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Appropriateness Criteria

Variant 1: Chronic liver disease. Diagnosis and staging of liver fibrosis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US shear wave elastography abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 1 9 4
References Study Quality
37 (18095306) 2
38 (18836992) 3
26 (28965721) 3
MR elastography abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 2 9 3
References Study Quality
25 (25305349) 4
24 (19022517) 4
26 (28965721) 3
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 10 1 1 1 1
References Study Quality
33 (16437635) 2
24 (19022517) 4
34 (12216750) 4
US abdomen with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 1 0 4 5 4 0 0 0 0
References Study Quality
35 (27538445) 4
36 (27161854) 3
US duplex Doppler abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 8 1 2 0 0
References Study Quality
40 (17924952) 2
41 (15837406) 3
MRI abdomen without and with hepatobiliary contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 2 0 9 4 1 0 0
References Study Quality
31 (23538889) 2
32 (21248234) 2
MRI abdomen without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 6 6 0 0 1
References Study Quality
28 (22566123) 2
29 (22278368) Good
30 (21879400) 2
MRI abdomen without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 2 1 10 1 0 0 0
References Study Quality
28 (22566123) 2
29 (22278368) Good
30 (21879400) 2
CT abdomen with IV contrast multiphase May be appropriate Limited ☢☢☢☢ 10-30 mSv 5 5 0 0 1 4 9 0 0 0 0
References Study Quality
23 (23192205) 3
21 (24261358) 4
22 (23169796) 3
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 1 4 2 1 0 0 0 0
References Study Quality
21 (24261358) 4
22 (23169796) 3
CT abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 4 2 8 0 0 0 0 0 0
References Study Quality
23 (23192205) 3
21 (24261358) 4
22 (23169796) 3
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 0 0 0 0 0 0 0
Variant 2: Chronic liver disease. No prior diagnosis of hepatocellular carcinoma (HCC). Screening and surveillance for HCC.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 3 3 3 5
References Study Quality
55 (20616602) 4
13 (28620797) 4
10 (29624699) 4
MRI abdomen without and with hepatobiliary contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 2 2 5 3 3
References Study Quality
57 (24475864) 3
58 (29629800) 4
56 (28886231) 4
MRI abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 1 2 3 5 4
References Study Quality
51 (18069697) 2
55 (20616602) 4
46 (20732773) 1
47 (22526270) 2
52 (15719410) 3
53 (23218794) 2
54 (22553295) 2
US duplex Doppler abdomen May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 1 6 0 2 1 2 1
MRI abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 1 0 3 5 5 1 1 0 0
CT abdomen with IV contrast multiphase May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 0 1 2 1 1 3 4 2 0
References Study Quality
46 (20732773) 1
47 (22526270) 2
45 (19802612) 3
US abdomen with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 0 2 9 1 1 1 0 0 0
References Study Quality
69 (23137926) 4
14 (18834687) 3
67 (18779929) 3
68 (16953832) 3
US shear wave elastography abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 4 7 1 2 0 1 0 0
References Study Quality
71 (23345944) 4
70 (21330078) 3
MR elastography abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 2 7 0 2 1 0 0 0
References Study Quality
50 (24636468) 4
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 3 5 2 1 0 0 0 0
References Study Quality
45 (19802612) 3
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 2 9 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 3 4 0 0 0 0 0 0
References Study Quality
49 (10845666) 3
Variant 3: Chronic liver disease. Previous diagnosis of HCC. Post-treatment monitoring for HCC.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with hepatobiliary contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 2 2 3 7 1
References Study Quality
57 (24475864) 3
78 (28859233) 4
MRI abdomen without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 6 10
CT abdomen with IV contrast multiphase Usually appropriate Strong ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 0 2 5 9 0
References Study Quality
72 (17259838) 2
73 (15671002) 2
CT abdomen without and with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 0 0 0 1 2 10 1
References Study Quality
72 (17259838) 2
73 (15671002) 2
US abdomen May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 0 0 8 6 0 2 0 0 0
US abdomen with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 2 2 9 0 0 1 0
MRI abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 1 1 5 6 1 0 0 0
US duplex Doppler abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 2 1 6 4 1 1 1 0 0
US shear wave elastography abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 5 8 0 0 0 0 0 0
References Study Quality
82 (23558071) 4
71 (23345944) 4
70 (21330078) 3
MR elastography abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 2 9 1 0 0 0 0 0
References Study Quality
50 (24636468) 4
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 4 4 4 0 0 0 0 0
References Study Quality
74 (25153274) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 5 2 2 2 0 0 0 0
References Study Quality
76 (23615075) 4
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.