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Appropriateness Criteria

Variant 1: Anosmia or other abnormalities of the sense of smell (olfactory nerve, CN I). 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 2 0 1 4 13
References Study Quality
49 (20472036) 3
39 (25712545) 2
41 (29269404) 2
55 (29324366) 2
54 (25977168) 2
29 (23775878) 4
4 (29088516) 4
50 (21330398) 2
51 (22730050) 2
52 (23376116) 2
53 (24051351) 2
56 (33132007) 4
MRI head without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 7 4 4 0 0 3 2 0 0
MRI orbits face neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 1 5 11 2 0 0
References Study Quality
49 (20472036) 3
39 (25712545) 2
41 (29269404) 2
55 (29324366) 2
54 (25977168) 2
29 (23775878) 4
4 (29088516) 4
50 (21330398) 2
51 (22730050) 2
52 (23376116) 2
53 (24051351) 2
56 (33132007) 4
CT maxillofacial with IV contrast May be appropriate Strong ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 1 4 3 11 1 0 0
References Study Quality
39 (25712545) 2
41 (29269404) 2
40 (26743838) 2
31 (24402746) 2
29 (23775878) 4
4 (29088516) 4
CT maxillofacial without IV contrast May be appropriate Strong ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 0 4 6 8 1 1 0
References Study Quality
39 (25712545) 2
41 (29269404) 2
40 (26743838) 2
31 (24402746) 2
29 (23775878) 4
4 (29088516) 4
US neck Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 1 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 17 1 0 0 0 1 0 0 1
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 1 0 0 0 1 0 0 1
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 1 0 1 0 0 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 4 0 2 0 1 0 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 3 4 1 3 1 0 0 0
MRI orbits face neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 3 6 0 0 0 0 0 0
References Study Quality
49 (20472036) 3
39 (25712545) 2
41 (29269404) 2
55 (29324366) 2
54 (25977168) 2
29 (23775878) 4
4 (29088516) 4
50 (21330398) 2
51 (22730050) 2
52 (23376116) 2
53 (24051351) 2
56 (33132007) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 10 2 4 1 2 1 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 4 0 0 2 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 9 9 1 0 1 0 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 1 3 0 0 0 0 0 0
References Study Quality
39 (25712545) 2
41 (29269404) 2
40 (26743838) 2
31 (24402746) 2
29 (23775878) 4
4 (29088516) 4
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 2 1 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 18 2 0 0 0 0 0 0 0
References Study Quality
42 (20709038) 3
48 (30409849) 1
47 (29602198) 2
46 (28734065) 2
45 (28671131) 2
43 (27289103) 2
44 (27421303) 2
Variant 2: Unilateral isolated weakness of the mastication muscles, paralysis of the mastication muscles, sensory abnormalities of the face and head, facial numbness, or trigeminal neuralgia (trigeminal nerve, CN V). 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] 7 7 2 0 0 0 2 1 8 0 7
References Study Quality
69 (21346659) 2
73 (25541189) 2
71 (23022639) 2
72 (23098388) 2
82 (16436823) 4
68 (21062923) 2
70 (22405984) 4
86 (24390084) 2
87 (26406792) 2
75 (29425330) 2
93 (30117773) 2
23 (30139749) 2
91 (29397449) 2
90 (29305127) 2
96 (29105886) 2
74 (29388798) 2
89 (28702348) 2
97 (29931400) 2
76 (29476993) 2
92 (29410338) 2
77 (28481804) 4
94 (26899433) 2
95 (27779254) 2
98 (26795500) 2
88 (26733127) 2
81 (26476278) 2
78 (26519891) 2
80 (25442253) 2
85 (25008460) 2
79 (24745706) 2
83 (24210310) 4
84 (31537003) 2
MRI orbits face neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 2 1 3 0 13
References Study Quality
69 (21346659) 2
73 (25541189) 2
71 (23022639) 2
72 (23098388) 2
82 (16436823) 4
68 (21062923) 2
70 (22405984) 4
86 (24390084) 2
87 (26406792) 2
75 (29425330) 2
93 (30117773) 2
23 (30139749) 2
91 (29397449) 2
90 (29305127) 2
96 (29105886) 2
74 (29388798) 2
89 (28702348) 2
97 (29931400) 2
76 (29476993) 2
92 (29410338) 2
77 (28481804) 4
94 (26899433) 2
95 (27779254) 2
98 (26795500) 2
88 (26733127) 2
81 (26476278) 2
78 (26519891) 2
80 (25442253) 2
85 (25008460) 2
79 (24745706) 2
83 (24210310) 4
84 (31537003) 2
MRA head with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 4 1 3 1 10 1 0 0 0
References Study Quality
69 (21346659) 2
73 (25541189) 2
71 (23022639) 2
72 (23098388) 2
76 (29476993) 2
MRA head without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 4 2 1 2 10 1 0 0 0
References Study Quality
69 (21346659) 2
73 (25541189) 2
71 (23022639) 2
72 (23098388) 2
76 (29476993) 2
MRA head without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 4 2 1 2 10 1 0 0 0
References Study Quality
69 (21346659) 2
73 (25541189) 2
71 (23022639) 2
72 (23098388) 2
76 (29476993) 2
