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Appropriateness Criteria

Variant 1: Suspected Crohn disease, no prior Crohn diagnosis. Initial Imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MR enterography Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 1 3 3 3 4
References Study Quality
65 (26179244) 4
54 (25222657) 4
24 (24912799) Good
69 (24037299) 2
53 (17502220) 4
28 (18372465) M
57 (19610137) 1
70 (21484959) 2
27 (19276325) 1
58 (18214582) 2
59 (19524458) 2
71 (12764646) 2
72 (19542402) 2
35 (20588038) 2
55 (17639383) 2
60 (19635832) 3
61 (19136510) 2
62 (20122516) 3
63 (16377481) 3
64 (15908538) 1
66 (15942733) 2
67 (16294149) 2
40 (21484958) 2
68 (21905974) 1
38 (23796374) 4
51 (16361048) 3
52 (16632735) 2
56 (15057562) 3
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 1 1 2 3 8
References Study Quality
22 (17963078) 2
25 (16436815) 2
27 (19276325) 1
42 (16373764) 2
41 (15710985) 3
36 (17701255) 3
40 (21484958) 2
39 (3680682) 4
CT enterography Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 0 1 1 1 11
References Study Quality
24 (24912799) Good
23 (15459329) 2
28 (18372465) M
22 (17963078) 2
25 (16436815) 2
26 (17032911) 2
27 (19276325) 1
32 (21057129) 4
33 (19155404) 2
34 (16648154) 2
35 (20588038) 2
36 (17701255) 3
37 (18551336) 4
29 (18623171) 4
30 (12719900) 3
31 (17206719) 2
19 (17604930) 2
20 (19118968) 4
21 (15638233) 3
38 (23796374) 4
US abdomen and pelvis May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 3 2 3 5 2 0 0 0
References Study Quality
90 (23182513) 4
85 (27495028) Good
94 (24344807) 3
84 (23921767) Good
95 (23643057) 3
93 (22483566) 3
11 (27338853) 4
86 (15987966) M
87 (14616167) 2
88 (19408327) 1
89 (23796373) 4
91 (19148846) 3
97 (21615440) 4
66 (15942733) 2
92 (18067121) 2
96 (17680844) 1
Fluoroscopy small bowel follow-through May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 0 4 4 2 4 0 0 0
References Study Quality
18 (12944602) 2
81 (16696781) M
79 (18513722) 1
50 (16799782) 2
80 (12873576) 2
27 (19276325) 1
82 (16279905) 4
42 (16373764) 2
46 (16304016) 2
83 (16020490) 3
MRI abdomen and pelvis without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 3 10 2 0 0
References Study Quality
77 (26959382) 4
78 (26457380) Good
73 (25592192) 2
27 (19276325) 1
58 (18214582) 2
72 (19542402) 2
40 (21484958) 2
74 (12562451) 4
75 (19401571) 3
76 (19755971) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 1 4 3 2 4 1 0 0
References Study Quality
77 (26959382) 4
78 (26457380) Good
73 (25592192) 2
27 (19276325) 1
58 (18214582) 2
72 (19542402) 2
40 (21484958) 2
74 (12562451) 4
75 (19401571) 3
76 (19755971) 4
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 9 3 0 0 0
References Study Quality
22 (17963078) 2
25 (16436815) 2
27 (19276325) 1
42 (16373764) 2
41 (15710985) 3
36 (17701255) 3
40 (21484958) 2
39 (3680682) 4
Radiography abdomen Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 1 5 5 2 2 0 0 0 0
Fluoroscopy contrast enema Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 3 4 3 1 1 0 0 0
References Study Quality
9 (23583097) 4
MR enteroclysis Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 1 4 4 1 3 1 1 0 0
References Study Quality
50 (16799782) 2
17 (18158695) 3
48 (22821694) 4
49 (17483955) 1
HMPAO WBC scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 5 5 5 0 0 0 0 0 0
References Study Quality
28 (18372465) M
98 (19522018) 4
99 (15942487) Inadequate
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 5 8 1 0 0 0 0 0
References Study Quality
22 (17963078) 2
25 (16436815) 2
27 (19276325) 1
42 (16373764) 2
41 (15710985) 3
36 (17701255) 3
40 (21484958) 2
39 (3680682) 4
CT enteroclysis Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 1 8 4 2 0 0 0 0
References Study Quality
18 (12944602) 2
17 (18158695) 3
45 (16552508) 3
41 (15710985) 3
43 (19121904) 4
44 (23182514) 4
47 (20959377) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
101 (26436860) 2
103 (25192191) Good
100 (24253895) 2
102 (23516311) 3
