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Appropriateness Criteria

Variant 1: Acute (less than 4 weeks) uncomplicated rhinosinusitis. Initial Imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography paranasal sinuses Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 8 2 2 4 1 0 0 0 0
References Study Quality
21 (12820855) 2
20 (27481857) 4
1 (25833927) 4
22 (-3194068) 4
Arteriography craniofacial Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 1 0 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 1 0 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 2 1 0 0 0 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 3 1 0 0 0 0 0 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 2 3 1 0 1 0 1 0
References Study Quality
1 (25833927) 4
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 2 3 2 0 1 0 0 0
References Study Quality
1 (25833927) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 1 4 2 0 1 0 0 0
References Study Quality
1 (25833927) 4
MRI orbits face neck with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 1 2 3 0 1 1 0 0
References Study Quality
1 (25833927) 4
MRI orbits face neck without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 2 1 0 0 0 0 0 0
References Study Quality
1 (25833927) 4
MRI orbits face neck without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 1 2 0 0 0 0 0 0
References Study Quality
1 (25833927) 4
CT cone beam paranasal sinuses without IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv 3 3 5 3 4 4 1 0 1 0 0
References Study Quality
18 (8259141) 3
17 (26253983) 4
19 (26700263) 3
1 (25833927) 4
CT maxillofacial with IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 11 5 1 0 0 0 0 0 0
References Study Quality
18 (8259141) 3
17 (26253983) 4
1 (25833927) 4
CT maxillofacial without IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv 2 2 7 5 1 2 2 0 0 0 0
References Study Quality
18 (8259141) 3
17 (26253983) 4
1 (25833927) 4
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 9 4 1 1 1 2 0 0 0
References Study Quality
1 (25833927) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 1 3 0 1 0 0 0
References Study Quality
1 (25833927) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 9 3 2 2 0 1 1 0 0
References Study Quality
1 (25833927) 4
CT maxillofacial without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 15 2 0 0 0 0 0 0 0
References Study Quality
18 (8259141) 3
17 (26253983) 4
1 (25833927) 4
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 1 0 1 0 0 0 0
SPECT or SPECT/CT paranasal sinuses Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 2 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 16 1 1 0 0 0 0 0 0
Variant 2: Acute rhinosinusitis with suspected orbital or intracranial complication. 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 3 3 3 8
References Study Quality
23 (11889374) 3
17 (26253983) 4
MRI orbits face neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 2 14
References Study Quality
17 (26253983) 4
CT maxillofacial with IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 3 6 9
References Study Quality
23 (11889374) 3
17 (26253983) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 5 6 5 0 0 0
References Study Quality
23 (11889374) 3
17 (26253983) 4
MRI orbits face neck without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 5 4 3 2 0
References Study Quality
17 (26253983) 4
CT maxillofacial without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢ 0.1-1mSv 5 5 0 3 1 2 8 3 0 0 0
References Study Quality
23 (11889374) 3
17 (26253983) 4
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 0 4 3 5 5 0 0
References Study Quality
23 (11889374) 3
17 (26253983) 4
6 (28341385) 4
Radiography paranasal sinuses Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 13 1 2 0 1 1 0 0 0
Arteriography craniofacial Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 0 0 2 0 1 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 5 0 0 2 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 4 1 0 1 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 3 2 1 1 0 0 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 1 2 2 1 0 0 0 0
References Study Quality
23 (11889374) 3
17 (26253983) 4
MRI orbits face neck with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 0 2 2 0 1 0 0 0
References Study Quality
17 (26253983) 4
CT cone beam paranasal sinuses without IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv 3 3 7 2 6 1 1 1 0 0 0
