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Appropriateness Criteria

Variant 1: Routine follow-up of the asymptomatic patient after hip arthroplasty.
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 2 1 3 8
References Study Quality
45 (27178012) 2
43 (33714635) 4
42 (25633021) 4
36 (29105547) 4
44 (-3195183) 4
US hip Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 5 1 3 3 2 0 0 0 0
References Study Quality
50 (26439179) 3
47 (22426776) 4
52 (26895821) 3
51 (25582840) 3
49 (33325734) 4
48 (20591612) 4
46 (22159851) 4
41 (24908625) 2
36 (29105547) 4
MRI hip without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 1 2 0 0 0 0 0 0
References Study Quality
41 (24908625) 2
40 (23621810) 1
39 (24954485) 3
38 (23233174) 2
37 (21458784) 4
36 (29105547) 4
35 (27094245) 4
34 (33267695) 4
33 (34232144) 1
32 (31863147) 2
31 (20419484) 4
19 (25019450) 4
6 (23047842) 4
MRI hip without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 6 2 0 4 2 0 0 0 0
References Study Quality
36 (29105547) 4
31 (20419484) 4
37 (21458784) 4
6 (23047842) 4
41 (24908625) 2
40 (23621810) 1
39 (24954485) 3
38 (23233174) 2
35 (27094245) 4
34 (33267695) 4
33 (34232144) 1
32 (31863147) 2
19 (25019450) 4
Bone scan hip Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 13 1 0 0 0 0 0 0 0
References Study Quality
27 (3763923) 4
26 (2502609) 4
25 (2307997) 3
Bone scan with SPECT or SPECT/CT hip Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 0 0 0 0 0 0 0
References Study Quality
28 (24047953) 4
27 (3763923) 4
26 (2502609) 4
25 (2307997) 3
CT hip with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 1 0 0 0 0 0 0 0
CT hip without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 1 0 0 0 0 0 0 0
CT hip without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 3 0 0 0 0 0 0 0
Fluoride PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 13 1 0 0 0 0 0 0 0
References Study Quality
30 (22547382) 1
29 (23506163) 1
Variant 2: Symptomatic patient with hip prosthesis. 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 3 11
References Study Quality
65 (24382732) 4
64 (22915396) 4
63 (30854904) 2
62 (20876391) 2
61 (15044748) 2
60 (8037035) 4
59 (12555194) 4
58 (27303496) 4
57 (35317840) 4
56 (32796372) 2
55 (32742209) 3
54 (28145952) 2
49 (33325734) 4
44 (-3195183) 4
18 (23787986) 4
14 (16309990) 3
US hip Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 1 2 2 1 1 1 0 0
References Study Quality
51 (25582840) 3
66 (26733514) 2
Image-guided aspiration hip Usually not appropriate Expert Consensus Varies Varies 1 1 12 2 0 0 0 0 0 0 0
MRI hip without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 0 2 0 1 0 0 0 0
References Study Quality
49 (33325734) 4
54 (28145952) 2
MRI hip without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 1 1 0 0 0 0 0 0
References Study Quality
49 (33325734) 4
54 (28145952) 2
Bone scan hip Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 1 0 1 0 0 0 0 0
Bone scan with SPECT or SPECT/CT hip Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 0 0 1 0 0 0 0
CT hip with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 1 0 0 1 0 0 0 0
References Study Quality
53 (25744811) 4
CT hip without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 1 0 0 1 0 0 0 0
References Study Quality
53 (25744811) 4
CT hip without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 10 1 2 1 0 0 0 0 0
References Study Quality
53 (25744811) 4
Fluoride PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 12 1 1 0 0 0 0 0 0
Variant 3: Symptomatic hip arthroplasty patient, history of acute injury. Additional imaging following radiographs.
