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Appropriateness Criteria

Variant 1: Acute onset myelopathy. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
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 0 1 0 4 4 7
References Study Quality
47 (21743997) 4
14 (19525791) 3
43 (19901954) 3
37 (20494809) 3
56 (9715996) 4
7 (7477839) 4
13 (3257332) 4
36 (10735767) 3
57 (9517765) 3
63 (26822746) 4
40 (26243328) 2
55 (26677112) 4
33 (25025170) 4
4 (24788128) 4
52 (29449281) 2
53 (27267643) 4
54 (27007482) 4
34 (23917647) 4
42 (24838831) 4
45 (27645347) 4
35 (27509189) 2
12 (29500319) 4
38 (28498290) 4
58 (27480991) 4
39 (26077097) 2
21 (29332032) 2
32 (27175620) 2
41 (24411833) 4
59 (28749553) 4
60 (30694379) 4
28 (29627015) 4
61 (30300457) 4
67 (29358319) 4
69 (30015803) 4
70 (26564433) 4
44 (22733920) 4
27 (25324492) 4
62 (26009002) 4
64 (25248365) 4
68 (29275977) 4
50 (16977443) 4
49 (10851403) 4
MRI spine area of interest without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 2 4 9
References Study Quality
47 (21743997) 4
14 (19525791) 3
43 (19901954) 3
37 (20494809) 3
56 (9715996) 4
7 (7477839) 4
13 (3257332) 4
36 (10735767) 3
57 (9517765) 3
63 (26822746) 4
40 (26243328) 2
55 (26677112) 4
33 (25025170) 4
4 (24788128) 4
52 (29449281) 2
53 (27267643) 4
54 (27007482) 4
34 (23917647) 4
42 (24838831) 4
45 (27645347) 4
35 (27509189) 2
12 (29500319) 4
38 (28498290) 4
58 (27480991) 4
39 (26077097) 2
21 (29332032) 2
32 (27175620) 2
41 (24411833) 4
59 (28749553) 4
60 (30694379) 4
28 (29627015) 4
61 (30300457) 4
67 (29358319) 4
69 (30015803) 4
70 (26564433) 4
44 (22733920) 4
27 (25324492) 4
62 (26009002) 4
64 (25248365) 4
68 (29275977) 4
50 (16977443) 4
49 (10851403) 4
CT myelography spine area of interest May be appropriate Limited Varies Varies 6 6 0 0 0 0 4 12 0 1 0
References Study Quality
14 (19525791) 3
73 (3485355) 4
13 (3257332) 4
74 (28457932) 3
72 (30614510) 4
15 (19967536) 2
CT spine area of interest with IV contrast May be appropriate Limited Varies Varies 4 4 0 2 3 8 2 2 0 0 0
References Study Quality
14 (19525791) 3
13 (3257332) 4
76 (26708079) 4
75 (16523124) 4
15 (19967536) 2
CT spine area of interest without IV contrast May be appropriate Limited Varies Varies 5 5 1 0 1 0 7 7 0 0 0
References Study Quality
14 (19525791) 3
13 (3257332) 4
76 (26708079) 4
75 (16523124) 4
15 (19967536) 2
Arteriography spine area of interest Usually not appropriate Limited Varies Varies 1 1 10 0 2 4 0 0 0 0 0
References Study Quality
76 (26708079) 4
71 (30207937) 4
Radiography spine area of interest Usually not appropriate Limited Varies Varies 3 3 2 0 7 5 0 2 0 0 0
References Study Quality
14 (19525791) 3
13 (3257332) 4
74 (28457932) 3
77 (9231966) 2
MRA spine area of interest with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (29500319) 4
71 (30207937) 4
MRA spine area of interest with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 3 5 1 3 0 0 0 0
References Study Quality
12 (29500319) 4
71 (30207937) 4
MRA spine area of interest without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 4 5 1 2 0 0 0 0
References Study Quality
12 (29500319) 4
71 (30207937) 4
MRA spine area of interest without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (29500319) 4
71 (30207937) 4
MRA spine area of interest without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (29500319) 4
71 (30207937) 4
MRA spine area of interest without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 5 1 1 2 0 0 0 0
References Study Quality
12 (29500319) 4
71 (30207937) 4
MRI spine area of interest with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 6 2 5 0 2 1 0 0 1
References Study Quality
47 (21743997) 4
14 (19525791) 3
43 (19901954) 3
37 (20494809) 3
56 (9715996) 4
7 (7477839) 4
13 (3257332) 4
36 (10735767) 3
57 (9517765) 3
63 (26822746) 4
40 (26243328) 2
55 (26677112) 4
33 (25025170) 4
4 (24788128) 4
52 (29449281) 2
53 (27267643) 4
54 (27007482) 4
34 (23917647) 4
42 (24838831) 4
45 (27645347) 4
35 (27509189) 2
12 (29500319) 4
38 (28498290) 4
58 (27480991) 4
39 (26077097) 2
21 (29332032) 2
32 (27175620) 2
41 (24411833) 4
59 (28749553) 4
60 (30694379) 4
28 (29627015) 4
61 (30300457) 4
67 (29358319) 4
69 (30015803) 4
70 (26564433) 4
44 (22733920) 4
27 (25324492) 4
62 (26009002) 4
64 (25248365) 4
68 (29275977) 4
50 (16977443) 4
49 (10851403) 4
CT spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 3 3 5 3 2 0 4 1 1 0 0
References Study Quality
14 (19525791) 3
13 (3257332) 4
