AC Search
Document Navigator
Tracheobronchial Disease
Variant: 1
Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography chest | Usually Appropriate | ☢ |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest without IV contrast | Usually Appropriate | ☢☢☢ |
| CTA chest with IV contrast | May Be Appropriate | ☢☢☢ |
| CT neck and chest with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT neck and chest without IV contrast | May Be Appropriate | ☢☢☢☢ |
| Radiography neck | Usually Not Appropriate | ☢☢ |
| MRI chest without and with IV contrast | Usually Not Appropriate | O |
| MRI chest without IV contrast | Usually Not Appropriate | O |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck and chest without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Not Appropriate | ☢☢☢☢ |
Variant: 2
Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography chest | Usually Appropriate | ☢ |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest without IV contrast | Usually Appropriate | ☢☢☢ |
| CT neck without IV contrast | May Be Appropriate (Disagreement) | ☢☢☢ |
| CTA chest with IV contrast | May Be Appropriate | ☢☢☢ |
| CT neck and chest with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT neck and chest without IV contrast | May Be Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | May Be Appropriate | ☢☢☢☢ |
| Radiography neck | Usually Not Appropriate | ☢☢ |
| MRI chest without and with IV contrast | Usually Not Appropriate | O |
| MRI chest without IV contrast | Usually Not Appropriate | O |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck and chest without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 3
Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CT chest without IV contrast | Usually Appropriate | ☢☢☢ |
| Radiography chest | May Be Appropriate (Disagreement) | ☢ |
| CT neck and chest without IV contrast | May Be Appropriate (Disagreement) | ☢☢☢☢ |
| Radiography neck | Usually Not Appropriate | ☢☢ |
| MRI chest without and with IV contrast | Usually Not Appropriate | O |
| MRI chest without IV contrast | Usually Not Appropriate | O |
| CT chest with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CTA chest with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck and chest with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT neck and chest without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Not Appropriate | ☢☢☢☢ |
Variant: 4
Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CT chest without IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest with IV contrast | May Be Appropriate | ☢☢☢ |
| CTA chest with IV contrast | May Be Appropriate | ☢☢☢ |
| CT neck and chest with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT neck and chest without IV contrast | May Be Appropriate | ☢☢☢☢ |
| Radiography chest | Usually Not Appropriate | ☢ |
| Radiography neck | Usually Not Appropriate | ☢☢ |
| MRI chest without and with IV contrast | Usually Not Appropriate | O |
| MRI chest without IV contrast | Usually Not Appropriate | O |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck and chest without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Not Appropriate | ☢☢☢☢ |
Variant: 5
Adult. Clinically suspected bronchiectasis. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography chest | Usually Appropriate | ☢ |
| CT chest without IV contrast | Usually Appropriate | ☢☢☢ |
| MRI chest without IV contrast | May Be Appropriate | O |
| CTA chest with IV contrast | May Be Appropriate | ☢☢☢ |
| Radiography neck | Usually Not Appropriate | ☢☢ |
| MRI chest without and with IV contrast | Usually Not Appropriate | O |
| CT chest with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck and chest with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT neck and chest without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT neck and chest without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Not Appropriate | ☢☢☢☢ |
Variant: 6
Adult. Bronchiectasis. Assessment of complications or treatment response.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography chest | Usually Appropriate | ☢ |
| CT chest without IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest with IV contrast | May Be Appropriate | ☢☢☢ |
| CTA chest with IV contrast | May Be Appropriate | ☢☢☢ |
| Radiography neck | Usually Not Appropriate | ☢☢ |
| MRI chest without and with IV contrast | Usually Not Appropriate | O |
| MRI chest without IV contrast | Usually Not Appropriate | O |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck and chest with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT neck and chest without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT neck and chest without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Not Appropriate | ☢☢☢☢ |
Panel Members
Brent P. Little, MDa; Christopher M. Walker, MDb; Tami J. Bang, MDc; Anupama G. Brixey, MDd; Jared D. Christensen, MD, MBAe; Jose De Cardenas, MDf; Stephen B. Hobbs, MDg; Alan K. Klitzke, MDh; Rachna Madan, MBBSi; Fabien Maldonado, MDj; M. Blair Marshall, MDk; William H. Moore, MDl; Edwin Rosas, MDm; Jonathan H. Chung, MDn.