References Study Quality
25 (24449524) 3
19 (26700263) 3
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 2 2 1 0 0 0 0
References Study Quality
23 (11889374) 3
17 (26253983) 4
6 (28341385) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 4 2 2 1 0 0 0 0
References Study Quality
23 (11889374) 3
17 (26253983) 4
6 (28341385) 4
CT maxillofacial without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 1 1 2 1 0 0 0 0
References Study Quality
23 (11889374) 3
17 (26253983) 4
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 1 2 4 0 2 0 0 0
SPECT or SPECT/CT paranasal sinuses Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 3 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 14 1 2 0 0 1 0 0 0
Variant 3: Acute recurrent sinusitis or chronic rhinosinusitis or noninvasive fungal sinusitis or sinonasal polyposis. Possible surgical candidate for these indications or other non-neoplastic indications, including suspected silent sinus syndrome or suspected mucocele, or deviated nasal septum. Initial Imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT maxillofacial without IV contrast Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 1 0 0 1 0 0 2 0 13
References Study Quality
26 (25832968) 4
31 (26001236) 4
35 (27554662) 1
36 (28072563) 4
32 (27643765) 4
37 (27193478) 2
2 (26476379) 4
38 (25412986) 2
MRI orbits face neck without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 0 1 2 8 3 0 0 0
References Study Quality
40 (19379610) 2
39 (2294574) 4
24 (29685531) 4
MRI orbits face neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 3 0 0 6 8 0 0 0 0
References Study Quality
40 (19379610) 2
39 (2294574) 4
24 (29685531) 4
CT cone beam paranasal sinuses without IV contrast May be appropriate Strong ☢☢ 0.1-1mSv 5 5 0 0 2 1 12 2 0 0 0
References Study Quality
25 (24449524) 3
19 (26700263) 3
34 (28747616) 2
33 (25765366) 2
CT maxillofacial with IV contrast May be appropriate Strong ☢☢ 0.1-1mSv 5 5 0 0 0 3 8 2 4 0 0
References Study Quality
26 (25832968) 4
31 (26001236) 4
35 (27554662) 1
36 (28072563) 4
32 (27643765) 4
37 (27193478) 2
2 (26476379) 4
38 (25412986) 2
Radiography paranasal sinuses Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 9 3 2 1 1 0 1 0 0
References Study Quality
41 (8327669) 4
2 (26476379) 4
Arteriography craniofacial Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 1 0 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 2 0 1 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 1 0 0 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 2 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 15 1 1 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 14 3 0 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 14 3 0 0 0 0 0 0 0
MRI orbits face neck with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 0 1 3 0 0 0 0 0
References Study Quality
40 (19379610) 2
39 (2294574) 4
24 (29685531) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 2 4 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] 2 2 9 1 3 3 0 2 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 7 2 5 1 1 2 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 12 2 2 0 1 0 0 0 0
References Study Quality
26 (25832968) 4
31 (26001236) 4
35 (27554662) 1
36 (28072563) 4
32 (27643765) 4
37 (27193478) 2
2 (26476379) 4
38 (25412986) 2
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 1 0 0 2 0 0 0
SPECT or SPECT/CT paranasal sinuses Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 0 0 1 1 0 0 0
References Study Quality
42 (19401044) 3
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 1 0 0 0 0 0 0
Variant 4: Acute sinusitis with rapid progression or suspected invasive fungal sinusitis. 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 face neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 3 12
References Study Quality
45 (22006778) 2
46 (29774383) 4
5 (28438285) 4
4 (26476380) 4
CT maxillofacial with IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 8 8 0 0 0 0 2 0 6 3 6
References Study Quality
43 (18029900) 4
23 (11889374) 3
5 (28438285) 4
6 (28341385) 4
4 (26476380) 4
44 (25882281) 1
CT maxillofacial without IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 7 7 0 0 0 1 2 1 8 1 4
References Study Quality
43 (18029900) 4
23 (11889374) 3
5 (28438285) 4
6 (28341385) 4
4 (26476380) 4
44 (25882281) 1
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 6 7 3 0 0
