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Appropriateness Criteria

Variant 1: Acute pelvic pain in the reproductive age group. Gynecological etiology suspected, ß-hCG positive (either serum or urine). 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 adnexa Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 1 4 8
References Study Quality
12 (24658951) 3
11 (7509494) 3
10 (30693977) 4
US pelvis transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 2 10
References Study Quality
13 (-3195244) 4
14 (24901772) 4
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 0 13
References Study Quality
19 (19035545) 3
18 (21252743) 3
17 (9356647) 4
16 (3292977) 4
15 (23613077) 4
14 (24901772) 4
12 (24658951) 3
11 (7509494) 3
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 1 1 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 1 0 3 1 2 0 0 0
MRI pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 8 2 2 1 1 0 0 0 0
References Study Quality
5 (24660723) 4
6 (25035091) 3
MRI pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 3 3 5 3 0 0 0 0
References Study Quality
9 (29023142) 3
8 (29713741) 4
7 (28668435) 4
CT abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 3 0 0 0 0 0 0
References Study Quality
5 (24660723) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 2 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 11 0 3 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 11 1 2 0 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 12 0 2 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 13 0 1 0 0 0 0 0 0
Variant 2: Acute pelvic pain in the reproductive age group. Gynecological etiology suspected, ß-hCG negative (either serum or urine). 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 Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 2 11
References Study Quality
32 (11309174) 3
31 (20586041) 3
30 (23980225) 4
29 (19670236) 3
22 (32570294) Good
US pelvis transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 3 1 10
References Study Quality
13 (-3195244) 4
US pelvis transvaginal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 0 13
References Study Quality
36 (17947378) 3
35 (18242924) 4
34 (9697286) 3
33 (23503942) 2
32 (11309174) 3
29 (19670236) 3
26 (29719307) 3
22 (32570294) Good
21 (22268201) 4
13 (-3195244) 4
MRI pelvis without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 1 4 3 8 0 0 0
References Study Quality
28 (15205479) 3
27 (26894926) 3
26 (29719307) 3
25 (22527159) 2
22 (32570294) Good
21 (22268201) 4
MRI pelvis without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 3 2 1 5 3 0 0 0 0
CT abdomen and pelvis with IV contrast May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 4 5 7 0 0 0
References Study Quality
24 (26719159) 3
23 (17996605) 4
22 (32570294) Good
21 (22268201) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 4 7 3 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 2 2 5 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 3 4 3 0 0 0 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 6 6 3 0 0 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 3 3 0 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 4 3 5 0 1 0 1 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 3 1 0 0 0 0 0
Variant 3: Acute pelvic pain in the reproductive age group. Nongynecological etiology suspected, ß-hCG positive (either urine or serum). 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 and pelvis transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 2 3 8
References Study Quality
49 (27554180) 3
48 (27925040) 4
40 (25291255) 3
39 (21178041) 4
US duplex Doppler adnexa Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 3 10 4
US pelvis transvaginal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 1 0 2 4 6
MRI abdomen and pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 2 0 4 1 3 4 3 0
References Study Quality
47 (20627280) 3
46 (14665888) 4
45 (29869102) 3
44 (28097379) 3
43 (27511366) 3
42 (28471619) 3
41 (16505393) 3
40 (25291255) 3
CT abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 1 0 15 0 1 0 0 0
References Study Quality
37 (17709829) 3
38 (31760283) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 8 3 2 0 1 0 0 0 0
References Study Quality
39 (21178041) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 2 2 2 1 1 0 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 2 1 4 1 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 3 0 1 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 1 2 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 11 0 2 0 1 0 0 0 0
Variant 4: Acute pelvic pain in the reproductive age group. Nongynecological etiology suspected, ß-hCG negative (either urine or serum). 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 and pelvis transabdominal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 5 3 4
References Study Quality
50 (16928974) M
73 (26177650) 3
72 (26279392) 4
71 (25781382) 4
70 (27154825) 3
69 (17373690) 2
68 (27503383) 3
67 (33038600) 4
66 (27203288) 3
US duplex Doppler pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 2 8 0 2
References Study Quality
74 (27063853) 3
US pelvis transvaginal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 0 4 5 5 2
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 1 4 9
References Study Quality
57 (30048324) 4
56 (22533576) 1
55 (20959365) 2
54 (27318889) 2
53 (31483140) 3
52 (33474985) 3
51 (32406773) 3
50 (16928974) M
CT abdomen and pelvis without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 1 4 4 3 0
References Study Quality
62 (17377025) 2
61 (18647908) M
60 (16372698) 2
59 (29675722) 3
58 (17180324) 2
MRI abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 3 3 2 3 4 1 0 0
References Study Quality
45 (29869102) 3
63 (31420704) 3
64 (24272981) 2
MRI abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 2 3 0 3 4 2 0 0 0
References Study Quality
65 (23290346) 2
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 5 6 1 0 2 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 2 1 1 2 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 4 0 1 3 0 0 1 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 6 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.