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Appropriateness Criteria

Variant 1: Known acute subarachnoid hemorrhage (SAH) on CT. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Arteriography cervicocerebral Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 2 3 4 5 4
References Study Quality
12 (27659193) 4
11 (26338924) 4
10 (23142024) 2
CTA head with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 1 0 1 0 0 1 0 5 10
References Study Quality
4 (20935079) M
13 (20729022) 2
15 (18065510) 2
20 (19942709) 3
19 (28201559) 2
18 (27060510) 2
10 (23142024) 2
17 (21839961) 1
16 (21990653) 2
14 (25194636) Good
MRA head without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 13 2 1 0 0
References Study Quality
21 (24326447) Good
22 (24495263) 2
23 (21529794) 2
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 1 0 0 0 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 1 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 5 1 1 0 0 0 0 0
References Study Quality
21 (24326447) Good
22 (24495263) 2
23 (21529794) 2
MRA head without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 16 1 1 1 0 0 0 0 0
References Study Quality
21 (24326447) Good
22 (24495263) 2
23 (21529794) 2
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 0 0 2 1 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 2 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 1 0 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 2 0 0 0 0 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 1 3 1 0 0 0 0 0
References Study Quality
25 (21174171) 4
24 (20051974) 2
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 1 2 2 0 0 0 0 0
References Study Quality
25 (21174171) 4
24 (20051974) 2
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 0 4 2 3 2 0 0 0
References Study Quality
25 (21174171) 4
24 (20051974) 2
MRV head 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
MRV 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
MRV head without 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
CT head perfusion with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 3 2 1 0 0 0 0 0
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 2 0 0 0 0 0 0
References Study Quality
1 (31685104) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 3 1 0 0 0 0 0 0
References Study Quality
1 (31685104) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 18 1 0 0 0 0 0 0 0
References Study Quality
1 (31685104) 4
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 3 0 2 1 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 2 2 0 0 0 0 0
Variant 2: Suspected cerebral vasospasm. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Arteriography cervicocerebral Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 3 0 5 5 5
References Study Quality
28 (25468878) 4
6 (22556195) 4
31 (21350201) 1
CTA head with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 1 6 4 7
References Study Quality
33 (20884748) M
36 (18080806) 4
US duplex Doppler transcranial May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 5 5 7 0 1
References Study Quality
40 (26495942) Good
41 (21633870) 2
MRI head perfusion with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 5 4 0 9 1 0 0 0 0
References Study Quality
38 (29439196) 4
39 (29611451) 2
MRI head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 6 1 1 5 4 2 0 0 0
CT head perfusion with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv 5 5 1 0 0 2 9 7 0 0 0
References Study Quality
33 (20884748) M
32 (29058091) 2
28 (25468878) 4
29 (23982597) 2
26 (21748499) 4
34 (24200901) 4
CT head without IV contrast May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 0 3 13 0 1 0 1
References Study Quality
35 (28365434) Good
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 1 0 1 1 0 0 0
MRA head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 2 0 1 0 0 0 2 0
References Study Quality
37 (20532584) 2
MRA head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 18 1 0 0 0 0 0 0 0
References Study Quality
37 (20532584) 2
MRA head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 16 1 0 0 2 0 0 0 0
References Study Quality
37 (20532584) 2
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 1 1 1 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 1 0 1 0 1 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 1 0 1 0 1 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 3 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 2 1 1 0 0 0 0 0
MRV head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 1 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 0 1 0 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 1 0 0 0 0
CT head with IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 2 1 2 0 0 0 0 0
References Study Quality
35 (28365434) Good
CT head without and with IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 3 1 0 0 0 0 0 0
References Study Quality
35 (28365434) Good
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 17 1 0 0 0 0 0 1 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 0 1 0 1 0 0 0
Variant 3: Known cerebral aneurysm; untreated. Surveillance monitoring.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 1 6 10
References Study Quality
21 (24326447) Good
45 (25463352) 1
22 (24495263) 2
23 (21529794) 2
CTA head with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 2 2 4 10
References Study Quality
