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Appropriateness Criteria

Variant 1: Atrial fibrillation, atrial tachycardia, or atypical atrial flutter. Preprocedural planning prior to left atrial ablation.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US echocardiography transesophageal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 0 11 3 3
References Study Quality
40 (7486462) 1
39 (8249844) 2
38 (25666720) 3
MRA chest without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 2 11 4 1
References Study Quality
26 (26139321) 2
27 (29663178) 2
28 (27236529) 3
MRI heart function and morphology without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 3 10 3 0
References Study Quality
37 (32412119) 3
36 (24496537) 2
35 (26777218) 3
34 (31874788) 2
33 (31397511) 3
28 (27236529) 3
32 (34303756) Good
31 (25464427) 3
6 (33600025) 4
CTA chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 0 0 0 0 9 6 2
References Study Quality
25 (26341605) 4
24 (26332107) 3
23 (31023034) 3
CT heart function and morphology with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 2 0 2 0 6 3 5
References Study Quality
22 (25956477) 3
21 (34453377) 3
20 (24469219) 3
19 (22364703) 2
18 (32629004) 2
17 (25786766) 2
5 (25847091) 4
MRA chest without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 4 11 0 2 1 0
References Study Quality
29 (26149175) 3
30 (19561516) 3
MRI heart function and morphology without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 0 1 6 8 3 0 0 0 0
US echocardiography transthoracic resting Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 1 2 7 7 0 1 0 0 0
References Study Quality
41 (21440414) 2
42 (27822477) 2
Arteriography coronary Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 4 1 0 0 1 0 0 0
Catheter venography pulmonary Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 5 3 8 1 0 0 0 0 1
References Study Quality
15 (27116237) 3
MRA coronary arteries without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 5 1 0 2 0 0 0 0
MRA coronary arteries without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 5 0 1 1 0 0 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 1 2 3 2 0 0 1 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 1 3 2 2 0 1 0 0
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 3 1 0 1 0 0 0
References Study Quality
16 (21908449) 2
CTA coronary arteries with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 0 9 3 4 0 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 12 3 1 0 2 0 0 0 0
Variant 2: Atrial fibrillation. Preprocedural planning prior to left atrial appendage endovascular occlusion.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US echocardiography transesophageal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 2 11 5
References Study Quality
45 (26728988) 3
46 (27884358) 3
CTA chest with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 3 10 2 2
References Study Quality
43 (29388306) 2
49 (28761682) 3
48 (23406625) Good
CT heart function and morphology with IV contrast Usually appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 0 12 6
References Study Quality
48 (23406625) Good
47 (34398676) 3
46 (27884358) 3
45 (26728988) 3
44 (28012051) 3
43 (29388306) 2
MRA chest without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 3 10 4 0 0 0
References Study Quality
28 (27236529) 3
MRI heart function and morphology without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 2 4 11 0 1 0 0
References Study Quality
7 (30952613) 4
28 (27236529) 3
50 (23454807) 2
US echocardiography transthoracic resting Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 3 2 12 0 1 0 0 0 0
References Study Quality
41 (21440414) 2
42 (27822477) 2
Arteriography coronary Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 1 1 2 0 1 0 0 0
Catheter venography pulmonary Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 12 2 3 0 0 0 0 0 1
MRA chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 3 2 2 2 1 0 0 0
MRA coronary arteries without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 5 0 2 0 0 0 0 0
MRA coronary arteries without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 5 0 1 1 0 0 0 0
MRI heart function and morphology without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 2 8 3 3 0 0 0 1
References Study Quality
28 (27236529) 3
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 0 3 1 1 0 1 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 0 2 3 0 1 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 3 1 2 0 0 0 0 0
CTA coronary arteries with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 7 5 0 2 0 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 2 0 0 1 0 0 0 0
Variant 3: Atrial fibrillation. Preprocedural planning prior to electrical or pharmacologic cardioversion.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US echocardiography transesophageal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 1 9 8
References Study Quality
38 (25666720) 3
51 (27567465) 4
CTA chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 2 9 5 2
References Study Quality
48 (23406625) Good
CT heart function and morphology with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 2 10 6
References Study Quality
18 (32629004) 2
19 (22364703) 2
25 (26341605) 4
48 (23406625) Good
MRI heart function and morphology without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 9 2 4 2 1 0
References Study Quality
28 (27236529) 3
50 (23454807) 2
US echocardiography transthoracic resting Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 2 3 9 0 4 0 0 0 0
Arteriography coronary Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 1 2 0 0 1 0 0 0
Catheter venography pulmonary Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 13 2 2 0 0 0 0 1 0
MRA chest without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 0 8 2 3 2 0 0 1
References Study Quality
28 (27236529) 3
MRA chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 4 2 2 2 0 0 0 0
MRA coronary arteries without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 3 1 1 1 0 0 0 0
MRA coronary arteries without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 4 0 0 2 0 0 0 0
MRI heart function and morphology without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 2 8 2 3 1 0 0 0
References Study Quality
28 (27236529) 3
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 0 5 1 2 1 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 1 1 1 2 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 1 0 0 0 0 0 0
CTA coronary arteries with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 9 4 0 2 0 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 2 0 0 0 0 1 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.