MRI head without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 2 0 1 8 6 2 0 0
References Study Quality
69 (21346659) 2
73 (25541189) 2
71 (23022639) 2
72 (23098388) 2
82 (16436823) 4
68 (21062923) 2
70 (22405984) 4
86 (24390084) 2
87 (26406792) 2
75 (29425330) 2
93 (30117773) 2
23 (30139749) 2
91 (29397449) 2
90 (29305127) 2
96 (29105886) 2
74 (29388798) 2
89 (28702348) 2
97 (29931400) 2
76 (29476993) 2
92 (29410338) 2
77 (28481804) 4
94 (26899433) 2
95 (27779254) 2
98 (26795500) 2
88 (26733127) 2
81 (26476278) 2
78 (26519891) 2
80 (25442253) 2
85 (25008460) 2
79 (24745706) 2
83 (24210310) 4
84 (31537003) 2
MRI orbits face neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 1 4 4 7 2 0 1
References Study Quality
69 (21346659) 2
73 (25541189) 2
71 (23022639) 2
72 (23098388) 2
82 (16436823) 4
68 (21062923) 2
70 (22405984) 4
86 (24390084) 2
87 (26406792) 2
75 (29425330) 2
93 (30117773) 2
23 (30139749) 2
91 (29397449) 2
90 (29305127) 2
96 (29105886) 2
74 (29388798) 2
89 (28702348) 2
97 (29931400) 2
76 (29476993) 2
92 (29410338) 2
77 (28481804) 4
94 (26899433) 2
95 (27779254) 2
98 (26795500) 2
88 (26733127) 2
81 (26476278) 2
78 (26519891) 2
80 (25442253) 2
85 (25008460) 2
79 (24745706) 2
83 (24210310) 4
84 (31537003) 2
CT maxillofacial with IV contrast May be appropriate Strong ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 0 3 11 6 0 0 0
References Study Quality
66 (27890182) 4
67 (21538196) 2
64 (14736668) 4
65 (17576903) 2
CT maxillofacial without IV contrast May be appropriate Strong ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 0 5 11 3 0 0 0
References Study Quality
66 (27890182) 4
67 (21538196) 2
64 (14736668) 4
65 (17576903) 2
US neck Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 0 0 0 1 0 0 0 0
MRI head with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 9 5 2 1 1 1 0 0 1
References Study Quality
69 (21346659) 2
73 (25541189) 2
71 (23022639) 2
72 (23098388) 2
82 (16436823) 4
68 (21062923) 2
70 (22405984) 4
86 (24390084) 2
87 (26406792) 2
75 (29425330) 2
93 (30117773) 2
23 (30139749) 2
91 (29397449) 2
90 (29305127) 2
96 (29105886) 2
74 (29388798) 2
89 (28702348) 2
97 (29931400) 2
76 (29476993) 2
92 (29410338) 2
77 (28481804) 4
94 (26899433) 2
95 (27779254) 2
98 (26795500) 2
88 (26733127) 2
81 (26476278) 2
78 (26519891) 2
80 (25442253) 2
85 (25008460) 2
79 (24745706) 2
83 (24210310) 4
84 (31537003) 2
MRI orbits face neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 10 5 1 1 2 0 0 0 1
References Study Quality
69 (21346659) 2
73 (25541189) 2
71 (23022639) 2
72 (23098388) 2
82 (16436823) 4
68 (21062923) 2
70 (22405984) 4
86 (24390084) 2
87 (26406792) 2
75 (29425330) 2
93 (30117773) 2
23 (30139749) 2
91 (29397449) 2
90 (29305127) 2
96 (29105886) 2
74 (29388798) 2
89 (28702348) 2
97 (29931400) 2
76 (29476993) 2
92 (29410338) 2
77 (28481804) 4
94 (26899433) 2
95 (27779254) 2
98 (26795500) 2
88 (26733127) 2
81 (26476278) 2
78 (26519891) 2
80 (25442253) 2
85 (25008460) 2
79 (24745706) 2
83 (24210310) 4
84 (31537003) 2
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 10 3 5 1 1 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 13 4 1 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 3 5 2 1 0 1 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 2 1 1 3 0 0 0 0
References Study Quality
66 (27890182) 4
67 (21538196) 2
64 (14736668) 4
65 (17576903) 2
CTA head with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 8 2 4 2 2 1 1 0 0
References Study Quality
69 (21346659) 2
73 (25541189) 2
71 (23022639) 2
72 (23098388) 2
68 (21062923) 2
70 (22405984) 4
75 (29425330) 2
23 (30139749) 2
74 (29388798) 2
76 (29476993) 2
77 (28481804) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 19 0 1 0 0 0 0 0 0
Variant 3: Unilateral isolated weakness of the facial expression, paralysis of the facial expression, hemifacial spasm, or Bell palsy (facial nerve, CN VII). 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] 9 9 0 0 0 0 0 2 3 4 11
References Study Quality
121 (22784861) 3
106 (24518410) 4
118 (11960404) 2
119 (14699179) 2
111 (19546177) 4
110 (25795466) 2
123 (9576658) 2
104 (30717625) 2
115 (30139756) 4
128 (29490547) 4
20 (29927823) 2
130 (29633003) 2
76 (29476993) 2
122 (29135869) 2
107 (28826862) 2
114 (28696161) 2
127 (27625239) 2
126 (26905823) 2
129 (26449562) 2
78 (26519891) 2
101 (25430858) 2
100 (25044001) 2
113 (24758667) 2
124 (20645285) 2
19 (23578676) 2
112 (22207300) 2
7 (18596507) 4
125 (26178307) 2
65 (17576903) 2
102 (24431233) 4
116 (31624121) 4
117 (2114760) 4
120 (18618345) 2
MRI orbits face neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 2 0 0 1 1 1 3 12
References Study Quality
121 (22784861) 3
106 (24518410) 4
118 (11960404) 2
119 (14699179) 2
111 (19546177) 4
110 (25795466) 2
