MRI head without and with IV contrast | Usually Not Appropriate | O |
| MRI head without IV contrast | Usually Not Appropriate | O |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone without IV contrast | Usually Not Appropriate | ☢☢☢ |
Variant: 2
Adult. Otitis externa, complicated. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI head and internal auditory canal without and with IV contrast | Usually Appropriate | O |
| CT temporal bone with IV contrast | Usually Appropriate | ☢☢☢ |
| MRI head without and with IV contrast | May Be Appropriate | O |
| CT temporal bone without IV contrast | May Be Appropriate | ☢☢☢ |
| WBC scan with SPECT or SPECT/CT skull base | May Be Appropriate | ☢☢☢ |
| Radiography skull | Usually Not Appropriate | ☢ |
| MRI head and internal auditory canal with IV contrast | Usually Not Appropriate | O |
| MRI head and internal auditory canal without IV contrast | Usually Not Appropriate | O |
| MRI head with IV contrast | Usually Not Appropriate | O |
| MRI head without IV contrast | Usually Not Appropriate | O |
| CT head and neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head and neck without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head and neck without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
Variant: 3
Adult. Acute otitis media, uncomplicated. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography skull | Usually Not Appropriate | ☢ |
| MRI head and internal auditory canal with IV contrast | Usually Not Appropriate | O |
| MRI head and internal auditory canal without and with IV contrast | Usually Not Appropriate | O |
| MRI head and internal auditory canal without IV contrast | Usually Not Appropriate | O |
| MRI head with IV contrast | Usually Not Appropriate | O |
| MRI head without and with IV contrast | Usually Not Appropriate | O |
| MRI head without IV contrast | Usually Not Appropriate | O |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone without IV contrast | Usually Not Appropriate | ☢☢☢ |
Variant: 4
Adult. Complicated otitis media. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI head and internal auditory canal without and with IV contrast | Usually Appropriate | O |
| CT temporal bone with IV contrast | Usually Appropriate | ☢☢☢ |
| CTV head with IV contrast | Usually Appropriate | ☢☢☢ |
| MRV head with IV contrast | May Be Appropriate | O |
| MRV head without IV contrast | May Be Appropriate | O |
| CT temporal bone without IV contrast | May Be Appropriate | ☢☢☢ |
| Radiography skull | Usually Not Appropriate | ☢ |
| MRI head and internal auditory canal with IV contrast | Usually Not Appropriate | O |
| MRI head and internal auditory canal without IV contrast | Usually Not Appropriate | O |
| MRI head with IV contrast | Usually Not Appropriate | O |
| MRI head without and with IV contrast | Usually Not Appropriate | O |
| MRI head without IV contrast | Usually Not Appropriate | O |
| MRV head without and with IV contrast | Usually Not Appropriate | O |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CTV head and neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| WBC scan with SPECT or SPECT/CT skull base | Usually Not Appropriate | ☢☢☢ |
Variant: 5
Adult. Chronic otitis media. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI head and internal auditory canal without and with IV contrast | Usually Appropriate | O |
| CT temporal bone without IV contrast | Usually Appropriate | ☢☢☢ |
| Radiography skull | Usually Not Appropriate | ☢ |
| MRI head and internal auditory canal with IV contrast | Usually Not Appropriate | O |
| MRI head and internal auditory canal without IV contrast | Usually Not Appropriate | O |
| MRI head with IV contrast | Usually Not Appropriate | O |
| MRI head without and with IV contrast | Usually Not Appropriate | O |
| MRI head without IV contrast | Usually Not Appropriate | O |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
Variant: 6
Adult. Postoperative cholesteatoma. Surveillance Imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI head and internal auditory canal without and with IV contrast | Usually Appropriate | O |
| CT temporal bone without IV contrast | Usually Appropriate | ☢☢☢ |
| Radiography skull | Usually Not Appropriate | ☢ |
| MRI head and internal auditory canal with IV contrast | Usually Not Appropriate | O |
| MRI head and internal auditory canal without IV contrast | Usually Not Appropriate | O |
| MRI head with IV contrast | Usually Not Appropriate | O |
| MRI head without and with IV contrast | Usually Not Appropriate | O |
| MRI head without IV contrast | Usually Not Appropriate | O |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT temporal bone without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
Panel Members
Mohit Agarwal, MDa; Amy F. Juliano, MDb; Mari Hagiwara, MDc; Moises Auron, MDd; Judah Burns, MDe; Matthew L. Bush, MD, PhD, MBAf; Prachi Dubey, MBBS, MPHg; Elliott R. Friedman, MDh; Maria K. Gule-Monroe, MDi; Benjamin W. Hatten, MD, MPHj; Vikas Jain, MDk; Tanya J. Rath, MDl; Lilja B. Solnes, MD, MBAm; M. Reza Taheri, MD, PhDn; David Zander, MDo; Bruno Policeni, MD, MBAp.
