ACR logo

Appropriateness Criteria

Variant 1: Inflammatory back pain. Suspected axial spondyloarthritis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography sacroiliac joints Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 3 12
References Study Quality
15 (6231933) 4
17 (19297345) 3
38 (19433414) 4
47 (22081446) 2
42 (15309502) 2
39 (9858436) 4
40 (28957558) 2
45 (28283515) 2
46 (27744397) 3
48 (24909765) 2
16 (3262757) 4
22 (25837448) 4
41 (8970049) 2
43 (12759287) 2
44 (17610316) 3
Radiography sacroiliac joints and spine area of interest Usually appropriate Limited ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 0 0 2 13
References Study Quality
38 (19433414) 4
30 (31436026) 4
49 (29538011) 4
22 (25837448) 4
US sacroiliac joints Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 3 0 0 0 1 0 0 0
US spine area of interest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 3 0 0 0 1 0 0 0
MRI sacroiliac joints without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 7 1 0 2 4 0 1 0 0
References Study Quality
17 (19297345) 3
36 (18975311) 2
16 (3262757) 4
37 (10493676) 2
22 (25837448) 4
MRI sacroiliac joints without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 5 1 2 1 4 2 0 0 0
References Study Quality
17 (19297345) 3
36 (18975311) 2
16 (3262757) 4
37 (10493676) 2
22 (25837448) 4
MRI spine area of interest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 1 0 2 0 0 0 0
MRI spine area of interest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 0 2 1 3 1 0 0 0
Bone scan with SPECT or SPECT/CT sacroiliac joints Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 2 0 0 0 0 0 0
Bone scan with SPECT or SPECT/CT spine area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 2 0 0 0 0 0 0
CT sacroiliac joints with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 1 2 0 0 0 0 0 0
CT sacroiliac joints without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 8 0 4 1 2 0 0 0 0
CT sacroiliac joints without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 12 1 2 0 0 0 0 0 0
Fluoride PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 12 1 2 0 0 0 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 12 1 2 0 0 0 0 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 12 1 2 0 0 0 0 0 0
CT spine area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 8 1 4 1 1 0 0 0 0
Variant 2: Inflammatory back pain. Suspected axial spondyloarthritis. Additional imaging following radiographs. 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 sacroiliac joints and spine area of interest without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 1 5 5 2
References Study Quality
107 (19446974) 2
59 (22736088) 4
63 (18006539) 3
129 (22595499) 2
110 (20032094) 3
108 (23418080) 4
9 (15650011) 2
123 (22586174) 4
116 (19019894) 3
117 (22893316) 4
10 (19404934) 2
118 (20083538) 2
11 (19666937) 3
19 (19297344) 3
114 (31161154) 1
111 (28749173) 2
60 (28663306) 4
109 (28593478) 3
112 (28365579) 4
3 (28110981) 4
61 (27889235) 4
119 (27483411) 4
62 (27608795) 4
122 (26669910) 3
89 (26286018) 3
124 (26275972) 4
1 (27355535) 4
12 (18562734) 3
22 (25837448) 4
113 (24451240) 2
115 (24574227) 4
120 (19565558) 2
121 (25510605) 2
125 (15458963) 3
126 (12687557) 3
127 (16206370) 2
128 (15778243) 2
MRI sacroiliac joints and spine area of interest without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 1 2 2 3 6
References Study Quality
107 (19446974) 2
59 (22736088) 4
63 (18006539) 3
129 (22595499) 2
110 (20032094) 3
108 (23418080) 4
9 (15650011) 2
123 (22586174) 4
116 (19019894) 3
117 (22893316) 4
10 (19404934) 2
118 (20083538) 2
11 (19666937) 3
19 (19297344) 3
114 (31161154) 1
111 (28749173) 2
60 (28663306) 4
109 (28593478) 3
