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Appropriateness Criteria

Variant 1: Adult. Major blunt trauma. Hemodynamically unstable. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography trauma series Usually appropriate Limited ☢☢☢ 1-10 mSv 9 9 0 0 0 0 1 0 2 1 7
References Study Quality
13 (29950261) 4
14 (33703916) 2
CT whole body with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 6 6 0 0 0 0 4 3 1 1 2
References Study Quality
9 (23894365) 4
11 (33795900) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 3 2 0 1 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 4 0 0 1 1 0 0 0
CT whole body without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 4 4 1 1 0 1 0 0 0
References Study Quality
12 (26122129) 4
Variant 2: Adult. Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography trauma series Usually appropriate Limited ☢☢☢ 1-10 mSv 8 8 0 0 0 0 1 0 3 2 5
References Study Quality
13 (29950261) 4
14 (33703916) 2
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 9 9 0 0 0 0 0 0 3 2 6
References Study Quality
18 (25250591) Good
17 (23949104) 3
9 (23894365) 4
20 (27163732) 2
19 (28610777) Good
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 3 0 1 1 1 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 6 2 0 1 1 1 0 0 0
CT whole body without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 2 4 3 2 0 0 0 0 0
References Study Quality
9 (23894365) 4
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography trauma series Usually appropriate Limited ☢☢☢ 1-10 mSv 9 9 0 0 1 0 0 1 3 0 6
References Study Quality
13 (29950261) 4
14 (33703916) 2
CT maxillofacial without IV contrast Usually appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 0 1 0 1 1 5 3
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 1 0 1 0 2 0 7
References Study Quality
3 (33958108) 4
CTA head and neck with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 2 6 1 1
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 1 0 0 0 1 5 3 1
References Study Quality
18 (25250591) Good
17 (23949104) 3
9 (23894365) 4
20 (27163732) 2
19 (28610777) Good
CT whole body without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 4 4 2 1 2 3 3 0 0 0 0
References Study Quality
9 (23894365) 4
MRI head without IV contrast abbreviated Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 3 2 0 1 0 0 0 1
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 3 4 3 1 0 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 3 8 0 0 0 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 6 5 0 0 0 0 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 7 3 0 1 0 0 0 0 0
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography trauma series Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 0 1 1 0 4 3 2
References Study Quality
13 (29950261) 4
14 (33703916) 2
Radiography extremity area of interest Usually appropriate Expert Consensus Varies Varies 8 8 0 0 0 0 0 0 3 3 5
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 1 0 0 3 1 1 2 3
References Study Quality
18 (25250591) Good
17 (23949104) 3
9 (23894365) 4
20 (27163732) 2
19 (28610777) Good
CTA extremity area of interest with IV contrast May be appropriate Limited Varies Varies 6 6 1 0 0 0 3 4 2 0 1
References Study Quality
9 (23894365) 4
12 (26122129) 4
24 (24056401) 2
23 (33642083) 4
US duplex Doppler extremity area of interest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 4 0 0 2 0 0 0 0
CT whole body without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 3 2 1 3 1 0 0 1 0
References Study Quality
12 (26122129) 4
9 (23894365) 4
24 (24056401) 2
CT extremity area of interest with IV contrast Usually not appropriate Limited Varies Varies 2 2 2 6 1 1 1 0 0 0 0
References Study Quality
9 (23894365) 4
23 (33642083) 4
CT extremity area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 2 2 4 2 2 1 1 0 0 1 0
CT extremity area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 2 2 2 5 1 1 2 0 0 0 0
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography trauma series Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 0 1 1 1 3 1 4
References Study Quality
13 (29950261) 4
14 (33703916) 2
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 1 0 2 2 6
References Study Quality
25 (23624596) Inadequate
26 (30201138) 4
27 (33909460) 4
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 0 0 1 1 1 3 2 3
References Study Quality
18 (25250591) Good
17 (23949104) 3
25 (23624596) Inadequate
9 (23894365) 4
20 (27163732) 2
19 (28610777) Good
27 (33909460) 4
26 (30201138) 4
CTA abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv 8 8 1 0 0 0 3 0 1 2 4
References Study Quality
24 (24056401) 2
26 (30201138) 4
27 (33909460) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 2 1 1 3 3 1 0 0 0
References Study Quality
9 (23894365) 4
CT whole body without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 4 4 1 3 1 4 1 0 1 0 0
References Study Quality
9 (23894365) 4
US abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 3 6 1 0 0 0 1 0 0
References Study Quality
28 (36882128) 2