Summary of Literature Review
Introduction/Background
Initial Imaging Definition
Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant. More than one procedure can be considered usually appropriate in the initial imaging evaluation when:
- There are procedures that are equivalent alternatives (i.e., only one procedure will be ordered to provide the clinical information to effectively manage the patient’s care)
OR
- There are complementary procedures (i.e., more than one procedure is ordered as a set or simultaneously wherein each procedure provides unique clinical information to effectively manage the patient’s care).
Discussion of Procedures by Variant
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
A. CT head with IV contrast
A. CT head with IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
B. CT head without and with IV contrast
B. CT head without and with IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
C. CT head without IV contrast
C. CT head without IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
D. CT temporal bone with IV contrast
D. CT temporal bone with IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
E. CT temporal bone without and with IV contrast
E. CT temporal bone without and with IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
F. CT temporal bone without IV contrast
F. CT temporal bone without IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
G. MRI head and internal auditory canal with IV contrast
G. MRI head and internal auditory canal with IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
H. MRI head and internal auditory canal without and with IV contrast
H. MRI head and internal auditory canal without and with IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
I. MRI head and internal auditory canal without IV contrast
I. MRI head and internal auditory canal without IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
J. MRI head with IV contrast
J. MRI head with IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
K. MRI head without and with IV contrast
K. MRI head without and with IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
L. MRI head without IV contrast
L. MRI head without IV contrast
Variant 1: Adult. Otitis externa, uncomplicated. Initial imaging.
M. Radiography skull
M. Radiography skull
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
A. CT head and neck with IV contrast
A. CT head and neck with IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
B. CT head and neck without and with IV contrast
B. CT head and neck without and with IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
C. CT head and neck without IV contrast
C. CT head and neck without IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
D. CT head with IV contrast
D. CT head with IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
E. CT head without and with IV contrast
E. CT head without and with IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
F. CT head without IV contrast
F. CT head without IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
G. CT temporal bone with IV contrast
G. CT temporal bone with IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
H. CT temporal bone without and with IV contrast
H. CT temporal bone without and with IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
I. CT temporal bone without IV contrast
I. CT temporal bone without IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
J. MRI head and internal auditory canal with IV contrast
J. MRI head and internal auditory canal with IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
K. MRI head and internal auditory canal without and with IV contrast
K. MRI head and internal auditory canal without and with IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
L. MRI head and internal auditory canal without IV contrast
L. MRI head and internal auditory canal without IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
M. MRI head with IV contrast
M. MRI head with IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
N. MRI head without and with IV contrast
N. MRI head without and with IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
O. MRI head without IV contrast
O. MRI head without IV contrast
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
P. Radiography skull
P. Radiography skull
Variant 2: Adult. Otitis externa, complicated. Initial imaging.
Q. WBC scan with SPECT or SPECT/CT skull base
Q. WBC scan with SPECT or SPECT/CT skull base
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
A. CT head with IV contrast
A. CT head with IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
B. CT head without and with IV contrast
B. CT head without and with IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
C. CT temporal bone with IV contrast
C. CT temporal bone with IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
D. CT temporal bone without and with IV contrast
D. CT temporal bone without and with IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
E. CT temporal bone without IV contrast
E. CT temporal bone without IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
F. MRI head and internal auditory canal with IV contrast
F. MRI head and internal auditory canal with IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
G. MRI head and internal auditory canal without and with IV contrast
G. MRI head and internal auditory canal without and with IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
H. MRI head and internal auditory canal without IV contrast
H. MRI head and internal auditory canal without IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
I. MRI head with IV contrast
I. MRI head with IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
J. MRI head without and with IV contrast
J. MRI head without and with IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
K. MRI head without IV contrast
K. MRI head without IV contrast
Variant 3: Adult. Acute otitis media, uncomplicated. Initial imaging.
