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Appropriateness Criteria

Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 0 2 14
References Study Quality
30 (26248155) 3
25 (20116016) 4
34 (24280147) 3
26 (10789801) 3
17 (19878040) 3
24 (20463429) 4
31 (21257870) 4
23 (16769549) 3
27 (16738930) 2
29 (19841952) 3
28 (24902657) 3
11 (-3110988) 4
US abdomen May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 3 1 7 3 1 1
References Study Quality
40 (21638034) 2
39 (3510605) 4
41 (21365197) 2
Radiography abdomen May be appropriate Strong ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 4 4 0 0 3 11 2 0 0 0 0
References Study Quality
17 (19878040) 3
18 (18710981) 2
19 (17765461) 2
21 (20825832) 3
15 (12355000) 3
22 (26757563) 4
16 (22507493) 3
20 (24880255) 4
MRI abdomen and pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 2 7 4 2 0
References Study Quality
36 (26526902) 3
37 (18649091) 4
35 (19118967) 4
38 (21826466) 3
MRI abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 9 1 2 1 0
References Study Quality
36 (26526902) 3
37 (18649091) 4
35 (19118967) 4
38 (21826466) 3
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 3 5 5 4 0 0 0
References Study Quality
30 (26248155) 3
25 (20116016) 4
34 (24280147) 3
26 (10789801) 3
17 (19878040) 3
24 (20463429) 4
31 (21257870) 4
23 (16769549) 3
27 (16738930) 2
29 (19841952) 3
28 (24902657) 3
11 (-3110988) 4
CT abdomen and pelvis without and with IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 2 3 6 5 0 0 0 0
References Study Quality
30 (26248155) 3
25 (20116016) 4
34 (24280147) 3
26 (10789801) 3
17 (19878040) 3
24 (20463429) 4
31 (21257870) 4
23 (16769549) 3
27 (16738930) 2
29 (19841952) 3
28 (24902657) 3
11 (-3110988) 4
Fluoroscopy contrast enema Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 2 1 0 0 0 0 0
Fluoroscopy upper GI series with small bowel follow-through Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 4 3 1 0 0 0 0 0
Nuclear medicine scan gallbladder Usually not appropriate Strong ☢☢ 0.1-1mSv 3 3 3 4 2 5 2 0 0 0 0
References Study Quality
45 (4015374) 4
43 (2112472) 4
44 (3567506) 2
46 (1941134) 1
9 (-3110989) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 3 3 1 2 0 0 0
References Study Quality
42 (27399241) 4
WBC scan abdomen and pelvis Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 3 3 6 2 4 4 0 0 0 0 0
References Study Quality
45 (4015374) 4
43 (2112472) 4
44 (3567506) 2
46 (1941134) 1
9 (-3110989) 4
WBC scan abdomen and pelvis Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 3 3 4 4 4 4 0 0 0 0 0
References Study Quality
45 (4015374) 4
43 (2112472) 4
44 (3567506) 2
46 (1941134) 1
9 (-3110989) 4
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 0 2 14
References Study Quality
52 (23735667) 3
47 (17164970) 3
49 (17514398) 3
50 (17189112) 3
51 (17122986) 3
23 (16769549) 3
54 (22084185) 4
48 (25747433) 2
53 (18646473) 3
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 2 2 3 7 1 0 0
References Study Quality
55 (3515857) 3
39 (3510605) 4
Radiography abdomen May be appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 4 4 0 1 1 8 2 4 0 0 0
References Study Quality
15 (12355000) 3
Fluoroscopy contrast enema May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 1 11 2 2 0 0 0
References Study Quality
47 (17164970) 3
Fluoroscopy upper GI series with small bowel follow-through May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 2 10 2 2 0 0 0
References Study Quality
49 (17514398) 3
50 (17189112) 3
51 (17122986) 3
48 (25747433) 2
MRI abdomen and pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 0 4 6 5 0 0
References Study Quality
36 (26526902) 3
37 (18649091) 4
35 (19118967) 4
38 (21826466) 3
MRI abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 0 3 5 5 1 0 0
References Study Quality
36 (26526902) 3
37 (18649091) 4
35 (19118967) 4
38 (21826466) 3
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 2 5 5 5 0 0 0
References Study Quality
52 (23735667) 3
47 (17164970) 3
49 (17514398) 3
50 (17189112) 3
51 (17122986) 3
23 (16769549) 3
54 (22084185) 4
48 (25747433) 2
53 (18646473) 3
CT abdomen and pelvis without and with IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 2 4 3 6 1 0 0 0
References Study Quality
52 (23735667) 3
47 (17164970) 3
49 (17514398) 3
50 (17189112) 3
51 (17122986) 3
54 (22084185) 4
48 (25747433) 2
53 (18646473) 3
Nuclear medicine scan gallbladder Usually not appropriate Strong ☢☢ 0.1-1mSv 3 3 0 6 3 3 3 1 0 0 0
References Study Quality
45 (4015374) 4
43 (2112472) 4
44 (3567506) 2
46 (1941134) 1
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 3 2 3 1 0 0 0
References Study Quality
42 (27399241) 4
WBC scan abdomen and pelvis Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 3 3 4 3 4 4 0 1 0 0 0
References Study Quality
45 (4015374) 4
43 (2112472) 4
44 (3567506) 2
46 (1941134) 1
WBC scan abdomen and pelvis Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 3 3 2 6 3 4 0 1 0 0 0
References Study Quality
45 (4015374) 4
43 (2112472) 4
44 (3567506) 2
46 (1941134) 1
Variant 3: Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 0 2 14
References Study Quality
8 (18580213) 3
57 (23245270) 4
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 4 4 4 1 0