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 2 1 1 2 1 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 6 2 0 1 1 1 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 2 6 2 0 0 0 0 0 1
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography trauma series Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 1 0 1 3 1 0 5
References Study Quality
13 (29950261) 4
14 (33703916) 2
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 3 4 4
References Study Quality
25 (23624596) Inadequate
12 (26122129) 4
24 (24056401) 2
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 0 0 1 2 1 2 3 2
References Study Quality
18 (25250591) Good
17 (23949104) 3
25 (23624596) Inadequate
9 (23894365) 4
20 (27163732) 2
19 (28610777) Good
CT pelvis with bladder contrast (CT cystography) May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 1 4 1 2 0 2
References Study Quality
29 (32391715) 4
CTA abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 6 6 1 0 0 0 4 1 1 1 3
References Study Quality
24 (24056401) 2
9 (23894365) 4
12 (26122129) 4
23 (33642083) 4
US abdomen and pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 6 2 2 0 1 0 0 0 0
References Study Quality
28 (36882128) 2
Fluoroscopy cystography Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 3 4 2 0 2 0 0 0 0
References Study Quality
29 (32391715) 4
Fluoroscopy retrograde urethrography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 2 3 2 1 2 0 1 0 0
References Study Quality
31 (30605143) 1
Radiography intravenous urography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 4 5 2 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 6 1 1 1 2 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 6 0 1 3 1 0 0 0 0
MRU without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 6 2 0 0 0 0 0 1 0
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 2 4 3 2 0 0 0 0 0
References Study Quality
9 (23894365) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 0 4 2 0 4 0 0 1 0
CT whole body without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 3 1 4 0 2 1 0 0 0
References Study Quality
9 (23894365) 4
11 (33795900) 4
CTU without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 3 3 2 0 2 1 0 0 0
References Study Quality
30 (31494707) 4
31 (30605143) 1
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography trauma series Usually appropriate Limited ☢☢☢ 1-10 mSv 8 8 0 0 1 0 0 0 3 3 4
References Study Quality
13 (29950261) 4
14 (33703916) 2
CT chest with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 3 2 6
References Study Quality
20 (27163732) 2
9 (23894365) 4
13 (29950261) 4
28 (36882128) 2
CTA chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 2 0 1 1 6
References Study Quality
12 (26122129) 4
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 0 0 1 1 1 3 3 2
References Study Quality
18 (25250591) Good
17 (23949104) 3
25 (23624596) Inadequate
9 (23894365) 4
20 (27163732) 2
19 (28610777) Good
CT whole body without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 4 4 2 2 1 4 1 1 0 0 0
References Study Quality
9 (23894365) 4
US chest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 6 4 0 0 1 0 0 0 0
References Study Quality
4 (29146418) 2
6 (31597173) 4
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 6 2 1 0 1 1 0 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 6 2 1 1 0 1 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 3 0 0 0 0 0 0
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 2 3 4 0 0 0 0 0
References Study Quality
9 (23894365) 4
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. 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 Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 2 0 0 2 7
References Study Quality
28 (36882128) 2
Radiography trauma series Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 0 1 1 2 2 2 3
References Study Quality
13 (29950261) 4
14 (33703916) 2
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 3 2 3 3 0
References Study Quality
25 (23624596) Inadequate
24 (24056401) 2
31 (30605143) 1
CTA chest with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 2 3 1 2 2 0
References Study Quality
9 (23894365) 4
CT whole body with IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv 6 6 0 0 0 1 2 3 2 3 0
References Study Quality
18 (25250591) Good
17 (23949104) 3
9 (23894365) 4
20 (27163732) 2
19 (28610777) Good
CTA abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 5 5 1 0 0 3 2 1 3 1 0
References Study Quality
24 (24056401) 2
US abdomen and pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 6 1 0 0 0 0 0 0
References Study Quality
28 (36882128) 2
US pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 7 0 0 0 0 0 0 0
References Study Quality
28 (36882128) 2
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 1 1 1 2 0 0 1 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 3 2 0 0 1 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 1 4 1 1 1 0 0 0
References Study Quality
9 (23894365) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 2 3 1 0 0 0 0 0
CT whole body without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 3 1 3 1 2 1 0 0 0
References Study Quality
9 (23894365) 4
24 (24056401) 2
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.