112 (28365579) 4
3 (28110981) 4
61 (27889235) 4
119 (27483411) 4
62 (27608795) 4
122 (26669910) 3
89 (26286018) 3
124 (26275972) 4
1 (27355535) 4
12 (18562734) 3
22 (25837448) 4
113 (24451240) 2
115 (24574227) 4
120 (19565558) 2
121 (25510605) 2
125 (15458963) 3
126 (12687557) 3
127 (16206370) 2
128 (15778243) 2
MRI sacroiliac joints without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 1 2 2 0 3 8
References Study Quality
107 (19446974) 2
38 (19433414) 4
80 (21900284) 3
36 (18975311) 2
63 (18006539) 3
83 (20496416) 2
110 (20032094) 3
108 (23418080) 4
75 (19116919) 4
78 (12694111) 4
79 (19454404) 4
19 (19297344) 3
93 (30770520) 2
77 (31422357) 4
104 (31292710) 2
98 (29449501) 3
76 (30544144) 3
94 (30097454) 2
81 (30247978) 1
86 (29513924) 4
95 (29629794) 3
105 (31096431) 4
100 (30086145) 2
91 (29177804) 2
111 (28749173) 2
109 (28593478) 3
45 (28283515) 2
3 (28110981) 4
99 (27994095) 2
101 (27908306) 2
106 (27865027) 3
92 (27651143) 2
90 (26709251) 2
82 (26681230) 4
89 (26286018) 3
1 (27355535) 4
13 (19416801) 2
37 (10493676) 2
22 (25837448) 4
41 (8970049) 2
85 (23203670) 1
88 (24925836) 2
96 (24703519) 3
97 (18806131) 2
102 (18034343) 3
103 (24034836) 4
MRI sacroiliac joints without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 1 1 4 8
References Study Quality
107 (19446974) 2
38 (19433414) 4
80 (21900284) 3
36 (18975311) 2
63 (18006539) 3
83 (20496416) 2
110 (20032094) 3
108 (23418080) 4
75 (19116919) 4
78 (12694111) 4
79 (19454404) 4
19 (19297344) 3
93 (30770520) 2
77 (31422357) 4
104 (31292710) 2
98 (29449501) 3
76 (30544144) 3
94 (30097454) 2
81 (30247978) 1
86 (29513924) 4
95 (29629794) 3
105 (31096431) 4
100 (30086145) 2
91 (29177804) 2
111 (28749173) 2
109 (28593478) 3
45 (28283515) 2
3 (28110981) 4
99 (27994095) 2
101 (27908306) 2
106 (27865027) 3
92 (27651143) 2
90 (26709251) 2
82 (26681230) 4
89 (26286018) 3
1 (27355535) 4
13 (19416801) 2
37 (10493676) 2
22 (25837448) 4
41 (8970049) 2
85 (23203670) 1
88 (24925836) 2
96 (24703519) 3
97 (18806131) 2
102 (18034343) 3
103 (24034836) 4
CT sacroiliac joints without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv 5 5 0 0 1 1 6 4 1 1 1
References Study Quality
55 (17939334) 2
47 (22081446) 2
54 (23842966) 4
19 (19297344) 3
56 (30351251) 1
45 (28283515) 2
3 (28110981) 4
57 (26670154) 3
1 (27355535) 4
22 (25837448) 4
43 (12759287) 2
44 (17610316) 3
CT sacroiliac joints and spine area of interest without IV contrast May be appropriate Limited Varies Varies 5 5 0 0 0 1 12 1 2 0 0
References Study Quality
59 (22736088) 4
63 (18006539) 3
54 (23842966) 4
19 (19297344) 3
49 (29538011) 4
58 (29127092) 3
60 (28663306) 4
61 (27889235) 4
62 (27608795) 4
22 (25837448) 4
US sacroiliac joints Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 1 1 1 0 1 0 0 0
References Study Quality
130 (10470902) 3
133 (22552315) 2
132 (17216679) 3
136 (30099591) Good
131 (24914033) 2
22 (25837448) 4
134 (15934066) 1
135 (19565547) 2
US sacroiliac joints and spine area of interest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 1 2 0 0 1 0 0 0
References Study Quality
130 (10470902) 3
132 (17216679) 3
131 (24914033) 2
22 (25837448) 4
Bone scan with SPECT or SPECT/CT sacroiliac joints Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 0 3 5 2 0 0 0 0
References Study Quality
42 (15309502) 2
53 (28798229) 2
22 (25837448) 4
41 (8970049) 2
50 (20395643) 3
51 (6229308) 4
52 (25649319) 2
Bone scan with SPECT or SPECT/CT sacroiliac joints and spine area of interest Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 1 3 5 2 0 0 0 0
References Study Quality
42 (15309502) 2
53 (28798229) 2
22 (25837448) 4
41 (8970049) 2
50 (20395643) 3
51 (6229308) 4
52 (25649319) 2
CT sacroiliac joints with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 12 1 1 0 1 0 0 0 0
