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Appropriateness Criteria

Variant 1: Tenderness to palpation or contusion or edema over frontal bone. Suspect frontal bone injury. Initial imaging following primary survey.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT maxillofacial without IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 1 0 0 0 1 3 14
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
21 (24183372) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 0 0 2 2 6 5 4
References Study Quality
34 (29503015) 2
21 (24183372) 4
15 (23498333) 4
35 (18261526) 4
36 (1537220) 4
25 (33958108) 4
Radiography skull Usually not appropriate Limited ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 10 1 2 3 1 1 1 0 0
References Study Quality
60 (20495486) 4
30 (30454777) 4
50 (21371800) 4
59 (19050539) 2
Arteriography cervicocerebral Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 3 1 1 0 0 0 0 0
References Study Quality
71 (24355656) 3
72 (22695428) 3
27 (-3101271) 4
70 (24458034) 3
29 (31054754) 4
26 (29101988) 4
28 (-3194388) 4
25 (33958108) 4
MRA head and neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 2 2 1 2 0 0 0 0
References Study Quality
66 (27893647) 2
69 (12435934) 1
27 (-3101271) 4
68 (18635617) 2
29 (31054754) 4
26 (29101988) 4
28 (-3194388) 4
25 (33958108) 4
67 (29025722) 4
MRA head and neck without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 2 2 1 2 0 0 0 0
References Study Quality
66 (27893647) 2
69 (12435934) 1
27 (-3101271) 4
68 (18635617) 2
29 (31054754) 4
26 (29101988) 4
28 (-3194388) 4
25 (33958108) 4
67 (29025722) 4
MRA head and neck without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 3 1 1 1 1 0 0 0
References Study Quality
66 (27893647) 2
69 (12435934) 1
27 (-3101271) 4
68 (18635617) 2
29 (31054754) 4
26 (29101988) 4
28 (-3194388) 4
25 (33958108) 4
67 (29025722) 4
MRI cervical spine with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 3 2 1 0 0 0 0 0
References Study Quality
29 (31054754) 4
58 (31783411) 4
7 (18090013) 2
MRI cervical spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 4 1 1 0 0 0 0 0
References Study Quality
29 (31054754) 4
58 (31783411) 4
7 (18090013) 2
MRI cervical spine without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 2 2 2 2 0 0 0 0
References Study Quality
29 (31054754) 4
58 (31783411) 4
7 (18090013) 2
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 15 3 0 0 0 0 1 0 0
References Study Quality
8 (32224001) 2
2 (31345487) 4
25 (33958108) 4
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 15 2 0 0 0 2 0 0 0
References Study Quality
8 (32224001) 2
2 (31345487) 4
25 (33958108) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 2 1 1 0 0 1 0 0
References Study Quality
8 (32224001) 2
2 (31345487) 4
25 (33958108) 4
MRI maxillofacial with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 5 0 0 0 0 1 0 0
References Study Quality
49 (20599085) 4
31 (30007759) 4
50 (21371800) 4
25 (33958108) 4
MRI maxillofacial without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 3 0 1 0 2 0 0 0
References Study Quality
49 (20599085) 4
31 (30007759) 4
50 (21371800) 4
25 (33958108) 4
MRI maxillofacial without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 2 3 4 2 0 1 0 0
References Study Quality
49 (20599085) 4
31 (30007759) 4
50 (21371800) 4
25 (33958108) 4
CT maxillofacial with IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 11 3 2 0 1 0 1 0 1
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
21 (24183372) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
CT cervical spine with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 3 1 0 0 0 0 0 0
References Study Quality
51 (19509621) 2
29 (31054754) 4
20 (29154774) 4
54 (31377860) 2
19 (27527678) 4
12 (27070668) 4
52 (23954483) 4
53 (19996802) 4
55 (19231780) 2
56 (3965740) 4
57 (21042121) 4
CT cervical spine without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 2 1 0 0 0 0 0 0
References Study Quality
51 (19509621) 2
29 (31054754) 4
20 (29154774) 4
54 (31377860) 2
19 (27527678) 4
12 (27070668) 4
52 (23954483) 4
53 (19996802) 4
55 (19231780) 2
56 (3965740) 4
57 (21042121) 4
CT cervical spine without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 8 1 5 1 3 0 1 0 0
References Study Quality
51 (19509621) 2
29 (31054754) 4
20 (29154774) 4
54 (31377860) 2
19 (27527678) 4
12 (27070668) 4
52 (23954483) 4
53 (19996802) 4
55 (19231780) 2
56 (3965740) 4
57 (21042121) 4
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 3 1 1 1 0 1 0 0
References Study Quality
34 (29503015) 2
21 (24183372) 4
15 (23498333) 4
35 (18261526) 4
36 (1537220) 4
25 (33958108) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 3 1 1 1 0 1 0 0
References Study Quality
34 (29503015) 2
21 (24183372) 4
15 (23498333) 4
35 (18261526) 4
36 (1537220) 4
25 (33958108) 4
CT maxillofacial without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 10 5 2 0 0 0 1 0 1
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
21 (24183372) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
CTA head and neck with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 3 3 1 3 0 0 0 0
References Study Quality
66 (27893647) 2
27 (-3101271) 4
65 (16297680) 4
64 (15706217) 4
29 (31054754) 4
26 (29101988) 4
21 (24183372) 4
61 (22491644) 4
62 (11493789) 2
63 (12560700) 4
28 (-3194388) 4
25 (33958108) 4
Variant 2: Pain with upper jaw manipulation or pain overlying zygoma or zygomatic deformity or facial elongation or malocclusion or infraorbital nerve paresthesia. Suspect midface injury. Initial imaging following primary survey.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT maxillofacial without IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 2 17