123 (9576658) 2
104 (30717625) 2
115 (30139756) 4
128 (29490547) 4
20 (29927823) 2
130 (29633003) 2
76 (29476993) 2
122 (29135869) 2
107 (28826862) 2
114 (28696161) 2
127 (27625239) 2
126 (26905823) 2
129 (26449562) 2
78 (26519891) 2
101 (25430858) 2
100 (25044001) 2
113 (24758667) 2
124 (20645285) 2
19 (23578676) 2
112 (22207300) 2
7 (18596507) 4
125 (26178307) 2
65 (17576903) 2
102 (24431233) 4
116 (31624121) 4
117 (2114760) 4
120 (18618345) 2
MRA head with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 4 0 1 4 10 1 0 0 0
References Study Quality
110 (25795466) 2
103 (30446207) 2
76 (29476993) 2
109 (27178237) 2
102 (24431233) 4
MRA head without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 4 1 1 4 9 1 0 0 0
References Study Quality
110 (25795466) 2
103 (30446207) 2
76 (29476993) 2
109 (27178237) 2
102 (24431233) 4
MRA head without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 0 1 5 8 3 0 0 0
References Study Quality
110 (25795466) 2
103 (30446207) 2
76 (29476993) 2
109 (27178237) 2
102 (24431233) 4
MRI head without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 0 8 5 5 1 0
References Study Quality
121 (22784861) 3
106 (24518410) 4
118 (11960404) 2
119 (14699179) 2
111 (19546177) 4
110 (25795466) 2
123 (9576658) 2
104 (30717625) 2
115 (30139756) 4
128 (29490547) 4
20 (29927823) 2
130 (29633003) 2
76 (29476993) 2
122 (29135869) 2
107 (28826862) 2
114 (28696161) 2
127 (27625239) 2
126 (26905823) 2
129 (26449562) 2
78 (26519891) 2
101 (25430858) 2
100 (25044001) 2
113 (24758667) 2
124 (20645285) 2
19 (23578676) 2
112 (22207300) 2
7 (18596507) 4
125 (26178307) 2
65 (17576903) 2
102 (24431233) 4
116 (31624121) 4
117 (2114760) 4
120 (18618345) 2
MRI orbits face neck without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 1 0 3 7 7 0 0 0
References Study Quality
121 (22784861) 3
106 (24518410) 4
118 (11960404) 2
119 (14699179) 2
111 (19546177) 4
110 (25795466) 2
123 (9576658) 2
104 (30717625) 2
115 (30139756) 4
128 (29490547) 4
20 (29927823) 2
130 (29633003) 2
76 (29476993) 2
122 (29135869) 2
107 (28826862) 2
114 (28696161) 2
127 (27625239) 2
126 (26905823) 2
129 (26449562) 2
78 (26519891) 2
101 (25430858) 2
100 (25044001) 2
113 (24758667) 2
124 (20645285) 2
19 (23578676) 2
112 (22207300) 2
7 (18596507) 4
125 (26178307) 2
65 (17576903) 2
102 (24431233) 4
116 (31624121) 4
117 (2114760) 4
120 (18618345) 2
CT maxillofacial with IV contrast May be appropriate Strong ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 0 7 10 2 0 0 0
References Study Quality
106 (24518410) 4
107 (28826862) 2
2 (24210311) 4
99 (26001250) 4
105 (24081792) 2
108 (29258690) 4
CT maxillofacial without IV contrast May be appropriate Strong ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 1 0 3 7 7 2 0 0 0
References Study Quality
106 (24518410) 4
107 (28826862) 2
2 (24210311) 4
99 (26001250) 4
105 (24081792) 2
108 (29258690) 4
CT temporal bone with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv 5 5 0 0 1 2 9 7 1 0 0
References Study Quality
106 (24518410) 4
107 (28826862) 2
2 (24210311) 4
99 (26001250) 4
105 (24081792) 2
108 (29258690) 4
CT temporal bone without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv 6 6 1 0 1 0 4 7 3 1 3
References Study Quality
106 (24518410) 4
107 (28826862) 2
2 (24210311) 4
99 (26001250) 4
105 (24081792) 2
108 (29258690) 4
US neck Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 1 0 0 0 0 0 0 0
MRI head with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 9 6 2 1 1 0 0 0 1
References Study Quality
121 (22784861) 3
106 (24518410) 4
118 (11960404) 2
119 (14699179) 2
111 (19546177) 4
110 (25795466) 2
123 (9576658) 2
104 (30717625) 2
115 (30139756) 4
128 (29490547) 4
20 (29927823) 2
130 (29633003) 2
76 (29476993) 2
122 (29135869) 2
107 (28826862) 2
114 (28696161) 2
127 (27625239) 2
126 (26905823) 2
129 (26449562) 2
78 (26519891) 2
101 (25430858) 2
100 (25044001) 2
113 (24758667) 2
124 (20645285) 2
19 (23578676) 2
112 (22207300) 2
7 (18596507) 4
125 (26178307) 2
65 (17576903) 2
102 (24431233) 4
116 (31624121) 4
117 (2114760) 4
120 (18618345) 2
MRI orbits face neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 10 6 3 0 0 0 0 0 1
References Study Quality
121 (22784861) 3
106 (24518410) 4
118 (11960404) 2
119 (14699179) 2
111 (19546177) 4
110 (25795466) 2
123 (9576658) 2
104 (30717625) 2
115 (30139756) 4
128 (29490547) 4
20 (29927823) 2
130 (29633003) 2
76 (29476993) 2
122 (29135869) 2
107 (28826862) 2
114 (28696161) 2
127 (27625239) 2
126 (26905823) 2
129 (26449562) 2
78 (26519891) 2
101 (25430858) 2
100 (25044001) 2
113 (24758667) 2
124 (20645285) 2
19 (23578676) 2
112 (22207300) 2
7 (18596507) 4
125 (26178307) 2
65 (17576903) 2
102 (24431233) 4
116 (31624121) 4
117 (2114760) 4
