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Appropriateness Criteria

Variant 1: Female infertility. Evaluation of ovulatory function and ovarian reserve. 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 Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 6 7 0 0
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 2 13
References Study Quality
27 (7211967) 4
28 (15705365) M
29 (10389718) 3
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 1 2 10 0 0 0
References Study Quality
26 (23292744) 3
25 (24661732) 4
MRI pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 1 7 0 2 1 1 0 0
References Study Quality
26 (23292744) 3
25 (24661732) 4
Variant 2: 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 transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 0 1 13
References Study Quality
32 (1561343) 3
5 (24345633) 4
US color Doppler pelvis May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 4 1 5 2 1 0 0 1
References Study Quality
31 (8567828) 3
US pelvis transabdominal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 2 8 3 0 0
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 3 10 0 0 0
References Study Quality
26 (23292744) 3
25 (24661732) 4
30 (28742467) 3
MRI pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 1 7 0 2 1 0 1 0
References Study Quality
26 (23292744) 3
25 (24661732) 4
30 (28742467) 3
Variant 3: Female infertility. History or clinical suspicion of endometriosis. 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 Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 4 2 6 2 1
US pelvis transrectal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 3 2 4 2 3
References Study Quality
44 (1824581) 3
43 (15162229) 4
45 (24910933) 4
US pelvis transvaginal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 4 11
References Study Quality
47 (9491875) 3
49 (25715375) 3
50 (22034232) 2
51 (20954166) M
46 (25597884) 3
48 (29465552) 3
MRI pelvis without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 0 2 1 8 2
References Study Quality
34 (14615553) 4
36 (8327693) 2
40 (23169738) 2
35 (2052726) 3
41 (15665220) 2
37 (24475842) 3
38 (29193230) 3
39 (15205479) 3
US color Doppler pelvis May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 1 1 5 2 4 1
References Study Quality
43 (15162229) 4
42 (27054310) 4
US sonohysterography with tubal contrast agent May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 3 1 0 5 3 1 0 0
References Study Quality
53 (10207476) 2
55 (17636730) 4
42 (27054310) 4
54 (30244483) 3
Fluoroscopy hysterosalpingography May be appropriate Limited ☢☢ 0.1-1mSv 5 5 0 1 4 2 6 1 0 0 0
References Study Quality
8 (22031261) 4
33 (1834842) 3
MRI pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 2 0 3 1 6 1 1
References Study Quality
34 (14615553) 4
36 (8327693) 2
40 (23169738) 2
35 (2052726) 3
41 (15665220) 2
37 (24475842) 3
38 (29193230) 3
39 (15205479) 3
US sonohysterography Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 4 5 0 0 2 0 0 0
References Study Quality
52 (17947378) 3
Variant 4: Female infertility. Suspicion of tubal occlusion. 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 1 0 1 7 1 4
References Study Quality
64 (17625419) 4
63 (-3127398) 4
62 (27753111) 3
US sonohysterography with tubal contrast agent Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 1 2 3 1 7
References Study Quality
65 (19685552) 3
53 (10207476) 2
55 (17636730) 4
66 (1584936) 2
42 (27054310) 4
54 (30244483) 3
Fluoroscopy hysterosalpingography Usually appropriate Limited ☢☢ 0.1-1mSv 8 8 0 0 0 1 1 0 2 5 6
References Study Quality
58 (9885610) 1
56 () 4
11 (16549607) 4
57 (7641899) M
US pelvis transabdominal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 5 2 3 1 0
MRI pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 1 2 3 4 3 1 0 0 0
References Study Quality
34 (14615553) 4
61 (28184447) 2
59 (27933478) 4
60 (9680577) 3
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 2 1 7 3 0 1 0
References Study Quality
34 (14615553) 4
61 (28184447) 2
59 (27933478) 4
60 (9680577) 3
US sonohysterography Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 1 3 8 0 0 1 0 1 0
Variant 5: Female infertility. Recurrent pregnancy loss. 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 Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 1 5 4 3 1
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 0 3 4 7
References Study Quality
74 (7867273) 4
79 (22643500) 3
84 (20052665) 3
83 (11728660) 3
67 (18161399) 3
68 (10064410) 3
69 (15505312) 3
81 (23312248) 3
80 (12780419) 4
76 (20101638) 3
82 (25195158) 3
US sonohysterography Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 3 1 4 6
References Study Quality
71 (15653584) 4
83 (11728660) 3
87 (18314520) 4
85 (23269704) 4
86 (20970387) 3
76 (20101638) 3
52 (17947378) 3
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 3 0 3 6 2
References Study Quality
72 (23065174) 4
74 (7867273) 4
67 (18161399) 3
73 (10632403) 4
75 (11476785) 2
76 (20101638) 3
MRI pelvis without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 2 0 3 5 4
References Study Quality
72 (23065174) 4
74 (7867273) 4
67 (18161399) 3
73 (10632403) 4
75 (11476785) 2
76 (20101638) 3
US color Doppler pelvis May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 4 0 0 1 8 1 0 0
References Study Quality
78 (12899492) 4
77 (26023602) 3
US sonohysterography with tubal contrast agent May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 5 2 1 4 0 2 0 0
References Study Quality
42 (27054310) 4
Fluoroscopy hysterosalpingography May be appropriate (Disagreement) Expert Opinion ☢☢ 0.1-1mSv 5 5 0 1 1 5 4 1 1 1 0
References Study Quality
71 (15653584) 4
70 (10685551) 2
67 (18161399) 3
68 (10064410) 3
69 (15505312) 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.