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Appropriateness Criteria

Variant 1: Abnormal uterine bleeding. 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 pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 0 12
References Study Quality
35 (12905512) 3
38 (28766365) 4
36 (27629758) 4
37 (24862861) 2
4 (24157565) 4
34 (23529686) 4
30 (23341379) 3
US pelvis transabdominal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 2 3 6
US pelvis transvaginal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 0 0 1 11
References Study Quality
41 (19398089) M
39 (15293302) 4
44 (12780419) 4
45 (19921229) 2
46 (8184058) 3
40 (9809732) Inadequate
5 (11587008) 4
47 (11679533) 2
42 (25800522) 3
4 (24157565) 4
10 (29683909) 4
43 (15229010) 3
US sonohysterography May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 2 1 0 1 4 1 1 1
References Study Quality
49 (27454735) 4
37 (24862861) 2
50 (24371110) 3
10 (29683909) 4
48 (26206817) 4
51 (27862503) Good
MRI pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 2 7 1 0 1 0 0 0
MRI pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 4 5 0 0 0 0 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 1 0 0 0 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 1 1 0 0 0 0 1
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 1 0 0 0 0 0 0
Variant 2: Abnormal uterine bleeding. Follow-up imaging when original ultrasound is inconclusive or further imaging characterization is needed.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US sonohysterography Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 0 0 2 9 2
References Study Quality
60 (17429332) 2
58 (26576978) 4
28 (24984544) 3
10 (29683909) 4
MRI pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 1 7 2 3
References Study Quality
52 (-3132600) 4
55 (28106642) 4
17 (27921159) 2
12 (27903466) 4
20 (27997438) 4
16 (26383110) 3
21 (24368137) 4
13 (27810281) 4
53 (22665041) 3
14 (24380638) 3
US duplex Doppler pelvis May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 1 0 1 0 6 1 4
References Study Quality
57 (26980265) 4
58 (26576978) 4
37 (24862861) 2
56 (23379512) 4
30 (23341379) 3
US pelvis transabdominal May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 0 1 0 1 1 1 4 4
US pelvis transvaginal May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 1 0 1 0 1 5 5
References Study Quality
59 (23917081) 4
10 (29683909) 4
MRI pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 2 3 0 4 4 0 1
References Study Quality
55 (28106642) 4
17 (27921159) 2
12 (27903466) 4
20 (27997438) 4
16 (26383110) 3
21 (24368137) 4
13 (27810281) 4
53 (22665041) 3
14 (24380638) 3
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 2 0 0 1 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 1 0 0 0 0 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 1 0 0 1 0 0 0
Variant 3: Abnormal uterine bleeding. Follow-up imaging when surveillance is appropriate given findings from the initial ultrasound.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 2 7 5
References Study Quality
57 (26980265) 4
58 (26576978) 4
37 (24862861) 2
56 (23379512) 4
30 (23341379) 3
US pelvis transabdominal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 5 5 4
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 4 9
References Study Quality
59 (23917081) 4
10 (29683909) 4
US sonohysterography Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 1 2 4 5
References Study Quality
60 (17429332) 2
49 (27454735) 4
58 (26576978) 4
37 (24862861) 2
50 (24371110) 3
10 (29683909) 4
48 (26206817) 4
51 (27862503) Good
MRI pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 2 4 4 2 1
References Study Quality
55 (28106642) 4
17 (27921159) 2
12 (27903466) 4
20 (27997438) 4
16 (26383110) 3
21 (24368137) 4
13 (27810281) 4
53 (22665041) 3
14 (24380638) 3
MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 3 2 8 0 0 0
References Study Quality
55 (28106642) 4
17 (27921159) 2
12 (27903466) 4
20 (27997438) 4
16 (26383110) 3
21 (24368137) 4
13 (27810281) 4
53 (22665041) 3
14 (24380638) 3
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 1 0 1 0 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 1 1 0 0 0 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 2 0 0 0 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.