120 (18618345) 2
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 3 0 1 1 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 2 0 0 2 1 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 0 0 4 2 0 1 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 3 2 2 1 0 0 0 0
References Study Quality
106 (24518410) 4
107 (28826862) 2
2 (24210311) 4
99 (26001250) 4
105 (24081792) 2
108 (29258690) 4
CT temporal bone without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 13 2 0 1 2 1 1 0 0
References Study Quality
106 (24518410) 4
107 (28826862) 2
2 (24210311) 4
99 (26001250) 4
105 (24081792) 2
108 (29258690) 4
CTA head with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 4 2 0 2 0 1 0 0
References Study Quality
103 (30446207) 2
109 (27178237) 2
102 (24431233) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 18 2 0 0 0 0 0 0 0
Variant 4: Multiple different middle cranial nerve palsies (CN V-VII). 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] 9 9 0 0 0 0 1 0 3 4 12
References Study Quality
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
MRI orbits face neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 1 0 0 0 2 2 4 11
References Study Quality
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
MRI head without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 0 7 7 4 1 0
References Study Quality
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
MRI orbits face neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 2 0 0 1 9 7 1 0 0
References Study Quality
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
CT head without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 1 0 3 12 2 0 1 0
US neck Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 2 0 0 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 4 0 1 2 0 0 0 1
References Study Quality
131 (31283463) 4
132 (16286545) 4
135 (20483390) 4
MRA head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 4 0 1 2 0 0 0 1
References Study Quality
131 (31283463) 4
132 (16286545) 4
135 (20483390) 4
MRA head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 1 2 2 0 1 0 0
References Study Quality
131 (31283463) 4
132 (16286545) 4
135 (20483390) 4
MRI head with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 15 4 1 0 0 0 0 0 0
References Study Quality
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
MRI orbits face neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 4 1 0 1 1 1 0 0
References Study Quality
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
CT maxillofacial with IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 7 2 4 1 5 1 0 0 0
References Study Quality
134 (24216451) 4
CT maxillofacial without IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 3 4 1 2 1 0 1 0
References Study Quality
134 (24216451) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 10 3 3 0 4 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 13 2 2 0 2 0 1 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 2 1 0 2 1 1 0 0
References Study Quality
134 (24216451) 4
CT neck with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 6 3 3 1 6 1 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 1 2 4 0 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
CT neck without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 10 3 5 2 0 0 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
CT temporal bone with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 8 4 4 2 2 0 0 0 0
References Study Quality
134 (24216451) 4
CT temporal bone without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 14 2 2 1 1 0 0 0 0
References Study Quality
134 (24216451) 4
CT temporal bone without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 7 3 5 3 2 0 0 0 0
References Study Quality
134 (24216451) 4
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 10 2 3 2 2 1 0 0 0
References Study Quality
131 (31283463) 4
132 (16286545) 4
135 (20483390) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 3 0 0 0 0 1 0 0
Variant 5: Oropharyngeal neurogenic dysphagia or oropharyngeal pain (glossopharyngeal nerve, CN IX). 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 1 0 0 0 2 3 3 4 7
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
2 (24210311) 4
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 2 2 1 4 11
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
2 (24210311) 4
MRI head without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 2 6 7 4 0 0
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
2 (24210311) 4
MRI orbits face neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 2 0 0 2 7 7 2 0 0
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
2 (24210311) 4
CT neck with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 2 0 0 0 7 3 2 3 3