Summary of Literature Review
Introduction/Background
Special Imaging Considerations
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. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
A. CT chest with IV contrast
A. CT chest with IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
B. CT chest without and with IV contrast
B. CT chest without and with IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
C. CT chest without IV contrast
C. CT chest without IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
D. CT neck and chest with IV contrast
D. CT neck and chest with IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
E. CT neck and chest without and with IV contrast
E. CT neck and chest without and with IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
F. CT neck and chest without IV contrast
F. CT neck and chest without IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
G. CT neck with IV contrast
G. CT neck with IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
H. CT neck without and with IV contrast
H. CT neck without and with IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
I. CT neck without IV contrast
I. CT neck without IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
J. CTA chest with IV contrast
J. CTA chest with IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
K. FDG-PET/CT skull base to mid-thigh
K. FDG-PET/CT skull base to mid-thigh
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
L. MRI chest without and with IV contrast
L. MRI chest without and with IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
M. MRI chest without IV contrast
M. MRI chest without IV contrast
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
N. Radiography chest
N. Radiography chest
Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging.
O. Radiography neck
O. Radiography neck
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
A. CT chest with IV contrast
A. CT chest with IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
B. CT chest without and with IV contrast
B. CT chest without and with IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
C. CT chest without IV contrast
C. CT chest without IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
D. CT neck and chest with IV contrast
D. CT neck and chest with IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
E. CT neck and chest without and with IV contrast
E. CT neck and chest without and with IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
F. CT neck and chest without IV contrast
F. CT neck and chest without IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
G. CT neck with IV contrast
G. CT neck with IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
H. CT neck without and with IV contrast
H. CT neck without and with IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
I. CT neck without IV contrast
I. CT neck without IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
J. CTA chest with IV contrast
J. CTA chest with IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
K. FDG-PET/CT skull base to mid-thigh
K. FDG-PET/CT skull base to mid-thigh
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
L. MRI chest without and with IV contrast
L. MRI chest without and with IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
M. MRI chest without IV contrast
M. MRI chest without IV contrast
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
N. Radiography chest
N. Radiography chest
Variant 2: Adult. Tracheal or bronchial stenosis. Pre- or posttreatment assessment.
O. Radiography neck
O. Radiography neck
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
A. CT chest with IV contrast
A. CT chest with IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
B. CT chest without and with IV contrast
B. CT chest without and with IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
C. CT chest without IV contrast
C. CT chest without IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
D. CT neck and chest with IV contrast
D. CT neck and chest with IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
E. CT neck and chest without and with IV contrast
E. CT neck and chest without and with IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
F. CT neck and chest without IV contrast
F. CT neck and chest without IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
G. CT neck with IV contrast
G. CT neck with IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
H. CT neck without and with IV contrast
H. CT neck without and with IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
I. CT neck without IV contrast
I. CT neck without IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
J. CTA chest with IV contrast
J. CTA chest with IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
K. FDG-PET/CT skull base to mid-thigh
K. FDG-PET/CT skull base to mid-thigh
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
L. MRI chest without and with IV contrast
L. MRI chest without and with IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
M. MRI chest without IV contrast
M. MRI chest without IV contrast
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
N. Radiography chest
N. Radiography chest
Variant 3: Adult. Clinically suspected tracheomalacia or bronchomalacia. Initial imaging.
O. Radiography neck
O. Radiography neck
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
A. CT chest with IV contrast
A. CT chest with IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
B. CT chest without and with IV contrast
B. CT chest without and with IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
C. CT chest without IV contrast
C. CT chest without IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
D. CT neck and chest with IV contrast
D. CT neck and chest with IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
E. CT neck and chest without and with IV contrast
E. CT neck and chest without and with IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
F. CT neck and chest without IV contrast
F. CT neck and chest without IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
G. CT neck with IV contrast
G. CT neck with IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
H. CT neck without and with IV contrast
H. CT neck without and with IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
I. CT neck without IV contrast
I. CT neck without IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
J. CTA chest with IV contrast
J. CTA chest with IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
K. FDG-PET/CT skull base to mid-thigh
K. FDG-PET/CT skull base to mid-thigh
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
L. MRI chest without and with IV contrast
L. MRI chest without and with IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
M. MRI chest without IV contrast
M. MRI chest without IV contrast
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
N. Radiography chest
N. Radiography chest
Variant 4: Adult. Tracheomalacia or bronchomalacia. Pre- or posttreatment assessment.