References Study Quality
55 (17939334) 2
47 (22081446) 2
54 (23842966) 4
19 (19297344) 3
56 (30351251) 1
45 (28283515) 2
3 (28110981) 4
57 (26670154) 3
1 (27355535) 4
22 (25837448) 4
43 (12759287) 2
44 (17610316) 3
CT sacroiliac joints without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 12 0 1 1 1 0 0 0 0
References Study Quality
55 (17939334) 2
47 (22081446) 2
54 (23842966) 4
19 (19297344) 3
56 (30351251) 1
45 (28283515) 2
3 (28110981) 4
57 (26670154) 3
1 (27355535) 4
22 (25837448) 4
43 (12759287) 2
44 (17610316) 3
Fluoride PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 10 1 2 1 1 0 0 0 0
References Study Quality
73 (20505935) 3
64 (22471910) 3
67 (31088514) 1
70 (30620270) 2
65 (29329443) 1
71 (29067775) 4
66 (27137206) 3
68 (26136491) 2
69 (22788874) 2
72 (26053386) 4
CT sacroiliac joints and spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 12 1 1 1 0 0 0 0 0
References Study Quality
59 (22736088) 4
63 (18006539) 3
54 (23842966) 4
19 (19297344) 3
49 (29538011) 4
58 (29127092) 3
60 (28663306) 4
61 (27889235) 4
62 (27608795) 4
22 (25837448) 4
CT sacroiliac joints and spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 12 0 1 1 0 1 0 0 0
References Study Quality
59 (22736088) 4
63 (18006539) 3
54 (23842966) 4
19 (19297344) 3
49 (29538011) 4
58 (29127092) 3
60 (28663306) 4
61 (27889235) 4
62 (27608795) 4
22 (25837448) 4
Variant 3: Inflammatory back pain. Suspected axial spondyloarthritis. Negative radiographs and negative MRI of the sacroiliac joints. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography spine area of interest Usually appropriate Limited Varies Varies 9 9 0 0 0 1 0 2 2 0 10
References Study Quality
38 (19433414) 4
MRI spine area of interest without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 2 3 2 7
References Study Quality
59 (22736088) 4
63 (18006539) 3
129 (22595499) 2
9 (15650011) 2
123 (22586174) 4
10 (19404934) 2
11 (19666937) 3
19 (19297344) 3
114 (31161154) 1
60 (28663306) 4
3 (28110981) 4
61 (27889235) 4
62 (27608795) 4
122 (26669910) 3
89 (26286018) 3
124 (26275972) 4
1 (27355535) 4
12 (18562734) 3
22 (25837448) 4
115 (24574227) 4
120 (19565558) 2
121 (25510605) 2
125 (15458963) 3
126 (12687557) 3
127 (16206370) 2
128 (15778243) 2
MRI spine area of interest without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 1 5 8
References Study Quality
107 (19446974) 2
59 (22736088) 4
63 (18006539) 3
129 (22595499) 2
123 (22586174) 4
10 (19404934) 2
11 (19666937) 3
19 (19297344) 3
60 (28663306) 4
3 (28110981) 4
61 (27889235) 4
62 (27608795) 4
122 (26669910) 3
89 (26286018) 3
124 (26275972) 4
1 (27355535) 4
12 (18562734) 3
22 (25837448) 4
115 (24574227) 4
120 (19565558) 2
121 (25510605) 2
125 (15458963) 3
126 (12687557) 3
127 (16206370) 2
128 (15778243) 2
CT spine area of interest without IV contrast Usually appropriate Limited Varies Varies 7 7 0 0 0 0 5 2 5 1 2
References Study Quality
59 (22736088) 4
63 (18006539) 3
54 (23842966) 4
19 (19297344) 3
49 (29538011) 4
58 (29127092) 3
60 (28663306) 4
3 (28110981) 4
61 (27889235) 4
62 (27608795) 4
1 (27355535) 4
22 (25837448) 4
US spine area of interest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 2 0 0 1 0 1 0 0
References Study Quality
132 (17216679) 3
22 (25837448) 4
Bone scan with SPECT or SPECT/CT spine area of interest Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 1 3 2 1 0 1 0 0
References Study Quality
42 (15309502) 2
53 (28798229) 2
22 (25837448) 4
41 (8970049) 2
50 (20395643) 3
51 (6229308) 4
52 (25649319) 2
Fluoride PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 10 1 2 1 1 0 0 0 0
References Study Quality
73 (20505935) 3
64 (22471910) 3
67 (31088514) 1
70 (30620270) 2