L. Radiography skull
L. Radiography skull
Variant 4: Adult. Complicated otitis media. Initial imaging.
Variant 4: Adult. Complicated otitis media. Initial imaging.
A. CT head with IV contrast
A. CT head with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
B. CT head without and with IV contrast
B. CT head without and with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
C. CT head without IV contrast
C. CT head without IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
D. CT temporal bone with IV contrast
D. CT temporal bone with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
E. CT temporal bone without and with IV contrast
E. CT temporal bone without and with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
F. CT temporal bone without IV contrast
F. CT temporal bone without IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
G. CTV head and neck with IV contrast
G. CTV head and neck with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
H. CTV head with IV contrast
H. CTV head with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
I. MRI head and internal auditory canal with IV contrast
I. MRI head and internal auditory canal with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
J. MRI head and internal auditory canal without and with IV contrast
J. MRI head and internal auditory canal without and with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
K. MRI head and internal auditory canal without IV contrast
K. MRI head and internal auditory canal without IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
L. MRI head with IV contrast
L. MRI head with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
M. MRI head without and with IV contrast
M. MRI head without and with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
N. MRI head without IV contrast
N. MRI head without IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
O. MRV head with IV contrast
O. MRV head with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
P. MRV head without and with IV contrast
P. MRV head without and with IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
Q. MRV head without IV contrast
Q. MRV head without IV contrast
Variant 4: Adult. Complicated otitis media. Initial imaging.
R. Radiography skull
R. Radiography skull
Variant 4: Adult. Complicated otitis media. Initial imaging.
S. WBC scan with SPECT or SPECT/CT skull base
S. WBC scan with SPECT or SPECT/CT skull base
Variant 5: Adult. Chronic otitis media. Initial imaging.
Variant 5: Adult. Chronic otitis media. Initial imaging.
A. CT head with IV contrast
A. CT head with IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
B. CT head without and with IV contrast
B. CT head without and with IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
C. CT head without IV contrast
C. CT head without IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
D. CT temporal bone with IV contrast
D. CT temporal bone with IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
E. CT temporal bone without and with IV contrast
E. CT temporal bone without and with IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
F. CT temporal bone without IV contrast
F. CT temporal bone without IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
G. MRI head and internal auditory canal with IV contrast
G. MRI head and internal auditory canal with IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
H. MRI head and internal auditory canal without and with IV contrast
H. MRI head and internal auditory canal without and with IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
I. MRI head and internal auditory canal without IV contrast
I. MRI head and internal auditory canal without IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
J. MRI head with IV contrast
J. MRI head with IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
K. MRI head without and with IV contrast
K. MRI head without and with IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
L. MRI head without IV contrast
L. MRI head without IV contrast
Variant 5: Adult. Chronic otitis media. Initial imaging.
M. Radiography skull
M. Radiography skull
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
A. CT head with IV contrast
A. CT head with IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
B. CT head without and with IV contrast
B. CT head without and with IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
C. CT head without IV contrast
C. CT head without IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
D. CT temporal bone with IV contrast
D. CT temporal bone with IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
E. CT temporal bone without and with IV contrast
E. CT temporal bone without and with IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
F. CT temporal bone without IV contrast
F. CT temporal bone without IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
G. MRI head and internal auditory canal with IV contrast
G. MRI head and internal auditory canal with IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
H. MRI head and internal auditory canal without and with IV contrast
H. MRI head and internal auditory canal without and with IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
I. MRI head and internal auditory canal without IV contrast
I. MRI head and internal auditory canal without IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
J. MRI head with IV contrast
J. MRI head with IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
K. MRI head without and with IV contrast
K. MRI head without and with IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
L. MRI head without IV contrast
L. MRI head without IV contrast
Variant 6: Adult. Postoperative cholesteatoma. Surveillance Imaging.
M. Radiography skull
M. Radiography skull
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
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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.