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Appropriateness Criteria

Variant 1: Adult. Clinically suspected pelvic 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 and US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 1 4 6
References Study Quality
14 (27624497) 4
51 (26433965) 3
52 (34919760) 3
US pelvis transvaginal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 3 3 6
References Study Quality
7 (26919512) Good
14 (27624497) 4
40 (29465552) 3
72 (32894615) 3
71 (23001892) 2
70 (31493569) 4
69 (32198902) 3
68 (35289968) Good
67 (33582378) 3
66 (32126302) 3
65 (29890654) 3
64 (24794315) 3
63 (32083128) 3
62 (29154402) Good
61 (33148442) Good
60 (35144419) Good
59 (34090310) 3
58 (35561121) 3
57 (24165087) 3
56 (26250349) Good
54 (32083336) Good
53 (32895927) 3
52 (34919760) 3
MRI pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 2 1 1 3 4
References Study Quality
49 (22582363) 4
48 (31503381) 3
47 (26283193) 2
46 (35421318) Good
45 (21497034) 3
44 (23478073) 3
43 (34639248) 4
42 (25604906) 3
41 (33221957) 3
40 (29465552) 3
39 (24428703) 3
38 (25288268) Good
37 (30273678) 3
33 (32193592) 4
MRI pelvis without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 4 1 6 0 0
References Study Quality
50 (21216125) 3
US pelvis transabdominal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 0 1 7 2 1 0 1 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 3 2 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 10 1 0 0 1 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 1 0 0 0 0 0 0
Variant 2: Adult. Clinically suspected pelvic endometriosis. Indeterminate or negative ultrasound. Next imaging study for characterization or treatment planning.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 1 10
References Study Quality
79 (33339775) 3
78 (27666420) 2
77 (23982288) 3
76 (31468155) 3
75 (33625575) 3
74 (32619220) 4
73 (31300849) 3
46 (35421318) Good
43 (34639248) 4
42 (25604906) 3
41 (33221957) 3
40 (29465552) 3
33 (32193592) 4
MRI pelvis without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 1 5 4 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 5 1 0 0 2 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 0 1 0 1 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 1 1 0 0 0 0 0 0
Variant 3: Adult. Clinically suspected rectosigmoid 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 and US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 0 1 7 3 0
References Study Quality
80 (29545217) 3
US pelvis transrectal Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 1 9 1 0
References Study Quality
40 (29465552) 3
100 (32698994) 4
99 (26051099) Good
US pelvis transvaginal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 0 10 1 1
References Study Quality
109 (29654939) 4
108 (34990811) 3
107 (32007640) 3
106 (33857130) 3
105 (34182605) 3
104 (22535651) 3
103 (30007066) 2
102 (26213903) Good
101 (33038269) Good
MRI pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 3 9
References Study Quality
42 (25604906) 3
98 (22744354) 3
97 (34241976) Good
96 (35107223) 3
95 (31739271) 2
94 (24297583) 3
93 (32851441) 3
92 (28802956) 3
91 (21822742) 3
MRI pelvis without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 0 8 3 0
Fluoroscopy contrast enema May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 2 4 2 1 3 0 0 0
References Study Quality
100 (32698994) 4
90 (28882922) 3
US pelvis transabdominal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 0 2 2 3 0 0 0 0
References Study Quality
14 (27624497) 4
CT pelvis with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 5 4 0 0 2 0 0 0
References Study Quality
89 (31493726) Good
88 (26725882) 3
87 (24045261) 3
86 (24012208) 3
85 (32620408) 4
84 (24287396) 3
83 (32558775) 3
82 (25757812) 2
81 (27841773) 3
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 0 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 1 0 0 0 0 0 0 0
Variant 4: Adult. Established postoperative endometriosis diagnosis. New or ongoing symptoms of endometriosis. Follow-up imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 1 0 0 1 4 6
References Study Quality
110 (30770231) 4
US pelvis transabdominal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 1 1 4 2 3 0 1 0 0
US pelvis transabdominal and US pelvis transvaginal May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 1 6 5 0 0
References Study Quality
52 (34919760) 3
US pelvis transvaginal May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 2 4 2 1 2
References Study Quality
111 (32936475) 3
MRI pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 2 0 3 1 6 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 2 4 2 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 1 0 1 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 0 1 0 1 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.