65 (29329443) 1
71 (29067775) 4
66 (27137206) 3
68 (26136491) 2
69 (22788874) 2
72 (26053386) 4
CT spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 11 0 2 1 1 0 0 0 0
References Study Quality
59 (22736088) 4
63 (18006539) 3
54 (23842966) 4
19 (19297344) 3
49 (29538011) 4
58 (29127092) 3
60 (28663306) 4
3 (28110981) 4
61 (27889235) 4
62 (27608795) 4
1 (27355535) 4
22 (25837448) 4
CT spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 11 0 1 1 1 0 1 0 0
References Study Quality
59 (22736088) 4
63 (18006539) 3
54 (23842966) 4
19 (19297344) 3
49 (29538011) 4
58 (29127092) 3
60 (28663306) 4
3 (28110981) 4
61 (27889235) 4
62 (27608795) 4
1 (27355535) 4
22 (25837448) 4
Variant 4: Known axial spondyloarthritis. Follow-up for treatment response or disease progression.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography sacroiliac joints Usually appropriate Strong ☢☢ 0.1-1mSv 7 7 0 0 0 0 3 2 8 1 2
References Study Quality
30 (31436026) 4
149 (30220240) Good
147 (28970213) 1
142 (28684556) 4
143 (28085226) 2
141 (26990518) 4
29 (29860356) 4
148 (30625261) 4
22 (25837448) 4
144 (21622969) 2
145 (26903442) 4
146 (26663907) 4
150 (9870884) 2
Radiography sacroiliac joints Usually appropriate Strong ☢☢ 0.1-1mSv 7 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
30 (31436026) 4
149 (30220240) Good
147 (28970213) 1
142 (28684556) 4
143 (28085226) 2
141 (26990518) 4
29 (29860356) 4
148 (30625261) 4
22 (25837448) 4
144 (21622969) 2
145 (26903442) 4
146 (26663907) 4
150 (9870884) 2
Radiography sacroiliac joints Usually appropriate Strong ☢☢ 0.1-1mSv 7 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
30 (31436026) 4
149 (30220240) Good
147 (28970213) 1
142 (28684556) 4
143 (28085226) 2
141 (26990518) 4
29 (29860356) 4
148 (30625261) 4
22 (25837448) 4
144 (21622969) 2
145 (26903442) 4
146 (26663907) 4
150 (9870884) 2
Radiography sacroiliac joints and spine area of interest Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 0 2 2 2 3 2 4
References Study Quality
30 (31436026) 4
149 (30220240) Good
155 (28939631) 2
154 (29611287) 2
143 (28085226) 2
151 (27696754) 3
141 (26990518) 4
29 (29860356) 4
148 (30625261) 4
156 (29984487) 2
22 (25837448) 4
144 (21622969) 2
145 (26903442) 4
150 (9870884) 2
152 (22127957) 2
153 (23956249) 4
157 (15051621) 2
MRI sacroiliac joints and spine area of interest without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 0 4 6 3 0 1 1
References Study Quality
107 (19446974) 2
129 (22595499) 2
110 (20032094) 3
108 (23418080) 4
9 (15650011) 2
30 (31436026) 4
111 (28749173) 2
109 (28593478) 3
22 (25837448) 4
125 (15458963) 3
126 (12687557) 3
127 (16206370) 2
128 (15778243) 2
137 (20191486) 2
138 (16208659) 4
139 (17407241) 3
140 (16082639) 2
MRI sacroiliac joints and spine area of interest without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 3 4 3 1 2
References Study Quality
107 (19446974) 2
129 (22595499) 2
110 (20032094) 3
108 (23418080) 4
9 (15650011) 2
30 (31436026) 4
111 (28749173) 2
109 (28593478) 3
22 (25837448) 4
125 (15458963) 3
126 (12687557) 3
127 (16206370) 2
128 (15778243) 2
137 (20191486) 2
138 (16208659) 4
139 (17407241) 3
140 (16082639) 2
MRI sacroiliac joints without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 0 4 4 5 0 1 1
References Study Quality
107 (19446974) 2
110 (20032094) 3
108 (23418080) 4
30 (31436026) 4
111 (28749173) 2
109 (28593478) 3
22 (25837448) 4
137 (20191486) 2
138 (16208659) 4
MRI sacroiliac joints without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 4 2 3 2 2
References Study Quality
107 (19446974) 2
110 (20032094) 3
108 (23418080) 4
30 (31436026) 4
111 (28749173) 2
109 (28593478) 3
22 (25837448) 4
137 (20191486) 2
138 (16208659) 4
