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Appropriateness Criteria

Variant 1: Adult. Brief episodic vertigo. Triggered by specific head movements (eg, Dix-Hallpike maneuver). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 3 1 1 0 1 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 2 2 1 0 1 0 0
MRA head and neck without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 2 2 1 1 0 0 0 0
References Study Quality
23 (23903461) 2
MRI cervical and thoracic spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 2 0 0 0 0 0 0
MRI cervical and thoracic spine without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 2 0 0 0 0 0 0
MRI cervical and thoracic spine without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 2 0 0 0 0 0 0
MRI head and internal auditory canal with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 0 2 2 0 2 0 0
MRI head and internal auditory canal without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 2 1 0 1 2 0 0 0
References Study Quality
21 (28943053) 2
MRI head and internal auditory canal without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 1 1 0 0 0 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 1 1 0 1 0 0
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 2 1 2 2 0 0 0 0
References Study Quality
6 (32462345) 4
20 (29056234) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 2 2 3 0 0 0 0 0
References Study Quality
24 (28390809) 1
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 17 0 2 1 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 17 2 1 0 0 0 0 0 0
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 2 2 2 0 0 0 0 0
References Study Quality
6 (32462345) 4
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 2 0 0 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 2 0 0 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 2 1 0 0 0 0 0
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 1 0 1 2 0 0 0 0
Variant 2: Adult. Acute persistent vertigo. Normal neurologic examination and HINTS examination examination consistent with peripheral vertigo. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 3 2 0 4 9 0 0 0 1
References Study Quality
39 (28687453) 2
38 (25307984) 2
37 (23722117) 4
29 (24920847) 2
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 2 2 0 0 1 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 2 2 0 0 1 0 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 2 2 0 0 1 0 0
MRI cervical and thoracic spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 1 1 0 0 0 0 0 0
MRI cervical and thoracic spine without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 1 1 0 0 0 0 0 0
MRI cervical and thoracic spine without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 0 1 0 0 0 0 0 0
MRI head and internal auditory canal with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 2 0 1 0 1 0 0
MRI head and internal auditory canal without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 2 2 1 3 1 0 0 0
References Study Quality
1 (29395695) 4
36 (31531775) 2
35 (32079028) 2
34 (22844866) 2
MRI head and internal auditory canal without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 2 1 0 1 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 1 1 0 1 0 1 0 0
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 2 3 1 3 0 0 0 0
References Study Quality
25 (30882702) 2
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 19 1 0 0 0 0 1 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 19 1 1 0 0 0 0 0 0
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 2 1 2 3 0 0 0 0
References Study Quality
28 (27495834) 3
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 1 1 0 1 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 19 1 1 0 0 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 1 1 3 0 0 0 0 0
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 2 3 1 0 0 0 0
Variant 3: Adult. Acute persistent vertigo. Abnormal neurologic examination or HINTS examination is consistent with central vertigo. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 1 1 0 0 3 5 11
References Study Quality
47 (21986058) 2
46 (25956665) 3
45 (20861624) 2
44 (21330074) 4
37 (23722117) 4
30 (24127701) 2
29 (24920847) 2
2 (22940762) 4
1 (29395695) 4
6 (32462345) 4
MRA head and neck with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 0 0 2 9 3 2 0 0
MRA head and neck without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 0 0 1 6 4 5 0 0
MRA head and neck without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 0 0 2 9 4 1 0 0
MRI head without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 4 0 0 0 1 1 6 6 1
CT head without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 1 1 5 4 2 3 5
References Study Quality
2 (22940762) 4
6 (32462345) 4
CTA head and neck with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 3 0 0 1 5 5 4 1 0
MRI cervical and thoracic spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 0 2 0 0 0 0 0 0
MRI cervical and thoracic spine without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 0 2 0 0 0 0 0 0
MRI cervical and thoracic spine without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 0 2 0 0 0 0 0 0
MRI head and internal auditory canal with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 4 2 1 0 0 0 0
MRI head and internal auditory canal without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 3 2 1 0 0 0 0
MRI head and internal auditory canal without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 0 3 2 1 1 0 1 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 2 0 0 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 3 1 1 0 0 1 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 5 2 0 1 0 0 0 0
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 1 3 0 0 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 1 3 0 0 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 1 2 2 0 0 0 0 0
Variant 4: Adult. Chronic recurrent vertigo. Associated with unilateral hearing loss or tinnitus. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head and internal auditory canal without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 5 5 1 8
References Study Quality
67 (27187035) 4
66 (30337432) 2
65 (31356219) 4
64 (33492418) 2
63 (30600169) 2
62 (33528304) 2
61 (30556402) 2
60 (30719545) 2
59 (25456512) 2
58 (30550412) 2
57 (35759015) 2
56 (25742875) 2
55 (33646188) 4
54 (25457542) 2
53 (31743294) 2
52 (32241307) 4
51 (34142211) 4
CT temporal bone without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 1 0 0 0 4 4 4 6 2
References Study Quality
50 (32867723) 2
49 (25913283) 2
48 (32537729) 2
MRI head and internal auditory canal without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 0 0 2 12 3 1 0 0
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 2 0 1 0 2 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 2 0 1 0 2 0 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 2 0 1 0 2 0 0
MRI cervical and thoracic spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 1 1 0 0 0 0 0 0
MRI cervical and thoracic spine without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 1 1 0 0 0 0 0 0
MRI cervical and thoracic spine without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 1 1 0 0 0 0 0 0
MRI head and internal auditory canal with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 1 0 1 0 0 0 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 2 0 0 0 0 0 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 2 1 0 0 0 0 0 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 2 1 0 0 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 18 1 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 18 1 0 0 0 0 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 17 2 0 0 0 0 0 0 0