O. Radiography neck
O. Radiography neck
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
A. CT chest with IV contrast
A. CT chest with IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
B. CT chest without and with IV contrast
B. CT chest without and with IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
C. CT chest without IV contrast
C. CT chest without IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
D. CT neck and chest with IV contrast
D. CT neck and chest with IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
E. CT neck and chest without and with IV contrast
E. CT neck and chest without and with IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
F. CT neck and chest without IV contrast
F. CT neck and chest without IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
G. CT neck with IV contrast
G. CT neck with IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
H. CT neck without and with IV contrast
H. CT neck without and with IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
I. CT neck without IV contrast
I. CT neck without IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
J. CTA chest with IV contrast
J. CTA chest with IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
K. FDG-PET/CT skull base to mid-thigh
K. FDG-PET/CT skull base to mid-thigh
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
L. MRI chest without and with IV contrast
L. MRI chest without and with IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
M. MRI chest without IV contrast
M. MRI chest without IV contrast
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
N. Radiography chest
N. Radiography chest
Variant 5: Adult. Clinically suspected bronchiectasis. Initial imaging.
O. Radiography neck
O. Radiography neck
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
A. CT chest with IV contrast
A. CT chest with IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
B. CT chest without and with IV contrast
B. CT chest without and with IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
C. CT chest without IV contrast
C. CT chest without IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
D. CT neck and chest with IV contrast
D. CT neck and chest with IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
E. CT neck and chest without and with IV contrast
E. CT neck and chest without and with IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
F. CT neck and chest without IV contrast
F. CT neck and chest without IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
G. CT neck with IV contrast
G. CT neck with IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
H. CT neck without and with IV contrast
H. CT neck without and with IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
I. CT neck without IV contrast
I. CT neck without IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
J. CTA chest with IV contrast
J. CTA chest with IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
K. FDG-PET/CT skull base to mid-thigh
K. FDG-PET/CT skull base to mid-thigh
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
L. MRI chest without and with IV contrast
L. MRI chest without and with IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
M. MRI chest without IV contrast
M. MRI chest without IV contrast
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
N. Radiography chest
N. Radiography chest
Variant 6: Adult. Bronchiectasis. Assessment of complications or treatment response.
O. Radiography neck
O. Radiography neck
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.
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. | Dunlap DG, Ravenel J, Sechrist J, Semaan R. Interventional Therapies for Central Airways. [Review]. J Thorac Imaging. 34(4):W49-W59, 2019 Jul. | |