4 (20935079) M
13 (20729022) 2
15 (18065510) 2
19 (28201559) 2
18 (27060510) 2
10 (23142024) 2
17 (21839961) 1
16 (21990653) 2
14 (25194636) Good
Arteriography cervicocerebral May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 1 8 5 3 1 0
MRA head with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 5 2 1 2 3 2 2 2 0
References Study Quality
21 (24326447) Good
45 (25463352) 1
22 (24495263) 2
23 (21529794) 2
MRA head without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 4 1 2 5 6 1 0 0 0
References Study Quality
21 (24326447) Good
45 (25463352) 1
22 (24495263) 2
23 (21529794) 2
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 0 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 1 0 0 0 0 0 0
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 2 0 1 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 2 1 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 2 0 1 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 3 0 0 0 0 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 2 2 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 15 2 1 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 16 0 1 0 0 1 0 0 0
MRV head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 0 0 0
CT head perfusion with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 2 1 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 15 3 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 15 3 0 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 15 2 0 1 0 0 0 0 0
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 1 0 1 1 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 2 0 0 0 0 0 0
Variant 4: Known cerebral aneurysm; previously treated. Surveillance monitoring.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Arteriography cervicocerebral Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 2 2 3 5 6
MRA head without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 4 0 6 5 4
References Study Quality
58 (24008171) M
60 (25352582) 3
62 (29440326) 3
63 (27102311) 1
61 (25999378) 2
59 (23012464) 2
MRA head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 0 3 4 5 5
References Study Quality
58 (24008171) M
60 (25352582) 3
62 (29440326) 3
63 (27102311) 1
61 (25999378) 2
59 (23012464) 2
CTA head with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 4 1 5 4 4
References Study Quality
55 (30143820) 1
57 (30219936) 2
53 (28580532) 2
54 (26329465) 2
56 (21125478) 2
MRA head with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 2 2 1 4 1 2 5 0
References Study Quality
58 (24008171) M
60 (25352582) 3
62 (29440326) 3
63 (27102311) 1
61 (25999378) 2
59 (23012464) 2
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 0 0 0 0 0 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 1 0 0 0 0 0
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 2 0 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 2 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 2 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 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 15 1 0 1 0 0 0 1 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 2 0 0 0 1 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 1 1 0 0 0 0
MRV head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 0 0 0 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 0 0 0 0 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 0 0 0 0 0 0 0
CT head perfusion with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 1 1 0 1 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 17 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 17 0 1 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 16 0 1 0 1 0 0 0 0
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 0 1 0 1 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 1 0 1 0 0 0 0 0
Variant 5: High-risk cerebral aneurysm screening.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 0 1 5 11
References Study Quality
21 (24326447) Good
22 (24495263) 2
23 (21529794) 2
CTA head with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 2 6 4 5
References Study Quality
4 (20935079) M
13 (20729022) 2
15 (18065510) 2
19 (28201559) 2
18 (27060510) 2
10 (23142024) 2
17 (21839961) 1
16 (21990653) 2
14 (25194636) Good
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 0 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 1 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 0 5 0 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 15 4 0 0 0 0 0 0 0
References Study Quality
21 (24326447) Good
22 (24495263) 2
23 (21529794) 2
MRA head without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 2 2 1 2 0 0 0 1
References Study Quality
21 (24326447) Good
22 (24495263) 2
23 (21529794) 2
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 1 1 0 0 1 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 1 1 0 1 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 1 1 0 1 0 0
MRI head perfusion with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 0 0 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 2 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 16 0 2 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 15 1 1 0 1 0 0 0 0
MRV head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 0 0 0