104 (21078803) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 7 4 0 0 0 0 0 0
References Study Quality
101 (26436860) 2
103 (25192191) Good
100 (24253895) 2
102 (23516311) 3
104 (21078803) 2
Variant 2: Known Crohn disease, suspected acute exacerbation.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MR enterography Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 1 1 2 0 3 8
References Study Quality
65 (26179244) 4
54 (25222657) 4
24 (24912799) Good
69 (24037299) 2
53 (17502220) 4
28 (18372465) M
57 (19610137) 1
27 (19276325) 1
58 (18214582) 2
59 (19524458) 2
35 (20588038) 2
55 (17639383) 2
60 (19635832) 3
61 (19136510) 2
62 (20122516) 3
63 (16377481) 3
64 (15908538) 1
66 (15942733) 2
67 (16294149) 2
40 (21484958) 2
68 (21905974) 1
38 (23796374) 4
51 (16361048) 3
52 (16632735) 2
56 (15057562) 3
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 2 4 6 3
References Study Quality
22 (17963078) 2
25 (16436815) 2
27 (19276325) 1
42 (16373764) 2
36 (17701255) 3
40 (21484958) 2
CT enterography Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 1 0 2 2 9
References Study Quality
24 (24912799) Good
23 (15459329) 2
28 (18372465) M
22 (17963078) 2
25 (16436815) 2
26 (17032911) 2
27 (19276325) 1
32 (21057129) 4
33 (19155404) 2
34 (16648154) 2
35 (20588038) 2
36 (17701255) 3
37 (18551336) 4
19 (17604930) 2
20 (19118968) 4
21 (15638233) 3
Fluoroscopy small bowel follow-through May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 2 0 3 4 4 1 1 0 0
References Study Quality
18 (12944602) 2
81 (16696781) M
79 (18513722) 1
50 (16799782) 2
80 (12873576) 2
27 (19276325) 1
82 (16279905) 4
42 (16373764) 2
46 (16304016) 2
83 (16020490) 3
MR enteroclysis May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 0 2 13 0 0 0 0 0
References Study Quality
50 (16799782) 2
49 (17483955) 1
MRI abdomen and pelvis without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 5 6 2 1 0
References Study Quality
77 (26959382) 4
78 (26457380) Good
73 (25592192) 2
27 (19276325) 1
58 (18214582) 2
72 (19542402) 2
40 (21484958) 2
74 (12562451) 4
75 (19401571) 3
76 (19755971) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 5 6 4 0 0 0
References Study Quality
77 (26959382) 4
78 (26457380) Good
73 (25592192) 2
27 (19276325) 1
58 (18214582) 2
72 (19542402) 2
40 (21484958) 2
74 (12562451) 4
75 (19401571) 3
76 (19755971) 4
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 11 1 0 0 0
References Study Quality
22 (17963078) 2
25 (16436815) 2
27 (19276325) 1
42 (16373764) 2
36 (17701255) 3
40 (21484958) 2
CT enteroclysis May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 2 10 3 0 0 0 0
References Study Quality
46 (16304016) 2
45 (16552508) 3
41 (15710985) 3
43 (19121904) 4
44 (23182514) 4
47 (20959377) 2
US abdomen and pelvis Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 1 3 4 2 4 1 0 0 0
References Study Quality
90 (23182513) 4
85 (27495028) Good
94 (24344807) 3
84 (23921767) Good
95 (23643057) 3
93 (22483566) 3
11 (27338853) 4
86 (15987966) M
87 (14616167) 2
88 (19408327) 1
89 (23796373) 4
91 (19148846) 3
97 (21615440) 4
66 (15942733) 2
92 (18067121) 2
96 (17680844) 1
Radiography abdomen Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 2 3 3 3 2 2 0 0 0
Fluoroscopy contrast enema Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 2 4 3 1 1 0 0 0
References Study Quality
9 (23583097) 4
HMPAO WBC scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 5 4 5 1 0 0 0 0 0
References Study Quality
28 (18372465) M
98 (19522018) 4
99 (15942487) Inadequate
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 0 4 10 1 0 0 0 0 0
References Study Quality
22 (17963078) 2
25 (16436815) 2
27 (19276325) 1
42 (16373764) 2
36 (17701255) 3
40 (21484958) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
101 (26436860) 2
103 (25192191) Good
100 (24253895) 2
102 (23516311) 3
104 (21078803) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 4 5 2 0 0 0 0 0
References Study Quality
101 (26436860) 2
103 (25192191) Good
100 (24253895) 2
