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Appropriateness Criteria

Variant 1: Traumatic visual defect. Suspect orbital injury. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT head without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 1 0 0 3 3 10 2 0
References Study Quality
10 (22964404) 4
16 (27262056) 4
7 (21326128) 4
14 (10726796) 2
12 (24694248) 3
11 (24614544) 4
9 (21772209) 4
13 (22698295) 3
15 (23287107) 3
CT orbits without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 0 0 0 1 0 0 0 2 14
References Study Quality
10 (22964404) 4
16 (27262056) 4
7 (21326128) 4
14 (10726796) 2
12 (24694248) 3
11 (24614544) 4
9 (21772209) 4
13 (22698295) 3
15 (23287107) 3
MRA head and neck without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 2 0 5 3 8 1 0 0 0
MRA head and neck without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 2 0 5 5 6 1 0 0 0
MRI head without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 2 1 4 1 10 1 0 0 0
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 3 1 2 12 0 0 0
References Study Quality
17 (25882280) 2
MRI orbits without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 0 1 3 4 5 4 0 0
References Study Quality
16 (27262056) 4
17 (25882280) 2
MRI orbits without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 5 2 8 2 2 0
References Study Quality
16 (27262056) 4
17 (25882280) 2
CT orbits with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 2 0 5 2 2 6 1 1 0
References Study Quality
10 (22964404) 4
16 (27262056) 4
7 (21326128) 4
14 (10726796) 2
12 (24694248) 3
11 (24614544) 4
9 (21772209) 4
13 (22698295) 3
15 (23287107) 3
CTA head and neck with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 2 2 5 8 1 0 0
Radiography orbit Usually not appropriate Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 10 3 2 0 1 0 1 0 0
References Study Quality
10 (22964404) 4
16 (27262056) 4
7 (21326128) 4
14 (10726796) 2
12 (24694248) 3
11 (24614544) 4
9 (21772209) 4
13 (22698295) 3
15 (23287107) 3
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 8 1 9 0 1 0 0 0 0
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 3 2 11 2 0 1 0 0 0
References Study Quality
16 (27262056) 4
CT head without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 6 0 0 0 0 0 0
References Study Quality
10 (22964404) 4
16 (27262056) 4
7 (21326128) 4
14 (10726796) 2
12 (24694248) 3
11 (24614544) 4
9 (21772209) 4
13 (22698295) 3
15 (23287107) 3
CT orbits without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 10 1 6 2 0 0 0 0 0
References Study Quality
10 (22964404) 4
16 (27262056) 4
7 (21326128) 4
14 (10726796) 2
12 (24694248) 3
11 (24614544) 4
9 (21772209) 4
13 (22698295) 3
15 (23287107) 3
Variant 2: Nontraumatic orbital asymmetry, exophthalmos, or enophthalmos. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 6 11
References Study Quality
61 (23975080) 4
7 (21326128) 4
59 (25248586) 4
2 (15531324) 4
60 (25348417) 4
CT orbits with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv 8 8 0 0 0 0 0 1 6 5 5
Arteriography cervicocerebral May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 4 5 8 2 0 0 0 0
References Study Quality
36 (18356442) 4
35 (18071114) 4
MRA head and neck without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 5 5 3 2 0
References Study Quality
36 (18356442) 4
35 (18071114) 4
MRA head and neck without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 4 1 3 7 4 0 0 0
References Study Quality
36 (18356442) 4
35 (18071114) 4
MRI head without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 6 11 0 0 0
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 2 0 0 6 6 5 0 0 0
References Study Quality
7 (21326128) 4
MRI orbits without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 4 11 2 0 0
References Study Quality
29 (14746934) 4
27 (870165) 4
28 (9884691) 4
CT head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 0 3 0 10 5 1 0 0 0
CT head without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 1 3 1 7 6 1 0 0 0
CT orbits without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv 6 6 0 0 0 1 2 6 1 3 4
CTA head and neck with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 3 9 2 1 0
References Study Quality
36 (18356442) 4
35 (18071114) 4
Radiography orbit Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 0 0 0 1 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 3 4 1 1 0 0 0
CT orbits without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 9 6 2 0 0 0 0 0 0
References Study Quality
7 (21326128) 4
34 (25448997) 4
32 (21786273) 3
33 (22709420) 3
Variant 3: Suspected orbital cellulitis, uveitis, or scleritis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 2 10 5
References Study Quality
47 (22182506) 3
42 (19221728) 4
40 (23759440) 4
43 (19016810) 4
2 (15531324) 4
41 (21482868) 4
46 (24298218) 4
39 (22963447) M
CT orbits with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 1 4 0 12
References Study Quality
7 (21326128) 4
42 (19221728) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
MRA head and neck without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 2 3 3 10 1 0 0 0
MRA head and neck without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 0 5 2 9 3 0 0 0 0
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 1 0 7 9 1 0 0
References Study Quality
47 (22182506) 3
40 (23759440) 4
41 (21482868) 4
46 (24298218) 4
39 (22963447) M
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 1 6 8 3 0 0 0
References Study Quality
47 (22182506) 3
42 (19221728) 4
40 (23759440) 4
43 (19016810) 4
2 (15531324) 4
41 (21482868) 4
46 (24298218) 4
39 (22963447) M
MRI orbits without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 5 9 4 0 0
References Study Quality
47 (22182506) 3
42 (19221728) 4
40 (23759440) 4
43 (19016810) 4