References Study Quality
142 (25917666) 4
148 (25769354) 4
144 (6308990) 4
145 (10871029) 4
146 (14736665) 4
147 (19568338) 4
US neck Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 1 0 0 1 0 0 0 0
MRA head and neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 3 3 2 1 0 0 0 0
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
143 (28263933) 2
MRA head and neck without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 3 4 1 1 0 0 0 0
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
143 (28263933) 2
MRA head and neck without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 7 1 7 1 2 1 1 0 0
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
143 (28263933) 2
MRI head with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 3 1 2 1 0 0 0 1
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
2 (24210311) 4
MRI orbits face neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 13 3 1 1 1 1 0 0 0
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
2 (24210311) 4
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 0 1 1 2 0 0 0
CT maxillofacial without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 2 2 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 14 1 1 2 0 1 0 0 1
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 1 0 1 1 0 0 1
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 2 1 1 0 1 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 2 0 1 1 0 0 0
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 0 4 1 1 0 0 1
References Study Quality
142 (25917666) 4
148 (25769354) 4
144 (6308990) 4
145 (10871029) 4
146 (14736665) 4
147 (19568338) 4
CT neck without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 3 2 7 3 3 2 0 0 0
References Study Quality
142 (25917666) 4
148 (25769354) 4
144 (6308990) 4
145 (10871029) 4
146 (14736665) 4
147 (19568338) 4
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 2 2 0 0 1 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 2 2 0 0 1 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 3 2 0 1 0 0 0 0
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 10 3 2 1 2 1 0 0 1
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 4 0 0 0 0 0 0 0
Variant 6: Unilateral isolated palatal or vocal cord paralysis or both (vagal nerve, CN X). 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] 7 7 0 1 1 0 2 4 3 3 6
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
83 (24210310) 4
MRI orbits face neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 1 4 7 8
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
83 (24210310) 4
CT neck with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 0 1 0 3 3 4 9
References Study Quality
156 (27670956) 4
153 (16301111) 3
155 (27601300) 2
162 (27085701) 2
160 (25518905) 4
163 (31485732) 4
131 (31283463) 4
152 (22582356) 4
157 (29785934) 4
159 (22965930) 4
161 (26156423) 4
MRI head without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 0 4 10 4 1 0 0
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
83 (24210310) 4
MRI orbits face neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 7 7 4 0 1
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
83 (24210310) 4
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 9 8 0 1 1
References Study Quality
158 (23479100) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 1 1 8 7 2 0 0 0
References Study Quality
158 (23479100) 4
CT neck without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 2 0 0 5 9 3 1 0 0
References Study Quality
156 (27670956) 4
153 (16301111) 3
155 (27601300) 2
162 (27085701) 2
160 (25518905) 4
163 (31485732) 4
131 (31283463) 4
152 (22582356) 4
157 (29785934) 4
159 (22965930) 4
161 (26156423) 4
US neck Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 7 2 0 0 0 0 0 0
References Study Quality
174 (30577987) 2
173 (30460501) 4
172 (30353405) 4
171 (29678501) 2
170 (27871685) 2
158 (23479100) 4
157 (29785934) 4
169 (2863145) 4
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 12 3 3 1 1 0 0 0 0
References Study Quality
158 (23479100) 4
168 (21786449) 4
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 3 2 0 0 0 1 0 1
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 3 2 0 0 0 1 0 1
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 3 2 0 1 1 0 0 0
MRI head with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 4 1 2 2 0 0 0 0
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
83 (24210310) 4
MRI orbits face neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 13 2 3 0 1 1 0 0 0
References Study Quality
24 (18832666) 3
150 (21567138) 3
149 (19199448) 3
151 (30102011) 4
143 (28263933) 2
83 (24210310) 4
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 3 1 1 1 1 0 1 0