102 (23516311) 3
104 (21078803) 2
Variant 3: Known Crohn disease, disease surveillance; monitoring therapy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MR enterography Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 0 2 12
References Study Quality
77 (26959382) 4
65 (26179244) 4
111 (25666967) 4
54 (25222657) 4
24 (24912799) Good
69 (24037299) 2
53 (17502220) 4
28 (18372465) M
57 (19610137) 1
27 (19276325) 1
58 (18214582) 2
59 (19524458) 2
35 (20588038) 2
55 (17639383) 2
60 (19635832) 3
61 (19136510) 2
62 (20122516) 3
63 (16377481) 3
64 (15908538) 1
66 (15942733) 2
67 (16294149) 2
40 (21484958) 2
68 (21905974) 1
38 (23796374) 4
51 (16361048) 3
52 (16632735) 2
56 (15057562) 3
113 (24177375) 3
112 (29319414) 4
CT enterography Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 1 2 0 4 7
References Study Quality
24 (24912799) Good
23 (15459329) 2
22 (17963078) 2
25 (16436815) 2
26 (17032911) 2
27 (19276325) 1
32 (21057129) 4
33 (19155404) 2
34 (16648154) 2
19 (17604930) 2
20 (19118968) 4
21 (15638233) 3
108 (21710535) 2
109 (25637127) 4
110 (21621641) 3
US abdomen and pelvis May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 3 2 2 4 3 1 0 0 0
References Study Quality
90 (23182513) 4
85 (27495028) Good
114 (26231046) 4
94 (24344807) 3
84 (23921767) Good
95 (23643057) 3
93 (22483566) 3
116 (27446873) 3
11 (27338853) 4
86 (15987966) M
87 (14616167) 2
88 (19408327) 1
89 (23796373) 4
91 (19148846) 3
97 (21615440) 4
66 (15942733) 2
92 (18067121) 2
96 (17680844) 1
115 (21439749) 3
Fluoroscopy small bowel follow-through May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 1 1 4 4 4 0 0 0
References Study Quality
18 (12944602) 2
81 (16696781) M
79 (18513722) 1
50 (16799782) 2
80 (12873576) 2
27 (19276325) 1
82 (16279905) 4
42 (16373764) 2
46 (16304016) 2
83 (16020490) 3
MR enteroclysis May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 9 3 1 0 0
References Study Quality
9 (23583097) 4
50 (16799782) 2
48 (22821694) 4
49 (17483955) 1
MRI abdomen and pelvis without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 4 5 2 1 1
References Study Quality
77 (26959382) 4
78 (26457380) Good
111 (25666967) 4
73 (25592192) 2
27 (19276325) 1
58 (18214582) 2
72 (19542402) 2
40 (21484958) 2
74 (12562451) 4
75 (19401571) 3
76 (19755971) 4
113 (24177375) 3
112 (29319414) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 10 2 0 0 0
References Study Quality
77 (26959382) 4
78 (26457380) Good
111 (25666967) 4
73 (25592192) 2
27 (19276325) 1
58 (18214582) 2
72 (19542402) 2
40 (21484958) 2
74 (12562451) 4
75 (19401571) 3
76 (19755971) 4
113 (24177375) 3
112 (29319414) 4
CT abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 5 9 0 0 0
References Study Quality
19 (17604930) 2
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 2 2 3 8 0 0 0 0
References Study Quality
19 (17604930) 2
CT enteroclysis May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 2 1 0 7 4 0 0 1
References Study Quality
9 (23583097) 4
107 (20177090) 1
46 (16304016) 2
45 (16552508) 3
41 (15710985) 3
108 (21710535) 2
43 (19121904) 4
44 (23182514) 4
47 (20959377) 2
Radiography abdomen Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 3 8 3 1 0 0 0 0 0
Fluoroscopy contrast enema Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 4 2 1 1 0 0 0
References Study Quality
9 (23583097) 4
HMPAO WBC scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 7 1 1 0 0 0 0 0
References Study Quality
28 (18372465) M
98 (19522018) 4
99 (15942487) Inadequate
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 4 7 0 1 0 0 1 0
References Study Quality
19 (17604930) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
101 (26436860) 2
103 (25192191) Good
100 (24253895) 2
102 (23516311) 3
104 (21078803) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 4 5 1 1 0 0 0 0
References Study Quality
101 (26436860) 2
103 (25192191) Good
100 (24253895) 2
102 (23516311) 3
104 (21078803) 2
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.