| 2. | Little BP, Duong PT. Imaging of Diseases of the Large Airways. [Review]. Radiol Clin North Am. 54(6):1183-1203, 2016 Nov. | |
| 3. | McInnis MC, Weisbrod G, Schmidt H. Advanced Technologies for Imaging and Visualization of the Tracheobronchial Tree: From Computed Tomography and MRI to Virtual Endoscopy. [Review]. Thorac Surg Clin. 28(2):127-137, 2018 May. | |
| 4. | Aslam A, De Luis Cardenas J, Morrison RJ, et al. Tracheobronchomalacia and Excessive Dynamic Airway Collapse: Current Concepts and Future Directions. Radiographics. 42(4):1012-1027, 2022 Jul-Aug. | |
| 5. | Mitropoulos A, Song WJ, Almaghlouth F, Kemp S, Polkey M, Hull JH. Detection and diagnosis of large airway collapse: a systematic review. [Review]. ERJ open res.. 7(3), 2021 Jul. | |
| 6. | Bhatt SP, Terry NL, Nath H, et al. Association Between Expiratory Central Airway Collapse and Respiratory Outcomes Among Smokers. JAMA. 315(5):498-505, 2016 Feb 02. | |
| 7. | Tanabe N, Terada K, Shima H, et al. Expiratory central airway collapse and symptoms in smokers. Respir Investig. 59(4):522-529, 2021 Jul. | |
| 8. | Bezuidenhout AF, Boiselle PM, Heidinger BH, et al. Longitudinal Follow-up of Patients With Tracheobronchomalacia After Undergoing Tracheobronchoplasty: Computed Tomography Findings and Clinical Correlation. J Thorac Imaging. 34(4):278-283, 2019 Jul. | |
| 9. | Chalmers JD, Chang AB, Chotirmall SH, Dhar R, McShane PJ. Bronchiectasis. [Review]. Nat Rev Dis Prim. 4(1):45, 2018 11 15. | |
| 10. | Milliron B, Henry TS, Veeraraghavan S, Little BP. Bronchiectasis: Mechanisms and Imaging Clues of Associated Common and Uncommon Diseases. Radiographics 2015;35:1011-30. | |
| 11. | LoCicero J 3rd, Costello P, Campos CT, et al. Spiral CT with multiplanar and three-dimensional reconstructions accurately predicts tracheobronchial pathology. Ann Thorac Surg. 62(3):811-7, 1996 Sep. | |
| 12. | Luo M, Duan C, Qiu J, Li W, Zhu D, Cai W. Diagnostic Value of Multidetector CT and Its Multiplanar Reformation, Volume Rendering and Virtual Bronchoscopy Postprocessing Techniques for Primary Trachea and Main Bronchus Tumors. PLoS ONE. 10(9):e0137329, 2015. | |
| 13. | Taha MS, Mostafa BE, Fahmy M, Ghaffar MK, Ghany EA. Spiral CT virtual bronchoscopy with multiplanar reformatting in the evaluation of post-intubation tracheal stenosis: comparison between endoscopic, radiological and surgical findings. Eur Arch Otorhinolaryngol. 266(6):863-6, 2009 Jun. | |
| 14. | Hernandez-Rojas D, Abia-Trujillo D, Rojas C, et al. Cinematic CT as a valuable protocol for severe ECAC. Respirol. case rep.. 10(1):e0884, 2022 Jan. | |
| 15. | Wagnetz U, Roberts HC, Chung T, Patsios D, Chapman KR, Paul NS. Dynamic airway evaluation with volume CT: initial experience. Can Assoc Radiol J. 61(2):90-7, 2010 Apr. | |
| 16. | Zhang J, Hasegawa I, Feller-Kopman D, Boiselle PM. 2003 AUR Memorial Award. Dynamic expiratory volumetric CT imaging of the central airways: comparison of standard-dose and low-dose techniques. Acad Radiol. 10(7):719-24, 2003 Jul. | |
| 17. | Boiselle PM, O'Donnell CR, Bankier AA, et al. Tracheal collapsibility in healthy volunteers during forced expiration: assessment with multidetector CT. Radiology. 252(1):255-62, 2009 Jul. | |
| 18. | Cohen SL, Ben-Levi E, Karp JB, et al. Ultralow Dose Dynamic Expiratory Computed Tomography for Evaluation of Tracheomalacia. J Comput Assist Tomogr. 43(2):307-311, 2019 Mar/Apr. | |
| 19. | Wang SC, Yin LK, Zhang Y, et al. CT diagnosis and prognosis prediction of tracheal adenoid cystic carcinoma. Eur J Radiol. 140:109746, 2021 Jul. | |
| 20. | Finkelstein SE, Schrump DS, Nguyen DM, Hewitt SM, Kunst TF, Summers RM. Comparative evaluation of super high-resolution CT scan and virtual bronchoscopy for the detection of tracheobronchial malignancies. Chest. 124(5):1834-40, 2003 Nov. | |