CT head perfusion with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 1 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 16 0 1 0 0 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 18 0 0 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 16 0 1 0 1 0 0 0 0
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 0 0 1 1 0 1 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 18 0 0 0 0 0 0 0 0
Variant 6: Known high-flow vascular malformation (AVM/AVF). Surveillance monitoring.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Arteriography cervicocerebral Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 1 2 1 5 8
References Study Quality
84 (28746939) 4
85 (23615081) 2
MRA head with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 4 3 7 3 1
References Study Quality
95 (24029646) 1
97 (19833802) 2
88 (24904052) 3
96 (24475797) 2
94 (29188304) 4
93 (25994036) 2
91 (24475838) 1
89 (22300925) 2
92 (22095967) 1
90 (19467814) 3
MRA head without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 0 9 6 2
References Study Quality
95 (24029646) 1
97 (19833802) 2
88 (24904052) 3
96 (24475797) 2
94 (29188304) 4
93 (25994036) 2
91 (24475838) 1
89 (22300925) 2
92 (22095967) 1
90 (19467814) 3
MRA head without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 3 10 5
References Study Quality
95 (24029646) 1
97 (19833802) 2
88 (24904052) 3
96 (24475797) 2
94 (29188304) 4
93 (25994036) 2
91 (24475838) 1
89 (22300925) 2
92 (22095967) 1
90 (19467814) 3
CTA head with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 1 0 0 2 1 6 7
References Study Quality
87 (21402614) 2
86 (22705129) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 12 3 2 0 0
References Study Quality
83 (22107856) 4
86 (22705129) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 11 3 0 0 2
References Study Quality
83 (22107856) 4
86 (22705129) 4
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 2 0 0 0 0 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 1 0 0 0
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 2 0 0 0 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 1 0 0 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 1 0 0 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 2 3 3 2 2 0 0 0
References Study Quality
83 (22107856) 4
98 (22791027) 3
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 4 0 0 0 0 1 0 0
References Study Quality
83 (22107856) 4
86 (22705129) 4
MRV head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 1 0 0 0 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 1 1 0 0 0 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 1 1 0 0
CT head perfusion with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 0 0 0 0 1 1 0 0
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 1 2 1 0 0 1 0 0
References Study Quality
83 (22107856) 4
85 (23615081) 2
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 0 1 1 1 0 1 0 0
References Study Quality
83 (22107856) 4
85 (23615081) 2
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 0 1 2 2 2 0 0 0
References Study Quality
83 (22107856) 4
85 (23615081) 2
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 18 1 0 0 0 0 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 19 0 0 0 0 0 0 0 0
Variant 7: Suspected central nervous system (CNS) vasculitis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 7 1 0 9 2
References Study Quality
99 (24491822) 4
MRI head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 0 1 10 6
References Study Quality
99 (24491822) 4
101 (17924545) 4
109 (19221296) 4
107 (29030476) 4
108 (24722305) 4
105 (25907920) 4
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 0 0 1 1 1 3 6 5
References Study Quality
99 (24491822) 4
101 (17924545) 4
109 (19221296) 4
107 (29030476) 4
108 (24722305) 4
105 (25907920) 4
Arteriography cervicocerebral May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 7 3 7 0 1
References Study Quality
99 (24491822) 4
107 (29030476) 4
CTA head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 6 4 7 0 2
References Study Quality
99 (24491822) 4
US duplex Doppler carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 1 1 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 1 1 0 0 0 0
MRA head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 1 1 2 3 0 0 0 0
References Study Quality
99 (24491822) 4
MRA head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 1 5 1 0 0 0 0 0
References Study Quality
99 (24491822) 4
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 1 0 0 0 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 2 0 0 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 3 0 0 0 0 0 0 0
MRI head perfusion with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 1 1 0 0 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 6 1 0 0 0 1 0 0
References Study Quality
99 (24491822) 4
101 (17924545) 4
109 (19221296) 4
107 (29030476) 4
108 (24722305) 4
105 (25907920) 4
MRV head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 1 0 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 1 0 0 0 0 0 0
CT head perfusion with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 0 0 0 1 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 17 0 0 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 16 0 0 1 0 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 0 1 0 1 1 0 0 1
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 2 1 0 0 0 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 1 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.