2 (15531324) 4
41 (21482868) 4
46 (24298218) 4
39 (22963447) M
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 0 2 3 8 5 1 0 0 0
References Study Quality
7 (21326128) 4
42 (19221728) 4
48 (21546008) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
CT orbits without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv 6 6 0 0 0 3 5 10 1 0 0
References Study Quality
7 (21326128) 4
42 (19221728) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
CTA head and neck with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 2 3 3 9 1 0 0 0
Radiography orbit Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 0 1 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 7 1 2 0 0 0 0
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 5 6 1 0 0 0 0 0
References Study Quality
7 (21326128) 4
42 (19221728) 4
48 (21546008) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 2 3 7 5 1 1 0 0 0
References Study Quality
7 (21326128) 4
42 (19221728) 4
48 (21546008) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
CT orbits without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 7 2 3 1 5 1 0 0 0
References Study Quality
7 (21326128) 4
47 (22182506) 3
42 (19221728) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
Variant 4: Suspected optic neuritis. 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 Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 3 5 8
References Study Quality
47 (22182506) 3
42 (19221728) 4
40 (23759440) 4
43 (19016810) 4
2 (15531324) 4
41 (21482868) 4
46 (24298218) 4
39 (22963447) M
MRI orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 2 15
References Study Quality
47 (22182506) 3
42 (19221728) 4
48 (21546008) 4
40 (23759440) 4
43 (19016810) 4
2 (15531324) 4
41 (21482868) 4
46 (24298218) 4
39 (22963447) M
MRI orbits without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 3 4 6 3 0
References Study Quality
47 (22182506) 3
42 (19221728) 4
48 (21546008) 4
40 (23759440) 4
43 (19016810) 4
2 (15531324) 4
41 (21482868) 4
46 (24298218) 4
39 (22963447) M
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 0 4 4 6 2 0
References Study Quality
47 (22182506) 3
42 (19221728) 4
40 (23759440) 4
43 (19016810) 4
2 (15531324) 4
41 (21482868) 4
46 (24298218) 4
39 (22963447) M
Radiography orbit Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 0 1 0 0 0 0 0 0
References Study Quality
49 (12820855) 2
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 0 1 0 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] 2 2 8 5 3 1 0 0 0 0 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 6 2 1 0 0 0 0 0
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 3 2 3 1 2 0 0 0
References Study Quality
7 (21326128) 4
47 (22182506) 3
42 (19221728) 4
43 (19016810) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 3 3 2 1 1 0 0 0
References Study Quality
7 (21326128) 4
42 (19221728) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 5 3 4 1 0 0 0 0
References Study Quality
7 (21326128) 4
47 (22182506) 3
42 (19221728) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
CT orbits with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 6 2 2 3 2 2 0 0 0
References Study Quality
7 (21326128) 4
42 (19221728) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
CT orbits without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 7 2 3 3 1 1 0 0 0
References Study Quality
7 (21326128) 4
42 (19221728) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
38 (5470225) 4
CT orbits without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 6 4 3 3 0 0 1 0 0
References Study Quality
7 (21326128) 4
42 (19221728) 4
48 (21546008) 4
43 (19016810) 4
2 (15531324) 4
46 (24298218) 4
44 (23053380) 4
45 (24924283) 3
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 3 1 0 0 0 0 0
Variant 5: Visual loss. Etiology identified on ophthalmologic examination or laboratory tests.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography orbit Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 0 0 1 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 1 1 0 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 9 5 2 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 9 6 1 0 0 0 1 0 0
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 6 2 0 0 0 0 0 0
References Study Quality
56 (21959626) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 2 0 3 3 1 1 0 0
References Study Quality
56 (21959626) 4
MRI orbits without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 5 4 1 1 0 0 0 0
References Study Quality
56 (21959626) 4
MRI orbits without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 0 2 2 5 0 1 0 0
References Study Quality
56 (21959626) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 2 2 2 1 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 9 3 3 0 1 1 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 2 2 2 2 0 0 1 0
CT orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 3 4 1 0 0 0 0 0
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 2 1 1 3 1 0 0 0
CT orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 8 1 3 2 2 0 0 1 0
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 5 2 0 0 0 1 0 0
Variant 6: Visual loss. Intraocular mass,optic nerve, or pre-chiasm symptoms. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 0 1 17
References Study Quality
7 (21326128) 4
1 (22284056) 4
58 (27843906) 4
MRI orbits without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 0 4 12 2 0
References Study Quality
7 (21326128) 4
1 (22284056) 4
58 (27843906) 4
CT orbits with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 0 0 2 4 5 5 3
References Study Quality
7 (21326128) 4
43 (19016810) 4
2 (15531324) 4
MRA head and neck without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 1 1 5 6 1 4 1 0 0
References Study Quality
