ACR logo

Appropriateness Criteria

Variant 1: Adult. Known thoracic aortic aneurysm or dissection without repair. With or without 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 chest abdomen pelvis with IV contrast Usually appropriate Strong ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 1 0 0 1 2 4 12
References Study Quality
44 (28701057) 4
43 (10567317) 3
42 (25415694) 2
41 (23958070) 4
40 (34655311) 2
39 (31257995) 3
38 (20395874) 4
37 (19001643) 4
36 (24220116) 4
34 (24267718) 4
27 (21723533) 4
20 (24560244) 2
5 (26916280) 4
1 (23701088) 4
35 (31264015) 3
CTA chest with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 0 0 2 3 8 3 3
References Study Quality
43 (10567317) 3
42 (25415694) 2
41 (23958070) 4
40 (34655311) 2
39 (31257995) 3
38 (20395874) 4
37 (19001643) 4
36 (24220116) 4
34 (24267718) 4
27 (21723533) 4
5 (26916280) 4
1 (23701088) 4
35 (31264015) 3
MRA chest abdomen pelvis with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 4 9 4 3
References Study Quality
49 (27894786) 4
48 (32251236) 3
47 (28905233) 2
46 (33409772) 1
45 (32506262) 3
36 (24220116) 4
MRA chest abdomen pelvis without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 2 4 8 5 0
References Study Quality
1 (23701088) 4
53 (27776656) 3
52 (30664117) 2
51 (29084542) 2
50 (32852711) 3
48 (32251236) 3
MRA chest with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 5 7 5 2 1
References Study Quality
49 (27894786) 4
48 (32251236) 3
47 (28905233) 2
46 (33409772) 1
45 (32506262) 3
36 (24220116) 4
MRA chest without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 7 2 6 2 0
References Study Quality
1 (23701088) 4
53 (27776656) 3
52 (30664117) 2
51 (29084542) 2
50 (32852711) 3
48 (32251236) 3
CT chest abdomen pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 9 4 1 0 0
References Study Quality
34 (24267718) 4
33 (28723768) 3
32 (28078377) 4
31 (32198657) 4
CT chest abdomen pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 0 1 3 7 4 1 0 0
References Study Quality
5 (26916280) 4
34 (24267718) 4
33 (28723768) 3
32 (28078377) 4
31 (32198657) 4
35 (31264015) 3
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 8 6 2 0 0 0
References Study Quality
34 (24267718) 4
33 (28723768) 3
32 (28078377) 4
31 (32198657) 4
US echocardiography transesophageal May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 2 2 11 0 1 0 0
References Study Quality
5 (26916280) 4
US echocardiography transthoracic resting May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 2 1 9 3 0 0 0
References Study Quality
1 (23701088) 4
5 (26916280) 4
55 (29927868) 1
54 (29398308) 3
48 (32251236) 3
28 (27060285) 4
CT chest without and with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 1 8 5 2 0 0 0
References Study Quality
5 (26916280) 4
34 (24267718) 4
33 (28723768) 3
32 (28078377) 4
31 (32198657) 4
35 (31264015) 3
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 3 9 3 2 2 0 0 0
Aortography chest abdomen pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 9 8 1 0 1 0 0 0 1
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 7 4 1 3 1 0 0 0
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 12 3 4 0 1 0 0 0 0
Variant 2: Adult. Prethoracic endovascular repair or open repair of thoracic aorta 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 chest abdomen pelvis with IV contrast Usually appropriate Strong ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 0 1 0 5 14
References Study Quality
1 (23701088) 4
67 (29156021) 2
66 (24139983) 2
65 (24820894) 2
64 (22109332) 2
63 (22305684) 4
61 (26070621) 4
41 (23958070) 4
40 (34655311) 2
37 (19001643) 4
MRA chest abdomen pelvis with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 1 0 1 0 0 2 5 9 2
References Study Quality
48 (32251236) 3
47 (28905233) 2
46 (33409772) 1
45 (32506262) 3
CT chest abdomen pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 5 8 2 0 0
References Study Quality
34 (24267718) 4
CT chest abdomen pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 0 0 0 1 7 7 1 0 0