References Study Quality
59 (10421038) 2
MRI abdomen and pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 3 7 4 0 0
References Study Quality
58 (18097696) 4
MRI abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 2 3 8 2 1 0 0
References Study Quality
58 (18097696) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 0 9 5 1 1
References Study Quality
8 (18580213) 3
57 (23245270) 4
CT abdomen and pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 2 3 7 4 0 0 0 0
References Study Quality
8 (18580213) 3
57 (23245270) 4
Radiography abdomen Usually not appropriate Strong ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 0 2 10 3 1 0 0 0 0
References Study Quality
17 (19878040) 3
18 (18710981) 2
19 (17765461) 2
21 (20825832) 3
22 (26757563) 4
16 (22507493) 3
20 (24880255) 4
Fluoroscopy contrast enema Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 7 0 2 0 0 0 0 0
Fluoroscopy upper GI series with small bowel follow-through Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 6 0 3 0 0 0 0 0
Nuclear medicine scan gallbladder Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 2 2 2 8 2 1 2 1 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 5 2 3 2 1 1 0 0
References Study Quality
42 (27399241) 4
WBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 4 4 3 2 2 1 0 0 0
WBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 3 4 4 2 2 1 0 0 0
Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 4 7 2 0
References Study Quality
36 (26526902) 3
37 (18649091) 4
85 (18443876) 1
86 (16505393) 3
58 (18097696) 4
84 (19959521) 4
35 (19118967) 4
87 (17848700) 4
88 (23479698) 4
38 (21826466) 3
89 (22264900) 4
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 0 4 12
References Study Quality
68 (26341808) 2
30 (26248155) 3
75 (25917534) 4
81 (23179149) 3
25 (20116016) 4
64 (20093517) 3
67 (17896131) 3
69 (8976942) 3
26 (10789801) 3
70 (1426841) 3
17 (19878040) 3
24 (20463429) 4
66 (18423315) 3
31 (21257870) 4
80 (20074835) 2
72 (20306104) 3
61 (17185667) 4
62 (16941110) 4
63 (17178362) 2
27 (16738930) 2
83 (22072086) 4
79 (23715771) 3
29 (19841952) 3
82 (24134171) 4
71 (26112159) 4
73 (24261352) 2
74 (24623365) 3
28 (24902657) 3
77 (17114622) 3
65 (21251432) Good
78 (-3121966) 4
CT abdomen and pelvis without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 8 7 0 1
References Study Quality
68 (26341808) 2
30 (26248155) 3
75 (25917534) 4
81 (23179149) 3
25 (20116016) 4
64 (20093517) 3
67 (17896131) 3
76 (25157993) 3
69 (8976942) 3
26 (10789801) 3
70 (1426841) 3
17 (19878040) 3
24 (20463429) 4
66 (18423315) 3
31 (21257870) 4
80 (20074835) 2
72 (20306104) 3
63 (17178362) 2
27 (16738930) 2
83 (22072086) 4
79 (23715771) 3
29 (19841952) 3
82 (24134171) 4
71 (26112159) 4
73 (24261352) 2
74 (24623365) 3
28 (24902657) 3
77 (17114622) 3
65 (21251432) Good
78 (-3121966) 4
US abdomen May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 2 7 2 3 1
References Study Quality
92 (24842498) 2
60 (19561056) 3
95 (10888131) 4
94 (20732861) 2
93 (22572686) 4
89 (22264900) 4
41 (21365197) 2
90 (19897964) 4
91 (19321676) 4
Radiography abdomen May be appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 4 4 0 3 0 9 2 2 0 0 0
References Study Quality
15 (12355000) 3
MRI abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 6 2 3 2 0
References Study Quality
36 (26526902) 3
37 (18649091) 4
85 (18443876) 1
86 (16505393) 3
58 (18097696) 4
84 (19959521) 4
35 (19118967) 4
87 (17848700) 4
88 (23479698) 4
89 (22264900) 4
CT abdomen and pelvis without and with IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 2 3 8 3 0 0 0 0
References Study Quality
68 (26341808) 2
30 (26248155) 3
75 (25917534) 4
81 (23179149) 3
25 (20116016) 4
64 (20093517) 3
67 (17896131) 3
76 (25157993) 3
69 (8976942) 3
26 (10789801) 3
70 (1426841) 3
17 (19878040) 3
24 (20463429) 4
66 (18423315) 3
31 (21257870) 4
80 (20074835) 2
72 (20306104) 3
63 (17178362) 2
23 (16769549) 3
27 (16738930) 2
83 (22072086) 4
79 (23715771) 3
29 (19841952) 3
82 (24134171) 4
71 (26112159) 4
73 (24261352) 2
74 (24623365) 3
28 (24902657) 3
77 (17114622) 3
65 (21251432) Good
78 (-3121966) 4
Fluoroscopy contrast enema Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 5 1 1 0 0 0 0 0
Fluoroscopy upper GI series with small bowel follow-through Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 4 1 3 0 0 0 0 0
Nuclear medicine scan gallbladder Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 2 2 5 6 2 1 1 1 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 3 2 1 0 0 0 0
WBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 6 4 4 1 0 1 0 0 0
WBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 6 4 4 1 0 1 0 0 0
Appendix Key

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

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

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

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

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

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

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

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

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