References Study Quality
43 (18029900) 4
5 (28438285) 4
6 (28341385) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 1 4 7 4 0 0 0
References Study Quality
43 (18029900) 4
5 (28438285) 4
6 (28341385) 4
MRI orbits face neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 5 5 5 1 1 0
References Study Quality
45 (22006778) 2
46 (29774383) 4
5 (28438285) 4
4 (26476380) 4
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 1 3 9 4 0 0 0
References Study Quality
43 (18029900) 4
23 (11889374) 3
6 (28341385) 4
Radiography paranasal sinuses Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 11 3 1 1 0 1 0 0 0
References Study Quality
47 (28599686) 2
Arteriography craniofacial Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 1 1 1 0 0 2 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 4 1 0 0 1 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 2 1 0 0 1 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 2 2 1 0 1 0 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 0 1 2 0 0 0 0
References Study Quality
43 (18029900) 4
5 (28438285) 4
6 (28341385) 4
MRI orbits face neck with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 0 1 2 0 0 0 0
References Study Quality
45 (22006778) 2
46 (29774383) 4
5 (28438285) 4
4 (26476380) 4
CT cone beam paranasal sinuses without IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv 2 2 8 1 3 2 3 0 0 0 0
References Study Quality
25 (24449524) 3
19 (26700263) 3
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 4 1 0 0 0 0 0
References Study Quality
43 (18029900) 4
23 (11889374) 3
6 (28341385) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 3 2 3 0 0 0 0 0
References Study Quality
43 (18029900) 4
23 (11889374) 3
6 (28341385) 4
CT maxillofacial without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 10 2 2 1 2 0 0 0 0
References Study Quality
43 (18029900) 4
23 (11889374) 3
5 (28438285) 4
6 (28341385) 4
4 (26476380) 4
44 (25882281) 1
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 3 1 0 1 0 0 0 0
SPECT or SPECT/CT paranasal sinuses Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 1 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 15 1 1 0 0 0 0 0 0
Variant 5: Suspected sinonasal mass. 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 face neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 0 16
References Study Quality
24 (29685531) 4
52 (31939885) 1
8 (29696477) 4
9 (29217745) 1
7 (26830408) 4
53 (26359585) 2
CT maxillofacial with IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 7 7 0 0 0 1 1 0 8 1 6
References Study Quality
51 (28391267) 2
7 (26830408) 4
CT maxillofacial without IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 7 7 1 0 1 0 1 4 3 3 4
References Study Quality
51 (28391267) 2
7 (26830408) 4
MRI head without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 1 0 0 1 1 8 4 2 0
MRI head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 2 0 0 5 9 1 0 0 0
MRI orbits face neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 7 6 0 1 0
References Study Quality
24 (29685531) 4
52 (31939885) 1
8 (29696477) 4
9 (29217745) 1
7 (26830408) 4
53 (26359585) 2
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 0 4 10 2 0 0 0
References Study Quality
51 (28391267) 2
Radiography paranasal sinuses Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 14 2 0 0 1 0 0 0 0
References Study Quality
51 (28391267) 2
Arteriography craniofacial Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 1 1 1 0 2 0 0 0
References Study Quality
43 (18029900) 4
48 (17213441) 4
49 (15794546) 4
50 (12487677) 4
MRA head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 0 2 2 1 1 0 0 0
References Study Quality
43 (18029900) 4
48 (17213441) 4
49 (15794546) 4
50 (12487677) 4
MRA head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 0 2 2 1 2 0 0 0
References Study Quality
43 (18029900) 4
48 (17213441) 4
49 (15794546) 4
50 (12487677) 4
MRA head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 1 3 1 1 1 0 0 0
References Study Quality
43 (18029900) 4
48 (17213441) 4
49 (15794546) 4
50 (12487677) 4
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 0 2 0 0 0 1 0
MRI orbits face neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 13 0 1 0 1 1 0 1 0
References Study Quality
24 (29685531) 4
52 (31939885) 1
8 (29696477) 4
9 (29217745) 1
7 (26830408) 4
53 (26359585) 2
CT cone beam paranasal sinuses without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 9 1 2 2 2 0 1 0 0