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 0 0 0 0 1 5 8
References Study Quality
68 (25603973) 3
22 (22786996) 4
53 (25744811) 4
70 (28622117) 4
71 (31138187) 3
MRI hip without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 0 5 3 3 0 0 1
References Study Quality
72 (25633023) 4
18 (23787986) 4
US hip Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 1 1 1 0 1 0 0 0
References Study Quality
73 (22298875) 4
Image-guided aspiration hip Usually not appropriate Expert Consensus Varies Varies 1 1 12 1 1 0 0 0 0 0 0
MRI hip without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 1 0 0 0 2 0 0 0
References Study Quality
18 (23787986) 4
72 (25633023) 4
Bone scan hip Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 3 0 0 1 0 0 0 0
Bone scan with SPECT or SPECT/CT hip Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 0 0 1 0 0 0
CT hip with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 11 1 0 0 0 0 1 0 1
References Study Quality
22 (22786996) 4
53 (25744811) 4
68 (25603973) 3
70 (28622117) 4
71 (31138187) 3
CT hip without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 14 0 0 0 0 0 0 0 0
References Study Quality
22 (22786996) 4
53 (25744811) 4
68 (25603973) 3
70 (28622117) 4
71 (31138187) 3
Bone scan and gallium scan hip Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 2 1 0 0 0 0 0 0
Bone scan and gallium scan with SPECT or SPECT/CT hip Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 2 1 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 0 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 1 0 0 0 0 0 0
WBC scan and sulfur colloid scan hip Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 2 0 0 1 0 0 0 0
Variant 4: Symptomatic hip arthroplasty patient, infection not excluded. Additional imaging following radiographs.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Image-guided aspiration hip Usually appropriate Strong Varies Varies 9 9 0 0 0 0 1 0 2 1 10
References Study Quality
105 (20449586) 2
106 (-3195185) 4
104 (28932957) 3
103 (33089335) 3
102 (30946198) 4
101 (34340666) 3
MRI hip without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 3 3 3 2
References Study Quality
112 (21744254) 3
107 (23091176) 2
111 (32937252) 2
110 (33225607) 2
109 (32396046) 2
108 (32830902) 2
72 (25633023) 4
WBC scan and sulfur colloid scan hip Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 5 2 6 1 0
References Study Quality
88 (16950069) 2
95 (24873788) 2
96 (15534056) 3
115 (11547374) 3
116 (2266391) 3
US hip May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 6 2 2 1 0
References Study Quality
114 (8037036) 3
47 (22426776) 4
113 (12818862) 3
MRI hip without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 1 2 4 2 2 2
References Study Quality
112 (21744254) 3
111 (32937252) 2
110 (33225607) 2
109 (32396046) 2
108 (32830902) 2
107 (23091176) 2
72 (25633023) 4
CT hip with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv 5 5 0 0 0 1 11 1 1 0 0
References Study Quality
84 (12147845) 2
85 (31900512) 2
23 (27451263) 4
CT hip without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv 4 4 1 1 0 6 5 1 0 0 0
References Study Quality
84 (12147845) 2
85 (31900512) 2
23 (27451263) 4
Radiographic arthrography hip Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 10 3 0 0 0 1 0 0 0
Bone scan hip Usually not appropriate Strong ☢☢☢ 1-10 mSv 3 3 6 1 3 1 3 0 0 0 0
References Study Quality
61 (15044748) 2
82 (15795194) 2
81 (18256077) 3
80 (29192730) 2
Bone scan with SPECT or SPECT/CT hip Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 3 3 1 1 0 0 0
References Study Quality
83 (28929195) 2
CT hip without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 2 2 7 3 2 0 2 0 0 0 0
References Study Quality
84 (12147845) 2
85 (31900512) 2
23 (27451263) 4
Bone scan and gallium scan hip Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 1 1 11 1 0 1 1 0 0 0 0
References Study Quality
79 (3163533) 3
78 (8301279) 3
77 (3410621) 3
Bone scan and gallium scan with SPECT or SPECT/CT hip Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 10 1 1 0 1 1 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 2 0 1 5 0 0 0 0
References Study Quality
94 (16512924) 3
61 (15044748) 2
96 (15534056) 3
95 (24873788) 2
93 (28791884) 3
92 (31362552) 3
91 (17662187) 2
90 (11197979) 3
89 (29679108) 3
88 (16950069) 2
87 (15821896) 3
86 (18421537) 2
82 (15795194) 2
Fluoride PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 7 2 2 2 1 0 0 0 0
References Study Quality
97 (21671714) 3
100 (26956663) 2
99 (26850923) 1
98 (21975412) 3
Variant 5: Symptomatic hip arthroplasty patient, infection excluded. Additional imaging following radiographs.
