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Appropriateness Criteria

Variant 1: Adult. Mild cognitive impairment not meeting criteria for dementia. 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 IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 2 3 1 8
References Study Quality
25 (23954175) 3
24 (21969707) 3
23 (20139996) 4
22 (19460794) 3
13 (18631949) 4
11 (16880360) 4
Amyloid PET/CT brain Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 0 0 5 2 6 1 2
References Study Quality
9 (31628215) 1
8 (30915522) 2
7 (29889941) 2
6 (29018162) 2
5 (38306055) 2
4 (19587325) 3
3 (21764791) 2
CT head without IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 0 0 1 2 8 3 2
FDG-PET/CT brain Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 3 0 10 0 2
References Study Quality
15 (34252877) 1
14 (32734458) 1
13 (18631949) 4
12 (18287270) 3
11 (16880360) 4
9 (31628215) 1
MRI head without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 1 2 3 6 3 0 0 0
Tau PET/CT brain May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 1 1 1 1 4 6 2 0 0
References Study Quality
27 (37690109) 2
26 (33852534) 2
10 (-3198414) 4
MR spectroscopy head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 0 3 4 1 1 0 0 0
References Study Quality
18 (24035276) 2
17 (18445744) 4
16 (16443495) 4
MRI functional (fMRI) head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 1 4 2 0 1 0 0 0
References Study Quality
21 (22189566) 3
20 (31357150) 2
19 (21807094) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 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 13 1 1 1 0 0 0 0 0
SPECT or SPECT/CT brain perfusion Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 3 0 0 0 0 0 0
SPECT or SPECT/CT brain striatal Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 3 0 0 0 0 0 0
Variant 2: Adult. Cognitive impairment with memory deficits. Suspect Alzheimer disease with typical clinical presentation. 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 IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 3 0 9
References Study Quality
47 (29762090) 2
46 (24331205) 1
28 (31917652) 4
24 (21969707) 3
23 (20139996) 4
13 (18631949) 4
Amyloid PET/CT brain Usually appropriate Strong ☢☢☢ 1-10 mSv 8 8 0 0 0 0 3 2 1 6 4
References Study Quality
42 (33219525) 1
41 (29962497) 2
40 (37561943) 2
39 (30094462) 1
38 (25988463) Good
37 (20501908) 3
36 (32808011) 3
35 (32385166) 2
34 (14991808) 3
33 (21245183) 2
31 (35649652) 4
28 (31917652) 4
25 (23954175) 3
8 (30915522) 2
7 (29889941) 2
6 (29018162) 2
3 (21764791) 2
FDG-PET/CT brain Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 3 1 8 1 2
References Study Quality
45 (11342678) 4
44 (11801698) 3
28 (31917652) 4
14 (32734458) 1
12 (18287270) 3
11 (16880360) 4
MR spectroscopy head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 3 0 2 7 2 2 0 0 0
References Study Quality
17 (18445744) 4
16 (16443495) 4
CT head without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 0 1 2 7 4 1 1
References Study Quality
43 (2105589) 4
SPECT or SPECT/CT brain perfusion May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 2 3 1 7 2 0 0 0
References Study Quality
49 (18855165) 3
48 (9527139) 2
45 (11342678) 4
Tau PET/CT brain May be appropriate Strong ☢☢☢ 1-10 mSv 6 6 0 0 2 0 4 4 5 1 0
References Study Quality
28 (31917652) 4
54 (30639421) 2
53 (30326496) 2
52 (32391858) 1
51 (31784374) 2
MRI functional (fMRI) head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 2 4 1 2 0 0 0 0
References Study Quality
19 (21807094) 4
21 (22189566) 3
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 3 7 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 1 1 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] 1 1 8 2 0 0 0 2 0 1 0
SPECT or SPECT/CT brain striatal Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 0 3 2 1 1 0 0 0
References Study Quality
50 (20075101) 3
Variant 3: Adult. Cognitive impairment with memory deficits. Suspect Alzheimer disease with atypical clinical presentation. 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 IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 2 1 9
References Study Quality
59 (31672482) 3
47 (29762090) 2
46 (24331205) 1
28 (31917652) 4
24 (21969707) 3
23 (20139996) 4