References Study Quality
34 (24267718) 4
CTA chest with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 4 3 5 2 0
References Study Quality
1 (23701088) 4
67 (29156021) 2
66 (24139983) 2
65 (24820894) 2
64 (22109332) 2
63 (22305684) 4
61 (26070621) 4
41 (23958070) 4
40 (34655311) 2
37 (19001643) 4
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 6 7 2 0 0 0
References Study Quality
34 (24267718) 4
61 (26070621) 4
CT chest without and with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 4 8 3 0 0 0
References Study Quality
34 (24267718) 4
61 (26070621) 4
MRA chest abdomen pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 1 1 0 0 10 2 1
References Study Quality
1 (23701088) 4
68 (33557887) 1
52 (30664117) 2
51 (29084542) 2
50 (32852711) 3
48 (32251236) 3
MRA chest with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 1 2 6 6 0 0 0
References Study Quality
61 (26070621) 4
48 (32251236) 3
47 (28905233) 2
46 (33409772) 1
45 (32506262) 3
MRA chest without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 1 1 3 9 1 0 0 0
References Study Quality
1 (23701088) 4
68 (33557887) 1
52 (30664117) 2
51 (29084542) 2
50 (32852711) 3
48 (32251236) 3
61 (26070621) 4
US echocardiography transesophageal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 2 7 3 1 1 0 0 0
References Study Quality
5 (26916280) 4
70 (25684644) 3
69 (8837572) 3
US echocardiography transthoracic resting Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 1 8 3 1 0 0 0 0
References Study Quality
1 (23701088) 4
5 (26916280) 4
28 (27060285) 4
54 (29398308) 3
Aortography chest abdomen pelvis Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 3 8 3 0 2 0 0 0 0
References Study Quality
62 (24085324) 2
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 6 3 2 0 2 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 7 1 3 0 1 0 0 0
US duplex Doppler iliofemoral arteries Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 6 0 3 1 0 1 0 0
US duplex Doppler aorta abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 3 1 2 1 1 0 0 0
Variant 3: Adult. Postthoracic endovascular repair of thoracic 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 chest abdomen pelvis with IV contrast Usually appropriate Strong ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 0 1 2 4 10
References Study Quality
88 (29097043) 2
87 (28369453) 3
86 (25282168) 4
85 (24571939) 2
84 (24816512) 3
83 (23345371) 3
82 (28341530) 3
81 (23830947) 2
80 (25173654) 4
74 (32891743) 2
37 (19001643) 4
23 (34233714) 2
22 (26787656) 2
21 (24952822) 2
20 (24560244) 2
19 (24144537) 2
12 (27707621) 3
CTA chest with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 4 2 2 6 2
References Study Quality
37 (19001643) 4
80 (25173654) 4
81 (23830947) 2
82 (28341530) 3
83 (23345371) 3
23 (34233714) 2
22 (26787656) 2
21 (24952822) 2
20 (24560244) 2
19 (24144537) 2
12 (27707621) 3
74 (32891743) 2
88 (29097043) 2
87 (28369453) 3
86 (25282168) 4
85 (24571939) 2
84 (24816512) 3
MRA chest abdomen pelvis with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 3 3 3 4 3
References Study Quality
92 (21331596) 3
91 (12835978) 3
90 (10470877) 4
89 (11042644) 4
CT chest abdomen pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 10 3 2 0 0
References Study Quality
34 (24267718) 4
33 (28723768) 3
32 (28078377) 4
31 (32198657) 4
CT chest abdomen pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 0 1 2 7 3 3 0 0
References Study Quality
34 (24267718) 4
33 (28723768) 3
32 (28078377) 4
31 (32198657) 4
CT chest abdomen pelvis without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 4 10 1 0 0 0
References Study Quality
34 (24267718) 4
36 (24220116) 4
79 (19703867) 3
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 12 1 0 0 0
References Study Quality
34 (24267718) 4
33 (28723768) 3
32 (28078377) 4
31 (32198657) 4
CT chest without and with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 2 3 3 5 3 1 0 0
References Study Quality
