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Appropriateness Criteria

Variant 1: Adult 50 years of age or younger. Female infertility. Evaluation of uterus and ovaries. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pelvis transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 3 5 0 1
References Study Quality
15 (34441389) 4
US pelvis transabdominal and US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 0 1 0 9
References Study Quality
17 (30758891) 4
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 0 2 1 7
References Study Quality
7 (36013146) 4
18 (-3195244) 4
MRI pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 4 1 2 3 0 0 1
References Study Quality
8 (39488350) 4
11 (36436959) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 9 0 0 0 0
References Study Quality
16 (35636975) 3
15 (34441389) 4
12 (18029861) 4
13 (32484082) 4
14 (27537397) 1
Variant 2: Adult 50 years of age or younger. Female infertility. Clinical features or history of polycystic ovary syndrome. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pelvis transabdominal and US pelvis transvaginal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 1 0 0 0 1 1 1 7
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 0 1 0 9
References Study Quality
19 (37580861) 4
US pelvis transabdominal May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 1 7 1 0 0
References Study Quality
18 (-3195244) 4
MRI pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 4 2 0 0 0
References Study Quality
20 (24661732) 4
21 (23292744) 3
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 3 5 0 0 0
References Study Quality
22 (28742467) 3
21 (23292744) 3
20 (24661732) 4
16 (35636975) 3
Variant 3: Adult 50 years of age or younger. Female infertility. Evaluation of the fallopian tubes. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 2 5 0 0
References Study Quality
23 (34597232) 4
US sonohysterography with tubal contrast agent Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 0 1 4 2 3
References Study Quality
23 (34597232) 4
31 (25219517) 4
32 (35719021) 4
Fluoroscopy hysterosalpingography Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 1 0 0 0 0 0 0 1 9
References Study Quality
26 (30579824) 1
25 (31976383) 4
23 (34597232) 4
24 (28520519) 4
US pelvis transabdominal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 0 2 2 1 4 0 1 0
US pelvis transabdominal and US pelvis transvaginal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 0 3 4 1 0
US sonohysterography May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 0 1 4 3 0 0
References Study Quality
30 (30194618) 3
29 (33665889) 4
MRI pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 8 0 0 0 0
References Study Quality
27 (32044003) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 3 4 1 0 0 0
References Study Quality
23 (34597232) 4
28 (9680577) 3
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.