13 (18631949) 4
Amyloid PET/CT brain Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 0 0 0 1 0 1 2 2 7
References Study Quality
56 (29107051) 2
42 (33219525) 1
41 (29962497) 2
40 (37561943) 2
39 (30094462) 1
37 (20501908) 3
35 (32385166) 2
34 (14991808) 3
33 (21245183) 2
31 (35649652) 4
28 (31917652) 4
27 (37690109) 2
25 (23954175) 3
8 (30915522) 2
7 (29889941) 2
6 (29018162) 2
5 (38306055) 2
3 (21764791) 2
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 0 0 1 1 9 4 1
References Study Quality
43 (2105589) 4
FDG-PET/CT brain Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 1 0 0 1 6 5
References Study Quality
58 (31633646) 2
57 (29756163) 4
45 (11342678) 4
44 (11801698) 3
28 (31917652) 4
14 (32734458) 1
12 (18287270) 3
11 (16880360) 4
Tau PET/CT brain Usually appropriate Strong ☢☢☢ 1-10 mSv 8 8 0 0 1 1 2 3 1 6 2
References Study Quality
60 (29105977) 1
61 (30615804) 2
SPECT or SPECT/CT brain perfusion May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 1 1 1 4 7 0 0 0
References Study Quality
49 (18855165) 3
48 (9527139) 2
45 (11342678) 4
SPECT or SPECT/CT brain striatal May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 7 0 1 1 6 1 0 0 0
References Study Quality
50 (20075101) 3
MR spectroscopy head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 2 9 0 0 0 0 0 0
References Study Quality
16 (16443495) 4
17 (18445744) 4
MRI functional (fMRI) head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 1 4 0 2 1 0 0 0
References Study Quality
19 (21807094) 4
21 (22189566) 3
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 4 6 1 2 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 8 1 0 0 2 1 1 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 0 0 0 2 0 1 0
Variant 4: Adult. Known Alzheimer disease considering therapy with anti-amyloid monoclonal antibodies. Pretreatment 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 IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 0 11
References Study Quality
62 (37357276) 4
Amyloid PET/CT brain Usually appropriate Limited ☢☢☢ 1-10 mSv 9 9 0 0 1 0 3 0 1 1 7
References Study Quality
62 (37357276) 4
10 (-3198414) 4
Tau PET/CT brain May be appropriate Limited ☢☢☢ 1-10 mSv 4 4 0 1 5 3 4 3 0 0 0
References Study Quality
62 (37357276) 4
10 (-3198414) 4
MR spectroscopy head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 1 0 1 0 0 0 0
MRI functional (fMRI) head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 1 0 1 0 0 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 7 1 7 1 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 11 0 1 0 0 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 11 0 1 0 0 0 1 0 0
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 7 0 1 2 2 1 0 0 0
References Study Quality
62 (37357276) 4
FDG-PET/CT brain Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 1 1 0 2 0 1 0 0
SPECT or SPECT/CT brain perfusion Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 0 2 1 0 0 1 0 0
SPECT or SPECT/CT brain striatal Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 2 0 0 0 1 0 0
Variant 5: Adult. Known Alzheimer disease undergoing therapy with anti-amyloid monoclonal antibodies. Posttreatment 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 IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 0 1 11
References Study Quality
63 (37651273) 4
Amyloid PET/CT brain May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 8 2 1 0 2 1 1 0 1
References Study Quality
67 (37639461) 4
66 (37459141) 1
10 (-3198414) 4
MR spectroscopy head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 1 0 0 1 0 0 0
MRI functional (fMRI) head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 1 0 0 1 0 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 4 2 1 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 11 0 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 11 0 1 1 0 0 0 0 0
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 0 2 1 1 0 0 0 0
References Study Quality
62 (37357276) 4
FDG-PET/CT brain Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 1 0 1 0 0 0 0
SPECT or SPECT/CT brain perfusion Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 1 0 0 0 1 0 0
SPECT or SPECT/CT brain striatal Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 1 0 0 0 1 0 0