33 (28723768) 3
32 (28078377) 4
31 (32198657) 4
MRA chest abdomen pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 10 5 0 0 0
References Study Quality
89 (11042644) 4
90 (10470877) 4
2 (25170271) 4
93 (22588711) 3
MRA chest with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 1 0 7 3 4 1 0
References Study Quality
92 (21331596) 3
91 (12835978) 3
90 (10470877) 4
89 (11042644) 4
MRA chest without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 12 2 0 0 0
References Study Quality
89 (11042644) 4
90 (10470877) 4
2 (25170271) 4
93 (22588711) 3
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 4 7 4 1 0 0 0
References Study Quality
34 (24267718) 4
36 (24220116) 4
79 (19703867) 3
Aortography chest abdomen pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 7 5 2 3 2 0 1 0 0
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 5 7 4 1 3 0 0 0 0
US echocardiography transthoracic resting Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 6 1 0 2 0 1 0 0
US duplex Doppler aorta abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 2 0 1 0 0 0 0
References Study Quality
73 (31303063) 4
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 2 0 2 0 1 0 0
Variant 4: Adult. Postopen repair of thoracic 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 chest abdomen pelvis with IV contrast Usually appropriate Strong ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 0 3 2 2 10
References Study Quality
38 (20395874) 4
37 (19001643) 4
36 (24220116) 4
34 (24267718) 4
27 (21723533) 4
1 (23701088) 4
40 (34655311) 2
41 (23958070) 4
80 (25173654) 4
24 (23322828) 4
94 (27771318) 4
95 (24656670) 2
96 (27111499) 2
CTA chest with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 3 4 4 2 3
References Study Quality
4 (28475566) 2
34 (24267718) 4
36 (24220116) 4
27 (21723533) 4
37 (19001643) 4
38 (20395874) 4
40 (34655311) 2
41 (23958070) 4
1 (23701088) 4
80 (25173654) 4
24 (23322828) 4
94 (27771318) 4
95 (24656670) 2
96 (27111499) 2
MRA chest abdomen pelvis with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 3 6 5 1
References Study Quality
97 (25623219) 4
98 (32772927) 3
CT chest abdomen pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 5 6 2 1 0
References Study Quality
34 (24267718) 4
31 (32198657) 4
32 (28078377) 4
33 (28723768) 3
MRA chest abdomen pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 4 3 6 2 0
References Study Quality
1 (23701088) 4
50 (32852711) 3
51 (29084542) 2
68 (33557887) 1
52 (30664117) 2
99 (35000609) 1
48 (32251236) 3
MRA chest with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 3 4 7 1 0
References Study Quality
97 (25623219) 4
98 (32772927) 3
CT chest abdomen pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 0 0 2 9 2 2 1 0
References Study Quality
34 (24267718) 4
31 (32198657) 4
32 (28078377) 4
33 (28723768) 3
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 10 4 0 0 0
References Study Quality
34 (24267718) 4
6 (28833419) 4
CT chest without and with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 2 5 7 2 0 0 0
References Study Quality
4 (28475566) 2
34 (24267718) 4
MRA chest without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 10 3 0 0 0
References Study Quality
1 (23701088) 4
99 (35000609) 1
68 (33557887) 1
52 (30664117) 2
51 (29084542) 2
50 (32852711) 3
48 (32251236) 3
CT chest abdomen pelvis without IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 3 3 2 3 4 2 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 7 3 1 0 0 0 0
Aortography chest abdomen pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 3 2 0 0 0 0 0 1
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 9 5 3 0 0 0 0 0 0
US duplex Doppler aorta abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 3 0 1 0 0 0 0 0
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 1 1 1 4 0 0 1 0
US echocardiography transthoracic resting Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 2 0 1 4 0 0 1 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.