76 (26708079) 4
75 (16523124) 4
15 (19967536) 2
CTA spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 3 3 4 4 1 5 2 0 0 0 0
References Study Quality
12 (29500319) 4
15 (19967536) 2
Variant 2: Chronic or progressive myelopathy. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
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 0 1 0 2 6 7
References Study Quality
9 (24986469) 4
14 (19525791) 3
43 (19901954) 3
37 (20494809) 3
13 (3257332) 4
88 (19213818) 4
36 (10735767) 3
63 (26822746) 4
40 (26243328) 2
33 (25025170) 4
81 (27074180) Good
34 (23917647) 4
42 (24838831) 4
82 (30602797) 4
83 (29502317) 4
35 (27509189) 2
89 (28831529) 4
12 (29500319) 4
38 (28498290) 4
39 (26077097) 2
21 (29332032) 2
90 (30109382) 4
11 (24756535) 4
32 (27175620) 2
41 (24411833) 4
84 (26965759) 4
91 (27814888) 2
61 (30300457) 4
69 (30015803) 4
70 (26564433) 4
44 (22733920) 4
92 (18084751) 4
93 (25091110) 4
94 (15526223) 4
95 (26235013) 3
96 (26430598) 4
97 (20212227) 4
62 (26009002) 4
86 (29490181) 4
87 (23186906) 4
85 (29773568) 4
78 (29545250) 2
79 (23348759) 4
80 (28338452) 4
MRI spine area of interest without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 3 6 7
References Study Quality
9 (24986469) 4
14 (19525791) 3
43 (19901954) 3
37 (20494809) 3
13 (3257332) 4
88 (19213818) 4
36 (10735767) 3
63 (26822746) 4
40 (26243328) 2
33 (25025170) 4
81 (27074180) Good
34 (23917647) 4
42 (24838831) 4
82 (30602797) 4
83 (29502317) 4
35 (27509189) 2
89 (28831529) 4
12 (29500319) 4
38 (28498290) 4
39 (26077097) 2
21 (29332032) 2
90 (30109382) 4
11 (24756535) 4
32 (27175620) 2
41 (24411833) 4
84 (26965759) 4
91 (27814888) 2
61 (30300457) 4
69 (30015803) 4
70 (26564433) 4
44 (22733920) 4
92 (18084751) 4
93 (25091110) 4
94 (15526223) 4
95 (26235013) 3
96 (26430598) 4
97 (20212227) 4
62 (26009002) 4
86 (29490181) 4
87 (23186906) 4
85 (29773568) 4
78 (29545250) 2
79 (23348759) 4
80 (28338452) 4
CT myelography spine area of interest May be appropriate Limited Varies Varies 6 6 1 0 0 0 4 8 2 1 0
References Study Quality
73 (3485355) 4
72 (30614510) 4
98 (28247081) 4
79 (23348759) 4
80 (28338452) 4
CT spine area of interest with IV contrast May be appropriate Limited Varies Varies 4 4 2 1 5 3 4 1 0 0 0
References Study Quality
14 (19525791) 3
13 (3257332) 4
CT spine area of interest without IV contrast May be appropriate Limited Varies Varies 6 6 1 0 0 2 5 8 0 0 0
References Study Quality
14 (19525791) 3
13 (3257332) 4
Arteriography spine area of interest Usually not appropriate Expert Consensus Varies Varies 1 1 9 0 2 2 3 0 0 0 0
Radiography spine area of interest Usually not appropriate Limited Varies Varies 3 3 5 0 8 3 0 1 0 0 0
References Study Quality
14 (19525791) 3
13 (3257332) 4
74 (28457932) 3
77 (9231966) 2
MRA spine area of interest with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 2 2 4 2 1 0 0 0
References Study Quality
5 (28220287) 4
89 (28831529) 4
90 (30109382) 4
91 (27814888) 2
MRA spine area of interest without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 3 2 3 3 0 0 0 0
References Study Quality
5 (28220287) 4
89 (28831529) 4
90 (30109382) 4
91 (27814888) 2
MRA spine area of interest without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 3 2 1 3 0 0 0 0
References Study Quality
5 (28220287) 4
89 (28831529) 4
90 (30109382) 4
91 (27814888) 2
MRI spine area of interest with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 6 3 5 0 1 1 0 1 0
References Study Quality
9 (24986469) 4
14 (19525791) 3
43 (19901954) 3
37 (20494809) 3
13 (3257332) 4
88 (19213818) 4
36 (10735767) 3
63 (26822746) 4
40 (26243328) 2
33 (25025170) 4
81 (27074180) Good
34 (23917647) 4
42 (24838831) 4
82 (30602797) 4
83 (29502317) 4
35 (27509189) 2
89 (28831529) 4
12 (29500319) 4
38 (28498290) 4
39 (26077097) 2
21 (29332032) 2
90 (30109382) 4
11 (24756535) 4
32 (27175620) 2
41 (24411833) 4
84 (26965759) 4
91 (27814888) 2
61 (30300457) 4
69 (30015803) 4
70 (26564433) 4
44 (22733920) 4
92 (18084751) 4
93 (25091110) 4
94 (15526223) 4
95 (26235013) 3
96 (26430598) 4
97 (20212227) 4
62 (26009002) 4
86 (29490181) 4
87 (23186906) 4
85 (29773568) 4
78 (29545250) 2
79 (23348759) 4
80 (28338452) 4
CT spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 2 2 5 4 1 0 5 0 1 0 0
References Study Quality
14 (19525791) 3
13 (3257332) 4
CTA spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 2 2 8 3 3 2 0 1 0 0 0
References Study Quality
99 (29114089) 4
100 (28366753) 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.