| 21. | Koletsis EN, Kalogeropoulou C, Prodromaki E, et al. Tumoral and non-tumoral trachea stenoses: evaluation with three-dimensional CT and virtual bronchoscopy. J Cardiothorac Surg. 2:18, 2007 Apr 12. | |
| 22. | Chen Q, Goo JM, Seo JB, Chung MJ, Lee YJ, Im JG. Evaluation of tracheobronchial diseases: comparison of different imaging techniques. Korean J Radiol. 1(3):135-41, 2000 Jul-Sep. | |
| 23. | Sundarakumar DK, Bhalla AS, Sharma R, Hari S, Guleria R, Khilnani GC. Multidetector CT evaluation of central airways stenoses: Comparison of virtual bronchoscopy, minimal-intensity projection, and multiplanar reformatted images. Indian J Radiol Imaging. 21(3):191-4, 2011 Jul. | |
| 24. | Godoy MC, Saldana DA, Rao PP, et al. Multidetector CT evaluation of airway stents: what the radiologist should know. [Review]. Radiographics. 34(7):1793-806, 2014 Nov-Dec. | |
| 25. | Righini C, Aniwidyaningsih W, Ferretti G, et al. Computed tomography measurements for airway stent insertion in malignant airway obstruction. J Bronchology Interv Pulmonol. 17(1):22-8, 2010 Jan. | |
| 26. | Xiong M, Zhang W, Wang D, Xu J. CT virtual bronchoscopy: imaging method and clinical application. Chin Med J. 113(11):1022-5, 2000 Nov. | |
| 27. | Wang SY, Wang SX, Liao JQ, Chen G. 18F-FDG PET/CT and Contrast-Enhanced CT of Primary Malignant Tracheal Tumor. Clin Nucl Med. 41(8):595-605, 2016 Aug. | |
| 28. | Shao D, Gao Q, Cheng Y, Du DY, Wang SY, Wang SX. The Prognostic Value of 18F-Fluorodeoxyglucose PET/CT in the Initial Assessment of Primary Tracheal Malignant Tumor: A Retrospective Study. Korean J Radiol. 22(3):425-434, 2021 03. | |
| 29. | Baroni RH, Feller-Kopman D, Nishino M, et al. Tracheobronchomalacia: comparison between end-expiratory and dynamic expiratory CT for evaluation of central airway collapse. Radiology. 235(2):635-41, 2005 May. | |
| 30. | Heussel CP, Hafner B, Lill J, Schreiber W, Thelen M, Kauczor HU. Paired inspiratory/expiratory spiral CT and continuous respiration cine CT in the diagnosis of tracheal instability. Eur Radiol. 11(6):982-9, 2001. | |
| 31. | O'Donnell CR, Bankier AA, O'Donnell DH, Loring SH, Boiselle PM. Static end-expiratory and dynamic forced expiratory tracheal collapse in COPD. Clin Radiol. 69(4):357-62, 2014 Apr. | |
| 32. | Ciet P, Boiselle PM, Heidinger B, et al. Cine MRI of Tracheal Dynamics in Healthy Volunteers and Patients With Tracheobronchomalacia. AJR Am J Roentgenol. 209(4):757-761, 2017 Oct. | |
| 33. | Heussel CP, Ley S, Biedermann A, et al. Respiratory lumenal change of the pharynx and trachea in normal subjects and COPD patients: assessment by cine-MRI. Eur Radiol. 14(12):2188-97, 2004 Dec. | |
| 34. | Watase S, Sonoda A, Matsutani N, et al. Evaluation of intrathoracic tracheal narrowing in patients with obstructive ventilatory impairment using dynamic chest radiography: A preliminary study. Eur J Radiol. 129:109141, 2020 Aug. | |
| 35. | Baroni RH, Ashiku S, Boiselle PM. Dynamic CT evaluation of the central airways in patients undergoing tracheoplasty for tracheobronchomalacia. AJR Am J Roentgenol. 184(5):1444-9, 2005 May. | |
| 36. | Lee KS, Ashiku SK, Ernst A, et al. Comparison of expiratory CT airway abnormalities before and after tracheoplasty surgery for tracheobronchomalacia. J Thorac Imaging. 23(2):121-6, 2008 May. | |
| 37. | Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008; 246(3):697-722. | |
| 38. | Cartier Y, Kavanagh PV, Johkoh T, Mason AC, Muller NL. Bronchiectasis: accuracy of high-resolution CT in the differentiation of specific diseases. AJR Am J Roentgenol. 173(1):47-52, 1999 Jul. | |
| 39. | Lee PH, Carr DH, Rubens MB, Cole P, Hansell DM. Accuracy of CT in predicting the cause of bronchiectasis. Clin Radiol. 50(12):839-41, 1995 Dec. | |
| 40. | Pasteur MC, Bilton D, Hill AT. British Thoracic Society guideline for non-CF bronchiectasis. [Review] [549 refs]. Thorax. 65 Suppl 1:i1-58, 2010 Jul. | |