Tau PET/CT brain Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 10 0 1 0 1 0 1 0 0
References Study Quality
10 (-3198414) 4
Variant 6: Adult. Cognitive impairment with behavioral abnormalities or progressive aphasia. Suspect frontotemporal dementia. 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 IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 3 0 9
References Study Quality
28 (31917652) 4
75 (22976075) 3
74 (37500561) 2
73 (38012398) 3
70 (25171901) 4
CT head without IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 0 1 0 0 9 3 3
FDG-PET/CT brain Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 2 3 1 2 5
References Study Quality
28 (31917652) 4
11 (16880360) 4
68 (33402272) 4
Amyloid PET/CT brain May be appropriate Limited ☢☢☢ 1-10 mSv 5 5 0 0 1 1 13 0 1 0 0
References Study Quality
3 (21764791) 2
70 (25171901) 4
SPECT or SPECT/CT brain perfusion May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 1 1 6 6 1 0 0 0
References Study Quality
48 (9527139) 2
MR spectroscopy head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 3 7 0 0 0 0 0 0
References Study Quality
17 (18445744) 4
MRI functional (fMRI) head without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 6 4 6 0 0 0 0 0 0
References Study Quality
19 (21807094) 4
71 (12821731) 2
72 (25002573) 2
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 2 8 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 8 1 0 1 1 1 1 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 1 0 2 0 1 1 0 0
SPECT or SPECT/CT brain striatal Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 0 1 2 0 0 1 0 0
Tau PET/CT brain Usually not appropriate Strong ☢☢☢ 1-10 mSv 3 3 7 1 6 1 1 0 0 0 0
References Study Quality
28 (31917652) 4
78 (33824991) 3
77 (30594046) 2
76 (30704514) 2
53 (30326496) 2
Variant 7: Adult. Cognitive impairment with visual hallucinations or parkinsonian symptoms. Suspect dementia with Lewy bodies. 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 IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 1 3 8
References Study Quality
83 (26572170) 3
46 (24331205) 1
85 (18692749) 3
84 (36123123) 2
68 (33402272) 4
28 (31917652) 4
CT head without IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 0 1 0 1 8 5 1
FDG-PET/CT brain Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 0 0 0 2 1 3 3 3
References Study Quality
11 (16880360) 4
68 (33402272) 4
79 (33926896) 4
81 (37421880) 1
SPECT or SPECT/CT brain striatal Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 0 9 5 2
References Study Quality
50 (20075101) 3
89 (32198310) 2
88 (36920494) 4
68 (33402272) 4
MRI head without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 4 2 3 1 1 0 3 2 0
SPECT or SPECT/CT brain perfusion May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 4 0 0 2 8 2 0 0 0
References Study Quality
50 (20075101) 3
87 (38315966) 2
86 (19142710) 3
MR spectroscopy head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 2 7 0 0 0 0 0 0
References Study Quality
82 (24468473) 3
17 (18445744) 4
MRI functional (fMRI) head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 3 6 0 0 0 0 0 0
References Study Quality
21 (22189566) 3
19 (21807094) 4
Amyloid PET/CT brain Usually not appropriate Strong ☢☢☢ 1-10 mSv 2 2 7 3 5 0 1 0 0 0 0
References Study Quality
80 (23831180) 4
3 (21764791) 2
38 (25988463) Good
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 0 1 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] 1 1 14 1 1 0 0 0 0 0 0
Tau PET/CT brain Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 11 4 0 1 0 0 0 0 0
References Study Quality
61 (30615804) 2
91 (33631469) 2
90 (27654968) 1
Variant 8: Adult. Cognitive impairment with recent stroke or stepwise decline. Suspect vascular dementia. 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 IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 3 11
References Study Quality
100 (18436880) 2
102 (35614521) 2
101 (24557016) 1
97 (22135130) 4
94 (15729521) 4
92 (35678401) 4
28 (31917652) 4
MRA head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 1 0 1 11 1 2 0 0
MRA neck without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 1 0 5 8 1 1 0 0
MRA neck without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 1 0 5 8 1 1 0 0
