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Appropriateness Criteria

Variant 1: Low risk for placenta accreta spectrum disorder. No known clinical risk factors. Initial Imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pregnant uterus transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 1 11
References Study Quality
15 (-3112890) 4
US duplex Doppler pregnant uterus May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 0 5 2 1 3
References Study Quality
14 (19001647) 4
4 (27875472) 4
US pregnant uterus transvaginal May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 3 6 3 1 0
References Study Quality
15 (-3112890) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 1 0 0 0 0 0 0 0
References Study Quality
13 (30471891) 4
MRI abdomen and pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 6 1 0 0 0 0 0 0
References Study Quality
13 (30471891) 4
Variant 2: High risk for placenta accreta spectrum disorder. 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 pregnant uterus Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 1 10
References Study Quality
37 (15118654) 3
14 (19001647) 4
45 (12047546) 4
US pregnant uterus transabdominal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 1 11
References Study Quality
46 (1522623) 4
16 (10776009) 3
37 (15118654) 3
38 (9393534) 3
2 (24176160) 4
6 (21907956) 2
10 (26428505) 4
11 (29405319) 4
US pregnant uterus transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 1 3 8
References Study Quality
15 (-3112890) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 3 4 4 1 0
References Study Quality
20 (16946217) 3
14 (19001647) 4
33 (17222719) 2
30 (22109310) 3
41 (16582134) 4
28 (23020968) 2
29 (24210438) 4
31 (23489020) 3
32 (26295658) 2
34 (22268173) 4
43 (28293719) 3
44 (25748486) 2
26 (20070704) 4
11 (29405319) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 6 0 2 0 0 0 0 0
References Study Quality
27 (-3112580) 4
20 (16946217) 3
14 (19001647) 4
26 (20070704) 4
Variant 3: Follow-up of placenta accreta spectrum disorder.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler pregnant uterus Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 4 9
References Study Quality
14 (19001647) 4
45 (12047546) 4
US pregnant uterus transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 1 11
References Study Quality
5 (21055510) 4
10 (26428505) 4
US pregnant uterus transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 0 4 8
References Study Quality
15 (-3112890) 4
MRI abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 6 4 0 0 0
References Study Quality
32 (26295658) 2
49 (26195324) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 6 0 2 0 0 0 0 0
References Study Quality
27 (-3112580) 4
14 (19001647) 4
17 (18716136) 4
26 (20070704) 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.