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Appropriateness Criteria

Variant 1: Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 0 0 0 0 3 6 8
References Study Quality
43 (27250693) 4
CTA abdomen and pelvis without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 1 1 0 1 4 5 5
References Study Quality
43 (27250693) 4
MRA abdomen and pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 2 2 2 8 2
References Study Quality
46 (35638926) 4
CT abdomen and pelvis without and with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 0 1 0 0 1 5 8 2 0
References Study Quality
56 (28648650) 3
US duplex Doppler aorta abdomen Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 6 0 5 3 1
References Study Quality
57 (28416190) 4
54 (26206524) 4
CT abdomen and pelvis with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 6 3 4 3 0
References Study Quality
56 (28648650) 3
CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 6 8 1 0 0
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 9 4 1 0 0
MRA abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 4 5 7 1 0 0
References Study Quality
46 (35638926) 4
US abdomen and pelvis with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 1 5 10 0 0 0 0
US aorta abdomen with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 2 1 2 10 1 0 0 0
Aortography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 5 3 6 2 1 0 0 0 0
US abdomen and pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 5 6 4 0 1 0 0 0
References Study Quality
57 (28416190) 4
Aortography abdomen Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 6 3 7 0 1 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 4 6 0 0 0 0 0 0
Variant 2: Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 0 0 0 0 2 7 8
References Study Quality
43 (27250693) 4
CTA abdomen and pelvis without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 1 0 2 1 2 5 6
References Study Quality
43 (27250693) 4
MRA abdomen and pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 2 7 5 1
References Study Quality
46 (35638926) 4
CT abdomen and pelvis without and with IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 0 0 0 0 5 6 4 1 1
CT abdomen and pelvis with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 5 4 2 5 1 0
CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 2 6 0 2 6 1 0 0
MRA abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 4 10 3 0 0 0
References Study Quality
46 (35638926) 4
Aortography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 4 4 4 2 2 1 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 3 8 2 2 1 0 0 0
US abdomen and pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 3 6 1 2 1 0 0 0
US abdomen and pelvis with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 5 4 0 3 1 1 0 0
US duplex Doppler aorta abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 4 5 1 4 0 1 0 0
References Study Quality
54 (26206524) 4
Aortography abdomen Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 3 7 6 1 0 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 5 4 0 0 0 0 0 0
US aorta abdomen with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 2 8 5 1 1 0 0 0 0
Variant 3: Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA abdomen and pelvis without and with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 1 0 2 3 11
References Study Quality
43 (27250693) 4
100 (30084107) 2
CTA abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 0 0 0 0 5 8 4
References Study Quality
43 (27250693) 4
100 (30084107) 2
CT abdomen and pelvis without and with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 0 0 1 0 3 4 6 1 2
MRA abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 3 2 6 4 2
CT abdomen and pelvis with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 1 4 5 4 1 1
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 1 6 8 0 0 1 0
CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 5 9 2 1 0 0
MRA abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 11 3 0 0 0
US abdomen and pelvis with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 5 9 3 0 0 0
References Study Quality
102 (36572095) 4
100 (30084107) 2
92 (29673811) 2
106 (28527199) 2
107 (29105814) 4
US aorta abdomen with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 1 4 11 1 0 0 0
References Study Quality
102 (36572095) 4
100 (30084107) 2
92 (29673811) 2
106 (28527199) 2
107 (29105814) 4
US duplex Doppler aorta abdomen May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 12 2 0 0 0
References Study Quality
102 (36572095) 4
100 (30084107) 2
91 (28535732) 2
99 (29876784) 1
Aortography abdomen and pelvis May be appropriate Limited ☢☢☢☢ 10-30 mSv 4 4 2 3 3 7 1 1 0 0 0
Aortography abdomen Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 3 3 3 7 0 1 0 0 0
Radiography abdomen and pelvis Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 4 2 4 3 2 1 1 0 0
US abdomen and pelvis Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 1 7 5 1 3 0 0 0 0
References Study Quality
102 (36572095) 4
100 (30084107) 2
Variant 4: Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA abdomen and pelvis without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 1 0 0 0 4 3 9
References Study Quality
43 (27250693) 4
CTA abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 0 0 0 0 4 7 6
References Study Quality
43 (27250693) 4
MRA abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 1 2 8 3 2
CT abdomen and pelvis with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 2 0 5 3 6 0 1
CT abdomen and pelvis without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 0 0 0 1 3 9 1 3 0
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 5 10 1 0 0 0
CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 1 4 10 1 0 0 0
MRA abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 12 3 0 0 0
US abdomen and pelvis with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 4 10 2 0 0 0
US aorta abdomen with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 4 10 2 0 0 0
US duplex Doppler aorta abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 12 2 0 0 0
US abdomen and pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 0 6 7 2 1 1 0 0 0
Aortography abdomen Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 6 5 1 3 1 0 1 0 0
Aortography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 6 5 1 3 1 0 1 0 0
Radiography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 5 6 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.