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Appropriateness Criteria

Variant 1: Adult. Acute hip pain, traumatic. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography hip Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 0 0 0 16
References Study Quality
2 (29959502) 4
17 (33131797) 4
16 (29894220) 2
15 (23365546) 2
14 (23787985) 4
US hip Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 0 0 1 1 0 0 0
MRI hip without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 1 0 0 0
MRI hip without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 1 0 0 0 0 0
Bone scan hip Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 0 0 0 0 0 0 0 0
CT hip with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 0 0 0 1 0 0 0 0
CT hip without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 0 0 0 0 1 0 0 0
CT hip without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 0 0 1 0 0 1 0 0
Variant 2: Adult. Acute hip pain, traumatic. Suspect fracture. Radiographs negative or indeterminate. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI hip without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 5 4 7
References Study Quality
31 (32755182) Not Assessed
30 (33175269) 4
29 (22623574) 2
28 (31725122) 4
23 (30249714) 4
22 (31650264) 1
21 (31461322) Good
20 (32633673) Good
19 (33039184) 4
18 (31209592) Inadequate
CT hip without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 1 0 0 0 0 0 3 3 9
References Study Quality
27 (28301779) 2
26 (31147733) 4
25 (34840828) 3
24 (32844321) 4
23 (30249714) 4
22 (31650264) 1
21 (31461322) Good
20 (32633673) Good
19 (33039184) 4
18 (31209592) Inadequate
US hip Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 0 1 1 0 0 0 0
References Study Quality
33 (36570856) 4
32 (36521235) 1
MRI hip without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 2 0 0 0 0 1 0 0
Bone scan hip Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 3 0 0 0 0 0 0 0
CT hip with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 0 0 0 0 0 0 0 0
CT hip without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 2 0 0 1 0 1 0 0
Variant 3: Adult. Acute hip pain, traumatic. Radiographs positive for hip fracture. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT hip without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv 9 9 0 0 1 0 2 1 3 1 8
References Study Quality
38 (32718752) 4
37 (31656307) 3
36 (34598792) 4
35 (30858044) 3
34 (30894062) 2
MRI hip without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 10 1 3 1 0
References Study Quality
41 (32792156) 4
40 (34904188) 4
39 (30899712) 3
20 (32633673) Good
US hip Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
MRI hip without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 1 0 0 0 0 0 0
Bone scan hip Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 0 0 0 0 0 0 0 0
CT hip with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 1 0 0 0 0 0 1 0
CT hip without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 1 2 0 0 0 0 0 0
Variant 4: Adult. Acute hip pain, traumatic. Post reduction of hip dislocation. Follow-up imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography hip Usually appropriate Limited ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 0 0 0 16
References Study Quality
44 (34623933) 4
CT hip without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 1 0 0 0 3 4 0 3 5
References Study Quality
43 (16424806) 4
42 (29146169) 4
8 (29131775) 4
US hip Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 1 0 0 0
MRI hip without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 2 0 0 0 0 0 0
MRI hip without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 2 1 0 2 0 0 0
Bone scan hip Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 0 0 0 0 0 0 0 0
CT hip with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 0 2 0 0 0 0 0 0
CT hip without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 1 1 0 0 0 0 0 0
Variant 5: Adult. Acute hip pain, traumatic. Suspect tendon, muscle, or ligament injury. Radiographs negative or indeterminate. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI hip without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 3 12
References Study Quality
58 (32718743) 4
57 (31163508) 4
56 (29757716) 4
55 (35494306) 3
54 (12942206) 4
53 (31283532) 4
52 (37092718) 4
51 (22038311) M
50 (32513090) 4
49 (25453914) 2
48 (27011854) 4
47 (18450496) 1
46 (14684527) 3
45 (10430134) 4
US hip Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
References Study Quality
59 (19941093) 4
56 (29757716) 4
54 (12942206) 4
MRI hip without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 0 2 0 0 0 0 0 1
Bone scan hip Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 0 1 1 0 0 0 0 0
CT hip with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 0 1 0 1 0 1 0 0
CT hip without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 0 2 0 0 0 1 0 0
CT hip without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 1 0 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.