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Appropriateness Criteria

Variant 1: Nonpulsatile neck mass(es). Not parotid region or thyroid. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 1 0 0 0 2 1 9 4
References Study Quality
13 (23641590) 3
14 (28891424) 4
19 () 4
35 (18995981) 3
36 (13679283) 3
37 (28438298) 4
28 (27542075) 4
34 (16448927) 3
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 0 1 0 1 3 12
References Study Quality
32 (23449649) 4
20 (25476177) 4
25 (25476176) 4
29 (21493241) 4
27 (24847947) 3
14 (28891424) 4
19 () 4
26 (25978199) 4
31 (25944574) 3
28 (27542075) 4
US neck May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 2 0 3 5 5 2 1
References Study Quality
54 (23562011) 3
58 (24567918) 3
55 (24768485) 3
45 (24434158) 4
56 (23243639) 3
42 (24263756) 3
52 (23453381) 3
57 (23820176) 3
43 (20652889) 2
41 (18390388) 4
46 (15121245) 3
50 (20950927) 3
14 (28891424) 4
44 (27070179) 2
47 (26025577) 2
48 (26256915) 3
49 (24819862) 3
51 (25542937) 3
53 (26617244) 3
MRI neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 0 4 4 4 5 0 0
References Study Quality
13 (23641590) 3
14 (28891424) 4
19 () 4
35 (18995981) 3
36 (13679283) 3
37 (28438298) 4
28 (27542075) 4
34 (16448927) 3
CT neck without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 1 2 2 4 8 0 0 0
References Study Quality
32 (23449649) 4
20 (25476177) 4
25 (25476176) 4
29 (21493241) 4
27 (24847947) 3
14 (28891424) 4
19 () 4
26 (25978199) 4
30 (25630849) 3
31 (25944574) 3
28 (27542075) 4
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 0 0 0 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 1 5 2 0 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 4 2 0 0 0 0 1
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 1 9 1 4 1 0 0 0
References Study Quality
32 (23449649) 4
20 (25476177) 4
25 (25476176) 4
29 (21493241) 4
27 (24847947) 3
14 (28891424) 4
19 () 4
26 (25978199) 4
30 (25630849) 3
31 (25944574) 3
28 (27542075) 4
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 8 0 5 1 2 1 0 0 1
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 8 3 3 1 2 0 1 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 3 4 0 3 0 1 0 0
Variant 2: Pulsatile neck mass(es). Not parotid region or thyroid. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 1 0 2 2 6 4 2
References Study Quality
62 (23928233) 3
MRI neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 3 8 7
References Study Quality
59 (25476181) 4
60 (18339724) 2
61 (25410709) 2
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 0 1 1 1 4 10
References Study Quality
32 (23449649) 4
33 () 4
CTA neck with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 2 0 0 0 0 5 6 5
US neck May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 3 6 3 3 1
References Study Quality
59 (25476181) 4
MRA neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 10 5 0 0 0
References Study Quality
62 (23928233) 3
MRI neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 3 5 6 2 1 0
References Study Quality
59 (25476181) 4
60 (18339724) 2
61 (25410709) 2
CT neck without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 2 2 2 2 7 3 0 0 0
References Study Quality
32 (23449649) 4
33 () 4
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 1 3 5 2 0 0 0 0
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 4 6 3 2 2 0 0 0
References Study Quality
32 (23449649) 4
33 () 4
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 14 1 3 0 0 0 0 0 0
References Study Quality
63 (26637204) 2
65 (26564322) 2
64 (28050631) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 4 0 0 0 0 0 0
References Study Quality
63 (26637204) 2
65 (26564322) 2
64 (28050631) 2
Variant 3: Parotid region mass(es). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US neck Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 4 2 6 3 2
References Study Quality
71 (23238699) 3
89 (24263755) 4
90 (28612315) 3
91 (19862655) 3
92 (25339101) 3
93 (25262550) 3
94 (23625388) 3
77 (19629770) 2
MRI neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 1 1 5 10
References Study Quality
77 (19629770) 2
78 (27093072) 4
74 (18581165) 3
79 (21724574) 2
80 (24948426) 3
81 (28074380) 3
82 (29101981) 4
83 (17502260) 2
84 (18504743) 3
85 (17213436) 3
86 (23703801) 3
87 (19131405) 2
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 1 0 0 0 7 9
References Study Quality
32 (23449649) 4
20 (25476177) 4
74 (18581165) 3
73 (25476182) 4
75 (17399933) 2
76 (17414771) 3
Fluoroscopy sialography parotid May be appropriate (Disagreement) Expert Opinion Varies Varies 5 5 2 1 1 6 5 2 1 0 0
MRI neck with parotid sialography without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 2 7 5 1 0
References Study Quality
88 (18478832) 3
MRI neck with parotid sialography without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 3 5 7 1 0 1
References Study Quality
88 (18478832) 3
MRI neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 0 5 7 5 0 0
References Study Quality
77 (19629770) 2
78 (27093072) 4
74 (18581165) 3
79 (21724574) 2
80 (24948426) 3
81 (28074380) 3
82 (29101981) 4
83 (17502260) 2
84 (18504743) 3
85 (17213436) 3
86 (23703801) 3
87 (19131405) 2
CT neck without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 2 0 2 11 0 2 0 0
References Study Quality
32 (23449649) 4
20 (25476177) 4
74 (18581165) 3
73 (25476182) 4
75 (17399933) 2
76 (17414771) 3
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 1 0 0 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 7 2 0 2 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 6 2 0 3 0 0 0 1
CT neck with parotid sialography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 3 3 5 2 5 2 2 0 2 0 0
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 2 9 0 5 0 1 0 0
References Study Quality
32 (23449649) 4
20 (25476177) 4
74 (18581165) 3
73 (25476182) 4
75 (17399933) 2
76 (17414771) 3
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 3 6 1 0 0 1 0 0
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 9 3 2 3 1 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 2 5 2 1 0 0 0 0
Variant 4: Child. Neck mass(es). Not parotid region or thyroid. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US neck Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 1 0 0 0 2 4 3 8
References Study Quality
102 (18830710) 3
103 (18455551) 4
104 (15645426) 3
105 (24485972) 3
101 (25476180) 4
59 (25476181) 4
41 (18390388) 4
MRI neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 1 0 0 0 0 5 5 6
References Study Quality
96 (25171800) 3
29 (21493241) 4
21 (24249813) 3
97 (8456703) 4
98 (10658158) 4
99 (24147487) 4
100 (10701595) 4
MRI neck without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 2 2 2 9 1 2
References Study Quality
96 (25171800) 3
29 (21493241) 4
21 (24249813) 3
97 (8456703) 4
98 (10658158) 4
99 (24147487) 4
100 (10701595) 4
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 1 0 1 1 1 4 3 7
References Study Quality
32 (23449649) 4
20 (25476177) 4
96 (25171800) 3
29 (21493241) 4
21 (24249813) 3
33 () 4
CT neck without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 3 0 1 3 2 7 2 0 0
References Study Quality
32 (23449649) 4
20 (25476177) 4
96 (25171800) 3
29 (21493241) 4
21 (24249813) 3
33 () 4
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 0 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 1 6 4 1 1 0 0 0
References Study Quality
59 (25476181) 4
MRA neck without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 2 6 4 0 1 0 0 0
References Study Quality
59 (25476181) 4
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 3 6 1 0 0 0 1 0
References Study Quality
32 (23449649) 4
20 (25476177) 4
96 (25171800) 3
29 (21493241) 4
21 (24249813) 3
33 () 4
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 5 2 0 3 0 0 0 1
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 2 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 14 1 2 1 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.