36 (18356442) 4
35 (18071114) 4
MRA head and neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 1 3 2 9 3 1 0 0 0
References Study Quality
36 (18356442) 4
35 (18071114) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 2 2 12 1 0 1
References Study Quality
7 (21326128) 4
1 (22284056) 4
58 (27843906) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 1 5 9 2 1 0 0
References Study Quality
7 (21326128) 4
1 (22284056) 4
58 (27843906) 4
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 1 1 3 11 1 0 0 0
References Study Quality
7 (21326128) 4
43 (19016810) 4
2 (15531324) 4
CT head without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 0 1 3 7 6 2 0 0 0
References Study Quality
7 (21326128) 4
43 (19016810) 4
2 (15531324) 4
CT orbits without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv 6 6 0 0 0 3 1 12 3 0 0
References Study Quality
7 (21326128) 4
43 (19016810) 4
2 (15531324) 4
CTA head and neck with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 0 4 5 7 1 1 0 0
References Study Quality
36 (18356442) 4
35 (18071114) 4
Radiography orbit Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 18 1 0 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 5 5 1 1 0 0 0 0
References Study Quality
36 (18356442) 4
35 (18071114) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 3 4 2 2 0 1 0 0
References Study Quality
7 (21326128) 4
43 (19016810) 4
2 (15531324) 4
CT orbits without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 9 3 5 0 0 0 0 0 0
References Study Quality
7 (21326128) 4
43 (19016810) 4
2 (15531324) 4
Variant 7: Nonischemic visual loss. Chiasm or post-chiasm symptoms. 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 Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 4 14
References Study Quality
61 (23975080) 4
59 (25248586) 4
43 (19016810) 4
2 (15531324) 4
60 (25348417) 4
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 4 10 4 0
References Study Quality
61 (23975080) 4
59 (25248586) 4
43 (19016810) 4
2 (15531324) 4
60 (25348417) 4
MRA head and neck without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 6 5 6 1 0 1
References Study Quality
36 (18356442) 4
35 (18071114) 4
MRA head and neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 3 2 5 7 0 0 0 0
References Study Quality
36 (18356442) 4
35 (18071114) 4
MRV head without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 0 3 3 3 8 0 0 0 0
MRV head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 1 4 1 7 4 2 0 0 0
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 0 2 7 3 4 2 0
References Study Quality
7 (21326128) 4
59 (25248586) 4
62 (27213742) 3
CT head without and with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 2 3 11 0 0 0 0
References Study Quality
7 (21326128) 4
59 (25248586) 4
62 (27213742) 3
CT head without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 0 5 4 3 5 1 0
References Study Quality
7 (21326128) 4
59 (25248586) 4
62 (27213742) 3
CTA head and neck with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 1 3 6 6 2 0 0
CTV head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 2 3 5 3 6 0 0 0
Radiography orbit Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 18 1 0 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 4 4 2 2 0 0 0 0
MRI orbits without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 2 10 0 1 0 0 0 0
MRI orbits without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 1 10 1 0 0 0 0 0
CT orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 3 3 5 3 4 4 1 1 0 0 1
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 8 3 6 1 0 1 0 0 0
CT orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 3 3 7 2 5 2 2 0 1 0 0
Variant 8: Ophthalmoplegia or diplopia. 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 Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 3 4 10
References Study Quality
1 (22284056) 4
43 (19016810) 4
2 (15531324) 4
68 (27448831) 3
67 (27768791) 3
MRI orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 3 13
References Study Quality
1 (22284056) 4
43 (19016810) 4
2 (15531324) 4
68 (27448831) 3
67 (27768791) 3
MRI orbits without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 1 6 7 2 0
References Study Quality
1 (22284056) 4
43 (19016810) 4
2 (15531324) 4
68 (27448831) 3
67 (27768791) 3
CT orbits with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 0 0 2 3 4 3 5
References Study Quality
43 (19016810) 4
MRA head and neck without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 4 13 0 0 0
References Study Quality
69 (11918895) 4
MRA head and neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 4 12 0 0 0
References Study Quality
69 (11918895) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 2 0 1 6 7 1 0
References Study Quality
1 (22284056) 4
43 (19016810) 4
2 (15531324) 4
68 (27448831) 3
67 (27768791) 3
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 1 4 12 2 0 0 0
References Study Quality
43 (19016810) 4
CT head without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 0 6 12 1 0 0 0
References Study Quality
43 (19016810) 4
CT orbits without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv 6 6 0 0 1 2 4 11 1 0 0
References Study Quality
43 (19016810) 4
CTA head and neck with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 1 4 13 0 0 0
References Study Quality
69 (11918895) 4
Radiography orbit Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 0 1 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 1 5 4 3 1 0 0 0
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 2 7 2 1 0 0 0 0
References Study Quality
43 (19016810) 4
CT orbits without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 9 3 4 1 0 0 0 0 0
References Study Quality
43 (19016810) 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.