CT maxillofacial without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 3 0 1 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 3 1 2 0 0 0 0 0
References Study Quality
158 (23479100) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 2 2 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 14 2 0 2 2 0 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 1 3 0 0 1 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 2 1 1 1 0 0 0
CT neck without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 5 1 1 0 0 0 0 1
References Study Quality
156 (27670956) 4
153 (16301111) 3
155 (27601300) 2
162 (27085701) 2
160 (25518905) 4
163 (31485732) 4
131 (31283463) 4
152 (22582356) 4
157 (29785934) 4
159 (22965930) 4
161 (26156423) 4
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 1 0 3 0 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 1 0 3 0 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 2 1 2 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 12 1 2 2 2 0 0 0 1
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 2 1 0 0 1 0 0 0
References Study Quality
165 (11348849) 4
166 (12091675) 3
167 (28636732) 1
164 (24491410) 4
152 (22582356) 4
Variant 7: Unilateral isolated weakness or paralysis of the sternocleidomastoid and trapezius muscles (accessory nerve, CN XI). 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 1 0 0 1 3 4 5 6
References Study Quality
24 (18832666) 3
149 (19199448) 3
2 (24210311) 4
131 (31283463) 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 5 13
References Study Quality
24 (18832666) 3
149 (19199448) 3
176 (26787069) 4
2 (24210311) 4
131 (31283463) 4
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 0 1 1 1 7 4 6
References Study Quality
2 (24210311) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 12 5 1 0 0
References Study Quality
24 (18832666) 3
149 (19199448) 3
2 (24210311) 4
131 (31283463) 4
MRI orbits face neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 3 4 5 5 2 0
References Study Quality
24 (18832666) 3
149 (19199448) 3
176 (26787069) 4
2 (24210311) 4
131 (31283463) 4
CT neck without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 1 2 11 6 0 0 0
References Study Quality
2 (24210311) 4
US neck Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 4 5 0 0 0 0 0 0
References Study Quality
180 (30216471) 4
179 (26543166) 4
178 (22261590) 4
177 (21596503) 4
MRA head and neck 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 1
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 2 1 0 1 0 0 0 1
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 2 1 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] 1 1 15 2 0 0 2 0 1 0 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 4 1 3 0 0 0 0 0
References Study Quality
24 (18832666) 3
149 (19199448) 3
2 (24210311) 4
131 (31283463) 4
MRI orbits face neck with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 5 1 2 0 0 0 0 0
References Study Quality
24 (18832666) 3
149 (19199448) 3
176 (26787069) 4
2 (24210311) 4
131 (31283463) 4
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 2 0 1 1 1 0 0 0
CT maxillofacial without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 2 0 2 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 14 1 3 0 0 2 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 1 0 2 1 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 1 1 1 1 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 2 0 0 2 1 0 0 0
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 4 1 0 0 0 0 0 0
References Study Quality
2 (24210311) 4
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 2 2 0 1 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 1 1 1 1 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 1 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 15 2 0 1 2 0 0 0 0
Variant 8: Unilateral isolated weakness or paralysis of the tongue (hypoglossal nerve, CN XII). 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] 7 7 0 0 0 0 4 1 6 3 6
References Study Quality
24 (18832666) 3
181 (12066914) 3
187 (30648931) 4
183 (25043533) 2
5 (24210309) 4
13 (28109859) 4
186 (23192210) 4
188 (9282872) 4
189 (18065504) 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 1 1 1 5 12
References Study Quality
24 (18832666) 3
181 (12066914) 3
187 (30648931) 4
183 (25043533) 2
5 (24210309) 4
13 (28109859) 4
186 (23192210) 4
188 (9282872) 4
189 (18065504) 4
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 1 1 2 1 4 4 7
References Study Quality
181 (12066914) 3
183 (25043533) 2
5 (24210309) 4
13 (28109859) 4
189 (18065504) 4
MRA head and neck with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 2 0 2 4 9 2 1 0 0
References Study Quality
192 (19770343) 4
190 (24458034) 3
191 (18635617) 2
