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Appropriateness Criteria

Variant 1: Adult. Liver transplant. Immediate postoperative imaging. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler abdomen Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 0 0 2 6 6
References Study Quality
22 (21906897) 3
21 (21257940) 4
17 (8058930) 4
18 (26534929) 4
19 (32709390) 4
20 (17515341) 3
7 (27616153) 3
16 (28545872) 4
13 (21343534) 4
8 (30577254) 2
12 (33043396) 4
11 (33249391) 3
14 (16304013) 4
15 (17646460) 4
6 (31797026) 4
CT abdomen with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 3 1 8 1 0
References Study Quality
7 (27616153) 3
8 (30577254) 2
CT abdomen with IV contrast multiphase Usually appropriate Limited ☢☢☢☢ 10-30 mSv 8 8 0 0 1 0 1 1 0 7 5
References Study Quality
8 (30577254) 2
7 (27616153) 3
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 3 3 4 3 0 0 0
References Study Quality
7 (27616153) 3
10 (27235874) 4
MRI abdomen without and with IV contrast with MRCP May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 1 4 1 3 3 0 0 0
CT abdomen without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 0 0 1 1 5 3 3 2 0
References Study Quality
8 (30577254) 2
7 (27616153) 3
Radiography abdomen Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 5 3 3 2 0 1 1 0 0
MRI abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 2 1 9 1 1 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 2 3 1 4 1 0 0 0
MRI abdomen without IV contrast with MRCP Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 2 4 1 3 1 1 0 0
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 2 6 2 3 1 0 0 0
References Study Quality
9 (29267144) 3
CTA abdomen with IV contrast Usually not appropriate Expert Opinion ☢☢☢ 1-10 mSv 3 3 3 1 8 1 0 1 0 0 0
Variant 2: Adult. Liver transplant. Postoperative complications, suspected vascular etiology. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler abdomen Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 2 5 7
References Study Quality
22 (21906897) 3
21 (21257940) 4
17 (8058930) 4
18 (26534929) 4
19 (32709390) 4
20 (17515341) 3
7 (27616153) 3
16 (28545872) 4
13 (21343534) 4
8 (30577254) 2
12 (33043396) 4
11 (33249391) 3
14 (16304013) 4
15 (17646460) 4
5 (30569729) Good
6 (31797026) 4
CT abdomen with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 2 2 9 0 0
References Study Quality
19 (32709390) 4
18 (26534929) 4
7 (27616153) 3
16 (28545872) 4
8 (30577254) 2
6 (31797026) 4
CTA abdomen with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 0 1 0 0 11 2 0
References Study Quality
23 (25498085) 4
19 (32709390) 4
7 (27616153) 3
16 (28545872) 4
8 (30577254) 2
CT abdomen with IV contrast multiphase Usually appropriate Limited ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 1 0 1 7 6
References Study Quality
19 (32709390) 4
16 (28545872) 4
7 (27616153) 3
8 (30577254) 2
MRI abdomen without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 2 5 1 4 2 0 0 0
References Study Quality
6 (31797026) 4
19 (32709390) 4
24 (12876028) 3
CT abdomen without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 1 0 0 2 3 2 6 1 0
References Study Quality
19 (32709390) 4
16 (28545872) 4
7 (27616153) 3
8 (30577254) 2
US abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 1 9 0 0 0 0 0 0
References Study Quality
7 (27616153) 3
Radiography abdomen Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 11 3 1 0 0 0 0 0 0
MRI abdomen without and with IV contrast with MRCP Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 1 3 7 2 1 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 4 5 1 1 0 0 0 0
MRI abdomen without IV contrast with MRCP Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 3 5 4 1 1 0 0 1 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 4 6 0 0 0 0 0 0
Variant 3: Adult. Liver transplant. Postoperative complications, suspected biliary etiology. Initial imaging.
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] 7 7 0 0 0 2 2 1 3 4 3
References Study Quality
25 (25590390) 4
12 (33043396) 4
6 (31797026) 4
11 (33249391) 3
US duplex Doppler abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 0 10 3 0
References Study Quality
10 (27235874) 4
12 (33043396) 4
MRI abdomen without and with hepatobiliary contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 2 5 6 1
References Study Quality
28 (28181823) 2
27 (24012454) 4
25 (25590390) 4
26 (34243928) 4
MRI abdomen without and with IV contrast with MRCP Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 1 2 6 6
References Study Quality
31 (21039885) 4
30 (28118992) 3
25 (25590390) 4
29 (30150050) 4
26 (34243928) 4
MRI abdomen without IV contrast with MRCP Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 3 7 1 1
References Study Quality
25 (25590390) 4
29 (30150050) 4
MRI abdomen without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 4 7 2 0 0
References Study Quality
25 (25590390) 4
29 (30150050) 4
CT abdomen with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 1 11 1 0 0 0
References Study Quality
16 (28545872) 4
CT abdomen with IV contrast multiphase May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 0 0 2 1 6 4 1 0 0
References Study Quality
16 (28545872) 4
Radiography abdomen Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 11 3 1 0 0 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 1 6 2 2 1 0 0 0
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 2 5 2 1 1 0 0 0
References Study Quality
16 (28545872) 4
CT abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 0 10 1 0 0 0 0 0
References Study Quality
16 (28545872) 4
Variant 4: Adult. Post liver transplant. Surveillance.
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] 7 7 0 0 0 0 3 2 4 5 0
References Study Quality
37 (-3198352) 4
36 (28009758) 4
35 (31306801) 4
32 (37199193) 4
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 0 10 2 2
References Study Quality
37 (-3198352) 4
36 (28009758) 4
35 (31306801) 4
32 (37199193) 4
MRI abdomen without and with IV contrast with MRCP Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 1 9 4 0
CT abdomen with IV contrast multiphase Usually appropriate Limited ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 0 0 3 10 1
References Study Quality
37 (-3198352) 4
36 (28009758) 4
35 (31306801) 4
32 (37199193) 4
US abdomen May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 1 2 0 1 7 1 0 0
US duplex Doppler abdomen May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 2 0 2 6 2 0 1
MRI abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 1 0 3 4 5 1 0 0 0
MRI abdomen without IV contrast with MRCP May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 0 1 2 8 2 0 0 0
CT abdomen with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 1 6 5 1 0 0
CT abdomen without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 1 3 6 2 2 0 0 0
Radiography abdomen Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 11 2 1 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 4 6 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] 2 2 4 8 1 0 1 0 0 0 0
References Study Quality
35 (31306801) 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.