| 41. | Reiff DB, Wells AU, Carr DH, Cole PJ, Hansell DM. CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types. AJR Am J Roentgenol. 165(2):261-7, 1995 Aug. | |
| 42. | Garcia B, Wilmskoetter J, Grady A, Mingora C, Dorman S, Flume P. Chest Computed Tomography Features of Nontuberculous Mycobacterial Pulmonary Disease Versus Asymptomatic Colonization: A Cross-sectional Cohort Study. J Thorac Imaging. 37(3):140-145, 2022 May 01. | |
| 43. | Meerburg JJ, Veerman GDM, Aliberti S, Tiddens HAWM. Diagnosis and quantification of bronchiectasis using computed tomography or magnetic resonance imaging: A systematic review. Respir Med. 170:105954, 2020 Aug - Sep. | |
| 44. | Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med. 189(5):576-85, 2014 Mar 01. | |
| 45. | Lynch DA, Newell J, Hale V, et al. Correlation of CT findings with clinical evaluations in 261 patients with symptomatic bronchiectasis. AJR Am J Roentgenol. 173(1):53-8, 1999 Jul. | |
| 46. | Dimakou K, Triantafillidou C, Toumbis M, Tsikritsaki K, Malagari K, Bakakos P. Non CF-bronchiectasis: Aetiologic approach, clinical, radiological, microbiological and functional profile in 277 patients. Respir Med. 116:1-7, 2016 07. | |
| 47. | Arslan S, Poyraz N, Ucar R, Yesildag M, Yesildag A, Caliskaner AZ. Magnetic Resonance Imaging May Be a Valuable Radiation-Free Technique for Lung Pathologies in Patients with Primary Immunodeficiency. J Clin Immunol. 36(1):66-72, 2016 Jan. | |
| 48. | Chung JH, Huitt G, Yagihashi K, et al. Proton Magnetic Resonance Imaging for Initial Assessment of Isolated Mycobacterium avium Complex Pneumonia. Annals of the American Thoracic Society. 13(1):49-57, 2016 Jan. | |
| 49. | Furuuchi K, Ito A, Hashimoto T, Kumagai S, Ishida T. Clinical significance of the radiological severity score in Mycobacterium avium complex lung disease patients. Int J Tuberc Lung Dis. 21(4):452-457, 2017 04 01. | |
| 50. | Mehrian P, Farnia P, Karamad M. The association between computed tomography scan findings of pulmonary infection caused by atypical mycobacteria and bacillus count in sputum samples. Int J Mycobacteriol. 7(4):355-357, 2018 Oct-Dec. | |
| 51. | Hwang JA, Kim S, Jo KW, Shim TS. Natural history of Mycobacterium avium complex lung disease in untreated patients with stable course. Eur Respir J. 49(3), 2017 03. | |
| 52. | Park TY, Chong S, Jung JW, et al. Natural course of the nodular bronchiectatic form of Mycobacterium Avium complex lung disease: Long-term radiologic change without treatment. PLoS ONE. 12(10):e0185774, 2017. | |
| 53. | Lee G, Kim HS, Lee KS, et al. Serial CT findings of nodular bronchiectatic Mycobacterium avium complex pulmonary disease with antibiotic treatment. AJR Am J Roentgenol. 201(4):764-72, 2013 Oct. | |
| 54. | Asakura T, Yamada Y, Namkoong H, et al. Impact of cavity and infiltration on pulmonary function and health-related quality of life in pulmonary Mycobacterium avium complex disease: A 3-dimensional computed tomographic analysis. Respir Med. 126:9-16, 2017 05. | |
| 55. | Kwak N, Lee JH, Kim HJ, Kim SA, Yim JJ. New-onset nontuberculous mycobacterial pulmonary disease in bronchiectasis: tracking the clinical and radiographic changes. BMC polm. med.. 20(1):293, 2020 Nov 10. | |
| 56. | Park J, Yoon SH, Kim JY, Gu KM, Kwak N, Yim JJ. Radiographic severity and treatment outcome of Mycobacterium abscessus complex pulmonary disease. Respir Med. 187:106549, 2021 10. | |
| 57. | Svenningsen S, Guo F, McCormack DG, Parraga G. Noncystic Fibrosis Bronchiectasis: Regional Abnormalities and Response to Airway Clearance Therapy Using Pulmonary Functional Magnetic Resonance Imaging. Academic Radiology. 24(1):4-12, 2017 01. | |
| 58. | 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.