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 1 0 0 2 0 4 1 6
References Study Quality
133 (15342757) 4
126 (16056041) 3
18 (23787986) 4
134 (25267500) 3
132 (31135538) 2
131 (22499278) 4
119 (31642691) 1
CT hip without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 0 2 2 3 5 1 1
References Study Quality
124 (30194473) 2
125 (11940623) 3
22 (22786996) 4
126 (16056041) 3
123 (27307862) 4
122 (25729518) 4
Image-guided anesthetic injection hip May be appropriate Limited Varies Varies 5 5 0 0 1 2 10 0 1 0 0
References Study Quality
130 (9331038) 4
129 (3809486) 4
128 (8545649) 3
127 (16294463) 4
Bone scan with SPECT or SPECT/CT hip May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 2 2 5 4 0 0 1
References Study Quality
119 (31642691) 1
120 (25583682) 3
Radiographic arthrography hip Usually not appropriate Limited ☢ <0.1 mSv 1 1 11 1 1 1 0 0 0 0 0
References Study Quality
135 (14513446) 3
136 (15655928) 3
MRI hip without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 1 3 0 0 0 0 0 0
References Study Quality
18 (23787986) 4
134 (25267500) 3
133 (15342757) 4
132 (31135538) 2
126 (16056041) 3
119 (31642691) 1
131 (22499278) 4
Bone scan hip Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 3 0 5 5 1 0 0 0 0
References Study Quality
80 (29192730) 2
117 (16547724) 3
118 (15523018) 3
CT arthrography hip Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 9 1 2 1 1 0 0 0 0
References Study Quality
22 (22786996) 4
23 (27451263) 4
121 (27452630) 4
CT hip with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 9 0 2 0 1 1 1 0 0
References Study Quality
22 (22786996) 4
126 (16056041) 3
125 (11940623) 3
124 (30194473) 2
123 (27307862) 4
122 (25729518) 4
CT hip without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 10 0 2 0 0 1 1 0 0
References Study Quality
22 (22786996) 4
126 (16056041) 3
125 (11940623) 3
124 (30194473) 2
123 (27307862) 4
122 (25729518) 4
Fluoride PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 5 0 3 0 4 1 1 0 0
References Study Quality
99 (26850923) 1
98 (21975412) 3
97 (21671714) 3
Variant 6: Evaluation of symptomatic hip arthroplasty patient with metal-on-metal prosthesis or findings suggesting trunnionosis. Question of adverse reaction to metal debris. Additional imaging following radiographs.
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 1 4 1 8
References Study Quality
142 (30499779) 2
143 (28479059) 3
66 (26733514) 2
9 (23354460) 3
141 (33036841) 4
140 (32622715) 4
139 (32005623) 4
134 (25267500) 3
131 (22499278) 4
126 (16056041) 3
52 (26895821) 3
41 (24908625) 2
40 (23621810) 1
39 (24954485) 3
36 (29105547) 4
US hip May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 4 2 4 2 0
References Study Quality
66 (26733514) 2
41 (24908625) 2
36 (29105547) 4
51 (25582840) 3
52 (26895821) 3
CT hip without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv 4 4 2 2 2 6 2 0 0 0 0
References Study Quality
126 (16056041) 3
134 (25267500) 3
MRI hip without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 3 2 4 2 1 2 0 0 0
References Study Quality
143 (28479059) 3
142 (30499779) 2
141 (33036841) 4
140 (32622715) 4
139 (32005623) 4
134 (25267500) 3
131 (22499278) 4
126 (16056041) 3
66 (26733514) 2
52 (26895821) 3
41 (24908625) 2
40 (23621810) 1
39 (24954485) 3
36 (29105547) 4
9 (23354460) 3
CT hip with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 7 1 5 1 0 0 0 0 0
References Study Quality
126 (16056041) 3
134 (25267500) 3
CT hip without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 9 1 2 1 1 0 0 0 0
References Study Quality
126 (16056041) 3
134 (25267500) 3
Variant 7: Hip arthroplasty patient with trochanteric pain. Suspect abductor injury, or trochanteric bursitis, or other soft tissue abnormality. Additional imaging following radiographs.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US hip Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 1 3 4 3 2
References Study Quality
150 (20194941) 4
47 (22426776) 4
73 (22298875) 4
149 (20729436) 4
MRI hip without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 2 2 1 9
References Study Quality
72 (25633023) 4
147 (15860673) 2
146 (21705558) 3
141 (33036841) 4
Image-guided anesthetic +/- corticosteroid injection hip joint or surrounding structures May be appropriate Limited Varies Varies 6 6 0 0 0 0 4 5 2 1 2
References Study Quality
144 (11929203) 4
Radiographic arthrography hip Usually not appropriate Limited ☢ <0.1 mSv 2 2 7 0 2 2 2 1 0 0 0
References Study Quality
148 (17611846) 3
MRI hip without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 1 4 2 0 0 0 0 0
References Study Quality
72 (25633023) 4
141 (33036841) 4
146 (21705558) 3
147 (15860673) 2
CT hip with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 10 0 3 0 0 1 0 0 0
References Study Quality
22 (22786996) 4
CT hip without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 11 0 1 1 0 1 0 0 0
References Study Quality
22 (22786996) 4
CT hip without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 5 0 6 1 1 1 0 0 0
References Study Quality
22 (22786996) 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.