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Appropriateness Criteria

Variant 1: Suspected perianal disease. Abscess or fistula. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 3 2 12
References Study Quality
23 (26643166) 4
19 (25038854) 3
24 (21348010) 3
22 (17805919) 4
21 (16773294) 4
18 (28218881) 4
17 (9606374) 4
20 (9694465) 3
CT pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 2 4 5 3 3
References Study Quality
11 (21337873) 3
12 (8119208) 4
US endoanal May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 2 4 2 5 0 0 0
References Study Quality
25 (25364961) 4
30 (14530683) 4
26 (15690671) 4
29 (8253014) 4
27 (28708274) 3
28 (15498901) 2
31 (30607867) 3
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 2 5 3 5 0
References Study Quality
23 (26643166) 4
19 (25038854) 3
24 (21348010) 3
22 (17805919) 4
21 (16773294) 4
18 (28218881) 4
17 (9606374) 4
20 (9694465) 3
CT pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 1 1 4 6 3 1 0 0
References Study Quality
11 (21337873) 3
12 (8119208) 4
Radiography pelvis Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 12 4 1 0 0 0 0 0 0
Fluoroscopy contrast enema Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 6 1 1 1 1 0 0 0
Fluoroscopy fistulography anus Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 1 5 3 3 3 1 1 0 0
References Study Quality
14 (25469082) 4
15 (27034072) 4
13 (1993416) 4
16 (3971802) 4
CT pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 2 11 0 0 1 0 0 0
References Study Quality
11 (21337873) 3
12 (8119208) 4
Variant 2: Suspected rectal fistula. Rectovesicular or rectovaginal. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 1 3 3 5 3
References Study Quality
43 (11856710) 4
CT pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 2 2 5 4 4
References Study Quality
1 (22350172) 4
35 (2335606) 4
US pelvis transrectal May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 1 7 5 0 0 0
References Study Quality
45 (27053063) 4
44 (10458131) 3
Fluoroscopy contrast enema May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 6 4 4 0 0
References Study Quality
36 (8620810) 4
37 (5909230) 4
38 (6608228) 4
Fluoroscopy cystography May be appropriate Limited ☢☢☢ 1-10 mSv 6 6 0 0 0 0 5 6 3 0 0
References Study Quality
39 (9248120) 4
Fluoroscopy vaginography May be appropriate Limited ☢☢☢ 1-10 mSv 6 6 0 0 0 0 5 7 1 1 0
References Study Quality
36 (8620810) 4
40 (28355089) 4
41 (14068403) 4
42 (14206630) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 7 5 0 0 0
References Study Quality
43 (11856710) 4
Radiography pelvis Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 11 5 1 0 0 0 0 0 0
CT pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 2 7 3 2 0 0 0 0
References Study Quality
1 (22350172) 4
35 (2335606) 4
CT pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 2 10 0 0 0 0 1 0
References Study Quality
1 (22350172) 4
35 (2335606) 4
Variant 3: Suspected proctitis or pouchitis. 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 Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 0 1 1 3 5 5 1
References Study Quality
53 (26496569) 3
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 1 3 4 8
References Study Quality
19 (25038854) 3
55 (16985109) 4
18 (28218881) 4
54 (27315072) 3
17 (9606374) 4
CT pelvis with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 1 0 1 5 7 3
CT enterography Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 0 4 4 8 0
References Study Quality
48 (22805666) 3
Fluoroscopy contrast enema May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 1 5 6 1 2 0 0 1
References Study Quality
52 (2152979) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 3 3 5 3 0 0 0
References Study Quality
19 (25038854) 3
55 (16985109) 4
18 (28218881) 4
54 (27315072) 3
17 (9606374) 4
US pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 2 5 3 2 0 1 0 0
References Study Quality
56 (28755790) 4
Radiography pelvis Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 13 3 1 0 0 0 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 2 8 3 1 0 0 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 3 8 2 0 0 1 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 1 4 3 3 2 0 0 0
References Study Quality
51 (21078803) 2
49 (29564671) 3
50 (21833729) 4
WBC scan abdomen and pelvis Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 5 1 6 3 1 0 1 0 0
References Study Quality
57 (2104730) 4
Variant 4: Suspected complication postproctectomy or coloproctectomy or colectomy with pouch or other anastomosis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 5 4 5 2
References Study Quality
19 (25038854) 3
62 (20049948) 4
18 (28218881) 4
65 (9676464) 4
17 (9606374) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 0 0 4 5 4
References Study Quality
61 (24156793) 3
60 (17245179) 4
CT pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 2 2 1 9 3
References Study Quality
61 (24156793) 3
60 (17245179) 4
Fluoroscopy contrast enema May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 0 0 0 3 5 3 2 3
References Study Quality
62 (20049948) 4
63 (17579147) 3
64 (19886140) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 0 7 4 2 0 0
References Study Quality
19 (25038854) 3
62 (20049948) 4
18 (28218881) 4
65 (9676464) 4
17 (9606374) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 5 5 2 1 0 0
References Study Quality
61 (24156793) 3
60 (17245179) 4
CT pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 2 5 4 4 1 0 0
References Study Quality
61 (24156793) 3
60 (17245179) 4
US pelvis transrectal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 2 5 2 0 0 1 0 0
Radiography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 3 2 4 6 0 2 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 2 7 1 1 1 0 0 0
References Study Quality
61 (24156793) 3
60 (17245179) 4
CT pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 1 10 1 0 0 0 1 0
References Study Quality
61 (24156793) 3
60 (17245179) 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.