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 2 1 4 0 1 1 0 0
References Study Quality
51 (28391267) 2
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 1 5 0 0 0 0 0 0
References Study Quality
51 (28391267) 2
CT maxillofacial without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 11 3 0 1 1 1 0 0 0
References Study Quality
51 (28391267) 2
7 (26830408) 4
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 0 1 3 1 2 0 0 0
References Study Quality
43 (18029900) 4
48 (17213441) 4
49 (15794546) 4
50 (12487677) 4
SPECT or SPECT/CT paranasal sinuses Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 3 1 0 0 0 0 0
References Study Quality
7 (26830408) 4
Variant 6: Suspected CSF leak. Initial Imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT maxillofacial without IV contrast Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 1 0 1 0 0 0 4 0 11
References Study Quality
57 (10319986) 3
58 (12087336) 3
12 (27890184) 4
13 (26370330) 4
55 (16145599) 2
61 (9576647) 2
62 (18079188) 4
MRI head without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 4 0 1 4 5 3 0 0 0
References Study Quality
11 (18710972) 4
58 (12087336) 3
64 (31685104) 4
12 (27890184) 4
14 (27738899) 2
13 (26370330) 4
55 (16145599) 2
61 (9576647) 2
63 (19723768) 3
MRI head without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 1 4 5 6 0 1 0
References Study Quality
11 (18710972) 4
58 (12087336) 3
12 (27890184) 4
14 (27738899) 2
13 (26370330) 4
55 (16145599) 2
61 (9576647) 2
63 (19723768) 3
MRI orbits face neck without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 0 1 2 5 3 2 2 0
References Study Quality
11 (18710972) 4
58 (12087336) 3
12 (27890184) 4
14 (27738899) 2
13 (26370330) 4
55 (16145599) 2
61 (9576647) 2
60 (17970620) 2
63 (19723768) 3
65 (19762462) 4
MRI orbits face neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 6 7 3 1 0
References Study Quality
11 (18710972) 4
58 (12087336) 3
12 (27890184) 4
14 (27738899) 2
13 (26370330) 4
55 (16145599) 2
61 (9576647) 2
60 (17970620) 2
63 (19723768) 3
65 (19762462) 4
CT head cisternography May be appropriate Strong ☢☢☢ 1-10 mSv 5 5 0 0 1 1 9 3 2 0 1
References Study Quality
57 (10319986) 3
58 (12087336) 3
12 (27890184) 4
13 (26370330) 4
55 (16145599) 2
56 (2287375) 4
59 (9369519) 2
60 (17970620) 2
DTPA cisternography May be appropriate Limited ☢☢☢ 1-10 mSv 5 5 1 0 1 3 8 4 0 0 0
References Study Quality
58 (12087336) 3
12 (27890184) 4
13 (26370330) 4
SPECT or SPECT/CT paranasal sinuses May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 5 1 0 4 6 1 0 0 0
References Study Quality
13 (26370330) 4
66 (23871275) 4
Radiography paranasal sinuses Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 15 1 0 0 0 1 0 0 0
Arteriography craniofacial Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 1 0 1 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 2 0 1 0 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 2 0 1 0 0 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 2 0 1 0 0 0 0 0
MRI head with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 13 1 0 1 2 0 0 0 0
References Study Quality
58 (12087336) 3
12 (27890184) 4
14 (27738899) 2
13 (26370330) 4
55 (16145599) 2
61 (9576647) 2
63 (19723768) 3
MRI orbits face neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 1 2 1 1 0 0 0 0
References Study Quality
11 (18710972) 4
58 (12087336) 3
12 (27890184) 4
14 (27738899) 2
13 (26370330) 4
55 (16145599) 2
61 (9576647) 2
60 (17970620) 2
63 (19723768) 3
65 (19762462) 4
CT cone beam paranasal sinuses without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 11 1 0 1 2 1 1 0 0
CT maxillofacial with IV contrast Usually not appropriate Strong ☢☢ 0.1-1mSv 1 1 11 2 4 0 0 0 0 0 0
References Study Quality
57 (10319986) 3
58 (12087336) 3
12 (27890184) 4
13 (26370330) 4
55 (16145599) 2
61 (9576647) 2
62 (18079188) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 1 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 15 0 2 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 12 3 2 0 0 0 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 12 1 4 0 0 0 0 0 0
References Study Quality
57 (10319986) 3
58 (12087336) 3
12 (27890184) 4
13 (26370330) 4
55 (16145599) 2
61 (9576647) 2
62 (18079188) 4
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 3 0 0 2 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 15 1 1 0 0 0 0 0 0
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.