MRA head and neck without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 2 0 2 5 9 2 0 0 0
References Study Quality
192 (19770343) 4
190 (24458034) 3
191 (18635617) 2
MRA head and neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 2 0 2 4 11 1 0 0 0
References Study Quality
192 (19770343) 4
190 (24458034) 3
191 (18635617) 2
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 4 5 6 4 0 0
References Study Quality
24 (18832666) 3
181 (12066914) 3
187 (30648931) 4
183 (25043533) 2
5 (24210309) 4
13 (28109859) 4
186 (23192210) 4
188 (9282872) 4
189 (18065504) 4
MRI orbits face neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 2 7 3 6 1 0
References Study Quality
24 (18832666) 3
181 (12066914) 3
187 (30648931) 4
183 (25043533) 2
5 (24210309) 4
13 (28109859) 4
186 (23192210) 4
188 (9282872) 4
189 (18065504) 4
CT neck without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 0 3 11 4 1 0 0
References Study Quality
181 (12066914) 3
183 (25043533) 2
5 (24210309) 4
13 (28109859) 4
189 (18065504) 4
CTA head and neck with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 2 10 5 1 0 0
References Study Quality
192 (19770343) 4
190 (24458034) 3
191 (18635617) 2
US neck Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 3 0 0 1 1 1 0 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 10 3 2 2 3 0 0 0 0
References Study Quality
24 (18832666) 3
181 (12066914) 3
187 (30648931) 4
183 (25043533) 2
5 (24210309) 4
13 (28109859) 4
186 (23192210) 4
188 (9282872) 4
189 (18065504) 4
MRI orbits face neck with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 2 3 0 2 0 0 0 0
References Study Quality
24 (18832666) 3
181 (12066914) 3
187 (30648931) 4
183 (25043533) 2
5 (24210309) 4
13 (28109859) 4
186 (23192210) 4
188 (9282872) 4
189 (18065504) 4
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 3 1 1 0 1 1 0 0
CT maxillofacial without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 2 2 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 14 2 1 1 1 1 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 3 0 0 2 1 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 2 0 2 0 0 1 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 1 2 0 1 0 0 0
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 5 0 1 0 0 0 0 0
References Study Quality
181 (12066914) 3
183 (25043533) 2
5 (24210309) 4
13 (28109859) 4
189 (18065504) 4
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 2 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 16 2 0 1 1 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 3 1 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 16 3 0 0 1 0 0 0 0
Variant 9: Multiple different lower cranial nerve palsies or combined lower cranial nerve syndromes (CN IX-XII). 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 3 3 3 2 9
References Study Quality
24 (18832666) 3
149 (19199448) 3
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
194 (27324575) 1
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 1 1 3 5 10
References Study Quality
24 (18832666) 3
149 (19199448) 3
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
194 (27324575) 1
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 0 2 3 2 2 5 6
References Study Quality
148 (25769354) 4
144 (6308990) 4
145 (10871029) 4
146 (14736665) 4
147 (19568338) 4
MRA head and neck with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 2 1 13 2 1 0 0
References Study Quality
187 (30648931) 4
132 (16286545) 4
186 (23192210) 4
188 (9282872) 4
MRA head and neck without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 1 2 13 3 0 0 0
References Study Quality
187 (30648931) 4
132 (16286545) 4
186 (23192210) 4
188 (9282872) 4
MRA head and neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 1 4 11 2 0 0 0
References Study Quality
187 (30648931) 4
132 (16286545) 4
186 (23192210) 4
188 (9282872) 4
MRI head without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 10 5 2 0 0
References Study Quality
24 (18832666) 3
149 (19199448) 3
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
194 (27324575) 1
MRI orbits face neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 0 2 9 7 1 0 0
References Study Quality
24 (18832666) 3
149 (19199448) 3
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
194 (27324575) 1
CT neck without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 2 0 3 3 9 2 1 0 0
References Study Quality
148 (25769354) 4
144 (6308990) 4
145 (10871029) 4
146 (14736665) 4
147 (19568338) 4
CTA head and neck with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 12 4 1 0 0
References Study Quality
192 (19770343) 4
190 (24458034) 3
191 (18635617) 2
132 (16286545) 4
US neck Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 1 1 1 0 0 0