CT head without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 3 0 1 2 1 1 5 1 2
References Study Quality
92 (35678401) 4
95 (8094895) 4
CTA head and neck with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 8 3 2 1 0
MR spectroscopy head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 1 4 0 0 0 0 0 0
References Study Quality
99 (1513253) 3
17 (18445744) 4
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 2 0 0 0 0 1 0
MRI functional (fMRI) head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 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] 2 2 8 1 3 2 1 0 0 0 1
Amyloid PET/CT brain Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 7 1 1 1 3 0 0 1 0
References Study Quality
3 (21764791) 2
96 (31929166) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 0 2 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] 1 1 15 0 1 0 0 0 0 0 0
FDG-PET/CT brain Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 4 1 0 1 0 0 0
References Study Quality
28 (31917652) 4
97 (22135130) 4
98 (29932266) 4
SPECT or SPECT/CT brain perfusion Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 4 1 0 0 0 0 0
References Study Quality
48 (9527139) 2
SPECT or SPECT/CT brain striatal Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 0 2 1 0 1 0 0 0
Tau PET/CT brain Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 0 2 1 0 1 0 0 0
Variant 9: Adult. Cognitive impairment with gait disturbance or urinary incontinence. Suspect normal pressure hydrocephalus. 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 IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 0 3 10
References Study Quality
103 (26644048) 4
104 (37898265) 4
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 1 0 0 0 2 1 5 2 3
References Study Quality
104 (37898265) 4
DTPA cisternography May be appropriate Limited ☢☢☢ 1-10 mSv 5 5 0 1 0 3 8 3 1 0 0
References Study Quality
103 (26644048) 4
106 (33395973) 2
MR spectroscopy head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 0 2 2 0 0 0 0 0
References Study Quality
108 (20647518) 2
MRI functional (fMRI) head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 1 1 0 0 0 1 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 2 6 0 0 0 0 0 0
Amyloid PET/CT brain Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 8 3 1 1 0 1 0 0 0
References Study Quality
105 (32906629) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 0 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] 1 1 16 0 0 0 0 0 0 0 0
FDG-PET/CT brain Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 1 3 1 1 0 0 0 0
References Study Quality
105 (32906629) 4
107 (29876274) 2
SPECT or SPECT/CT brain perfusion Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 0 1 4 0 1 0 0 0
References Study Quality
103 (26644048) 4
SPECT or SPECT/CT brain striatal Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 0 2 1 0 0 1 0 0
Tau PET/CT brain Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 0 1 1 1 1 0 0 0
Variant 10: Adult. Rapidly progressive dementia. 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 1 0 0 0 1 1 0 1 10
References Study Quality
113 (36304377) 4
112 (37698615) 2
111 (23413251) 4
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 1 2 4 6
References Study Quality
113 (36304377) 4
112 (37698615) 2
111 (23413251) 4
CT head without IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 0 0 1 0 9 3 3
MR spectroscopy head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 2 2 1 0 0 1 0 0
MRI functional (fMRI) head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 0 2 1 0 0 1 0 0
Amyloid PET/CT brain Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 2 0 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 1 1 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] 1 1 15 0 1 0 0 0 0 0 0
FDG-PET/CT brain Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 1 0 3 0 0 0 0
SPECT or SPECT/CT brain perfusion Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 4 0 1 0 0 0 0 0
SPECT or SPECT/CT brain striatal Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 3 0 0 0 0 0 0 0
Tau PET/CT brain Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 1 1 2 0 0 1 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.