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 1 1 1 0 0 2 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 2 0 0 0 0 0 0 0
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 18 1 0 0 0 0 0 0 0
Variant 5: Adult. Chronic recurrent vertigo. Associated with other brainstem neurologic deficits. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA head and neck with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 1 0 9 4 4
References Study Quality
13 (31967281) 2
14 (22931729) 4
69 (27000236) 4
MRA head and neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 1 0 4 8 5
References Study Quality
13 (31967281) 2
14 (22931729) 4
69 (27000236) 4
MRA head and neck without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 5 0 5 4 4
MRI head without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 2 0 6 6 4
CTA head and neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 5 1 2 6 7
References Study Quality
14 (22931729) 4
MRI head without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 0 1 0 2 3 2 6 3
References Study Quality
71 (22878005) 2
70 (22920240) 2
68 (22555580) 2
CT head without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 1 0 2 11 3 0 0 1
MRI cervical and thoracic spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 21 0 1 0 0 0 0 0 0
MRI cervical and thoracic spine without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 21 0 1 0 0 0 0 0 0
MRI cervical and thoracic spine without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 0 1 0 0 1 0 0 0
MRI head and internal auditory canal with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 1 1 0 0 0 0 0
MRI head and internal auditory canal without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 1 0 0 0 0 1 0
MRI head and internal auditory canal without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 4 2 0 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 1 1 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 3 2 1 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 17 3 2 0 0 0 0 0 0
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 4 0 0 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 4 0 0 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 1 3 0 0 1 0 0
Variant 6: Adult. Chronic disequilibrium with signs of cerebellar ataxia. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 0 5 6 7
References Study Quality
84 (35732792) 2
83 (23118909) 2
82 (24375449) 3
MRI head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 5 5 3 5
References Study Quality
84 (35732792) 2
83 (23118909) 2
82 (24375449) 3
MRI cervical and thoracic spine without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 0 2 12 2 2 0 0
References Study Quality
81 (27173364) 4
80 (30473193) 4
79 (34210665) 2
78 (28386793) 2
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 3 1 1 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 1 0 0 0 0 1 0 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 3 0 0 1 0
MRI cervical and thoracic spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 2 1 0 1 0 1 0 0
MRI cervical and thoracic spine without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 2 2 0 1 1 0 1 0
MRI head and internal auditory canal with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 0 1 1 1 0 0
MRI head and internal auditory canal without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 1 0 0 0 0 1 0 0
MRI head and internal auditory canal without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 0 0 0 0 1 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 1 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 19 0 1 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 19 0 1 0 0 0 0 0 0
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 1 3 0 4 0 1 0 0
References Study Quality
76 (21827916) 4
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 1 0 1 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 1 0 1 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 1 0 0 0 1 0 0
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 1 1 1 0 1 0 0
Variant 7: Adult. Chronic disequilibrium with signs of sensory or proprioceptive ataxia. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical and thoracic spine without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 2 4 5 5 3
References Study Quality
80 (30473193) 4
79 (34210665) 2
78 (28386793) 2
MRI cervical and thoracic spine without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 4 9 1 4
References Study Quality
80 (30473193) 4
79 (34210665) 2
78 (28386793) 2
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 1 2 1 0 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 2 1 0 0 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 2 0 1 1 0
MRI cervical and thoracic spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 2 0 0 0 0 0 0
MRI head and internal auditory canal with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 1 1 0 0 0
MRI head and internal auditory canal without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 1 1 0
MRI head and internal auditory canal without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 1 0 1 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 2 0 2 0 1 1 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 2 0 0 1 0 0 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 2 0 3 0 1 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 18 1 1 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 18 1 1 0 0 0 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 17 0 0 0 1 0 1 1 0
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 2 0 0 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 2 0 0 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 2 1 0 0 0 0 0
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 2 0 0 1 1 0
Variant 8: Adult. Nonspecific dizziness without vertigo, ataxia, or other neurologic deficits. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 1 10 4 3 0 0
References Study Quality
4 (32618835) 2
37 (23722117) 4
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 0 5 1 1 0 0 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 0 3 2 1 1 0 1 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 4 1 2 0 0 0 0
MRI cervical and thoracic spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 0 0 1 1 0 0 0
MRI cervical and thoracic spine without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 0 0 1 0 1 0 0
MRI cervical and thoracic spine without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 0 0 1 1 0 0 0
MRI head and internal auditory canal with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 1 1 0 0 0
MRI head and internal auditory canal without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 1 1 0
MRI head and internal auditory canal without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 1 1 0 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 2 0 1 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 1 2 1 0 0 1 1
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 18 1 1 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 17 2 1 0 0 0 0 0 0
CT head without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 2 1 0 3 1 1 0 0
References Study Quality
4 (32618835) 2
3 (33487089) 2
2 (22940762) 4
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 1 1 0 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 1 0 1 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 18 0 1 0 1 0 0 0 0
CTA head and neck with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 1 1 2 0 1 0 0
References Study Quality
3 (33487089) 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.