US sacroiliac joints Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
132 (17216679) 3
158 (26321072) 3
159 (23385982) 4
US sacroiliac joints Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 0 0 1 0 0 0 0
References Study Quality
132 (17216679) 3
158 (26321072) 3
159 (23385982) 4
US sacroiliac joints and spine area of interest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 0 0 1 0 0 0 0
References Study Quality
132 (17216679) 3
158 (26321072) 3
159 (23385982) 4
Bone scan with SPECT or SPECT/CT sacroiliac joints Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 4 0 0 0 0 0 0
Bone scan with SPECT or SPECT/CT sacroiliac joints and spine area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 4 0 0 0 0 0 0
CT sacroiliac joints with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 1 2 0 0 0 0 0 0
References Study Quality
22 (25837448) 4
CT sacroiliac joints without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 5 2 1 3 3 0 1 0 0
References Study Quality
22 (25837448) 4
CT sacroiliac joints without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 1 1 12 1 2 0 0 0 0 0 0
References Study Quality
22 (25837448) 4
Fluoride PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 1 2 1 0 0 0 0 0
CT sacroiliac joints and spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 11 2 2 0 0 0 0 0 0
References Study Quality
49 (29538011) 4
58 (29127092) 3
22 (25837448) 4
CT sacroiliac joints and spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 12 1 2 0 0 0 0 0 0
References Study Quality
49 (29538011) 4
58 (29127092) 3
22 (25837448) 4
CT sacroiliac joints and spine area of interest without IV contrast Usually not appropriate Limited Varies Varies 3 3 4 2 8 0 1 0 1 0 0
References Study Quality
49 (29538011) 4
58 (29127092) 3
22 (25837448) 4
Variant 5: Axial spondyloarthritis with spine ankylosis. Suspected fracture. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography spine area of interest Usually appropriate Limited Varies Varies 8 8 1 0 0 0 1 1 2 3 7
References Study Quality
34 (16155161) 3
31 (19304705) 4
32 (28816877) 4
22 (25837448) 4
160 (18421455) 4
161 (15191110) 4
MRI spine area of interest without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 2 2 4 5
References Study Quality
34 (16155161) 3
33 (18791749) 4
31 (19304705) 4
35 (20421858) 4
162 (31054754) 4
32 (28816877) 4
22 (25837448) 4
160 (18421455) 4
161 (15191110) 4
CT spine area of interest without IV contrast Usually appropriate Limited Varies Varies 9 9 0 0 0 0 1 1 0 1 12
References Study Quality
34 (16155161) 3
33 (18791749) 4
31 (19304705) 4
35 (20421858) 4
32 (28816877) 4
22 (25837448) 4
160 (18421455) 4
161 (15191110) 4
US spine area of interest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 2 0 0 0 0 0 0 0
MRI spine area of interest without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 0 1 0 0 1 0 1 0
References Study Quality
34 (16155161) 3
33 (18791749) 4
31 (19304705) 4
35 (20421858) 4
162 (31054754) 4
32 (28816877) 4
22 (25837448) 4
160 (18421455) 4
161 (15191110) 4
Bone scan with SPECT or SPECT/CT spine area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 0 1 2 0 1 0 0
Fluoride PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 14 1 0 0 0 0 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 12 1 1 1 0 0 0 0 0
References Study Quality
34 (16155161) 3
33 (18791749) 4
31 (19304705) 4
35 (20421858) 4
32 (28816877) 4
22 (25837448) 4
160 (18421455) 4
161 (15191110) 4
CT spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 12 1 2 0 0 0 0 0 0
References Study Quality
34 (16155161) 3
33 (18791749) 4
31 (19304705) 4
35 (20421858) 4
32 (28816877) 4
22 (25837448) 4
160 (18421455) 4
161 (15191110) 4
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.