MRI head with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 3 4 1 0 0 0 0 1
References Study Quality
24 (18832666) 3
149 (19199448) 3
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
194 (27324575) 1
MRI orbits face neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 2 4 0 0 1 1 0 0
References Study Quality
24 (18832666) 3
149 (19199448) 3
2 (24210311) 4
83 (24210310) 4
136 (20383633) 4
131 (31283463) 4
134 (24216451) 4
137 (21376629) 2
138 (28413710) 2
194 (27324575) 1
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 1 1 1 1 0 0 0
CT maxillofacial without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 4 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 14 2 0 1 2 1 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 1 0 2 0 1 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 0 2 1 0 0 1 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 0 1 2 1 0 0 0
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 4 1 0 0 0 0 0 0
References Study Quality
148 (25769354) 4
144 (6308990) 4
145 (10871029) 4
146 (14736665) 4
147 (19568338) 4
CT temporal bone with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 1 2 0 1 0 0 0 0
CT temporal bone without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 1 1 0 2 0 0 0 0
CT temporal bone without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 1 1 3 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 2 1 0 0 0 0 0
Variant 10: Head and neck cancer. Suspected or known perineural spread of tumor. 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] 9 9 0 1 0 0 2 0 3 4 10
References Study Quality
123 (9576658) 2
104 (30717625) 2
130 (29633003) 2
124 (20645285) 2
125 (26178307) 2
164 (24491410) 4
65 (17576903) 2
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 1 0 4 15
References Study Quality
123 (9576658) 2
104 (30717625) 2
130 (29633003) 2
124 (20645285) 2
125 (26178307) 2
164 (24491410) 4
65 (17576903) 2
MRI head without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 1 6 8 4 0 0 0
References Study Quality
123 (9576658) 2
104 (30717625) 2
130 (29633003) 2
124 (20645285) 2
125 (26178307) 2
164 (24491410) 4
65 (17576903) 2
MRI orbits face neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 1 0 5 8 5 0 0 0
References Study Quality
123 (9576658) 2
104 (30717625) 2
130 (29633003) 2
124 (20645285) 2
125 (26178307) 2
164 (24491410) 4
65 (17576903) 2
CT maxillofacial with IV contrast May be appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 2 0 1 5 7 5 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
CT neck with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 1 0 0 1 8 9 1 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
65 (17576903) 2
US neck Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 5 0 0 0 0 0 0 0
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 4 1 0 0 0 1 0 1
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 4 0 0 1 0 1 0 1
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 4 1 0 0 1 0 0 0
MRI head with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 13 2 2 0 2 1 0 0 0
References Study Quality
123 (9576658) 2
104 (30717625) 2
130 (29633003) 2
124 (20645285) 2
125 (26178307) 2
164 (24491410) 4
65 (17576903) 2
MRI orbits face neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 14 2 1 0 2 0 0 0 1
References Study Quality
123 (9576658) 2
104 (30717625) 2
130 (29633003) 2
124 (20645285) 2
125 (26178307) 2
164 (24491410) 4
65 (17576903) 2
CT maxillofacial without IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 9 1 6 1 2 1 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 2 1 1 1 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 2 0 0 3 0 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 3 0 2 0 0 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 1 0 2 2 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 3 2 0 0 0 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
65 (17576903) 2
CT neck without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 10 4 5 1 0 0 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
65 (17576903) 2
CT temporal bone with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 10 2 3 1 2 2 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
CT temporal bone without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 16 1 0 0 3 0 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
CT temporal bone without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 11 2 4 1 2 0 0 0 0
References Study Quality
66 (27890182) 4
64 (14736668) 4
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 2 0 0 1 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 3 2 0 0 0 0 0 0
References Study Quality
197 (21220969) 4
195 (29086023) 2
164 (24491410) 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.