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
21 (24183372) 4
22 (23322824) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
79 (24138736) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
78 (2017492) 4
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 12 2 0 2 2 1 0 0 0
References Study Quality
9 (25086804) 4
46 (21111135) 4
83 (21167087) 4
Radiography paranasal sinuses Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 3 3 7 2 2 4 2 1 1 0 0
References Study Quality
30 (30454777) 4
15 (23498333) 4
50 (21371800) 4
2 (31345487) 4
81 (26266185) 2
Arteriography cervicocerebral Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 3 1 0 0 0 0 0
References Study Quality
71 (24355656) 3
72 (22695428) 3
27 (-3101271) 4
70 (24458034) 3
29 (31054754) 4
26 (29101988) 4
28 (-3194388) 4
25 (33958108) 4
MRA head and neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 13 2 1 2 1 0 0 0 0
References Study Quality
66 (27893647) 2
69 (12435934) 1
27 (-3101271) 4
68 (18635617) 2
29 (31054754) 4
26 (29101988) 4
28 (-3194388) 4
25 (33958108) 4
67 (29025722) 4
MRA head and neck without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 13 2 2 1 1 0 0 0 0
References Study Quality
66 (27893647) 2
69 (12435934) 1
27 (-3101271) 4
68 (18635617) 2
29 (31054754) 4
26 (29101988) 4
28 (-3194388) 4
25 (33958108) 4
67 (29025722) 4
MRA head and neck without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 2 3 1 1 0 0 0 0
References Study Quality
66 (27893647) 2
69 (12435934) 1
27 (-3101271) 4
68 (18635617) 2
29 (31054754) 4
26 (29101988) 4
28 (-3194388) 4
25 (33958108) 4
67 (29025722) 4
MRI cervical spine with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 3 2 0 0 0 0 0 0
References Study Quality
29 (31054754) 4
58 (31783411) 4
7 (18090013) 2
MRI cervical spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 4 2 0 0 0 0 0 0
References Study Quality
29 (31054754) 4
58 (31783411) 4
7 (18090013) 2
MRI cervical spine without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 3 5 1 2 0 0 0 0
References Study Quality
29 (31054754) 4
58 (31783411) 4
7 (18090013) 2
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 3 1 1 0 0 0 0 0
References Study Quality
8 (32224001) 2
2 (31345487) 4
25 (33958108) 4
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 4 1 1 0 0 0 0 0
References Study Quality
8 (32224001) 2
2 (31345487) 4
25 (33958108) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 2 2 2 1 0 0 0 0
References Study Quality
8 (32224001) 2
2 (31345487) 4
25 (33958108) 4
MRI maxillofacial with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 3 0 1 0 0 1 0 0
References Study Quality
49 (20599085) 4
4 (29309356) 4
80 (26372709) 4
31 (30007759) 4
79 (24138736) 4
15 (23498333) 4
32 (22964407) 4
50 (21371800) 4
MRI maxillofacial without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 4 0 0 0 1 1 0 0
References Study Quality
49 (20599085) 4
4 (29309356) 4
80 (26372709) 4
31 (30007759) 4
79 (24138736) 4
15 (23498333) 4
32 (22964407) 4
50 (21371800) 4
MRI maxillofacial without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 4 1 0 0 0 0 0 0
References Study Quality
49 (20599085) 4
4 (29309356) 4
80 (26372709) 4
31 (30007759) 4
79 (24138736) 4
15 (23498333) 4
32 (22964407) 4
50 (21371800) 4
CT maxillofacial with IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 12 2 2 1 1 0 0 0 1
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
21 (24183372) 4
22 (23322824) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
79 (24138736) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
78 (2017492) 4
CT cervical spine with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 3 2 1 0 0 0 0 0
References Study Quality
51 (19509621) 2
29 (31054754) 4
20 (29154774) 4
54 (31377860) 2
19 (27527678) 4
12 (27070668) 4
52 (23954483) 4
53 (19996802) 4
55 (19231780) 2
56 (3965740) 4
57 (21042121) 4
CT cervical spine without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 2 0 0 0 1 0 0
References Study Quality
51 (19509621) 2
29 (31054754) 4
20 (29154774) 4
54 (31377860) 2
19 (27527678) 4
12 (27070668) 4
52 (23954483) 4
53 (19996802) 4
55 (19231780) 2
56 (3965740) 4
57 (21042121) 4
CT cervical spine without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 1 4 0 5 0 1 1 0
References Study Quality
51 (19509621) 2
29 (31054754) 4
20 (29154774) 4
54 (31377860) 2
19 (27527678) 4
12 (27070668) 4
52 (23954483) 4
53 (19996802) 4
55 (19231780) 2
56 (3965740) 4
57 (21042121) 4
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 3 0 2 0 0 1 0 0
References Study Quality
34 (29503015) 2
20 (29154774) 4
53 (19996802) 4
25 (33958108) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 1 2 0 0 1 0 0
References Study Quality
34 (29503015) 2
20 (29154774) 4
53 (19996802) 4
25 (33958108) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 2 4 0 0 1 0 0 0
References Study Quality
34 (29503015) 2
20 (29154774) 4
53 (19996802) 4
25 (33958108) 4
CT maxillofacial without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 11 3 2 1 1 0 0 0 1
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
21 (24183372) 4
22 (23322824) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
79 (24138736) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
78 (2017492) 4
CTA head and neck with IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 2 2 2 4 0 0 0 0
References Study Quality
66 (27893647) 2
17 (23992776) 3
82 (20154559) 4
27 (-3101271) 4
65 (16297680) 4
64 (15706217) 4
29 (31054754) 4
26 (29101988) 4
21 (24183372) 4
61 (22491644) 4
63 (12560700) 4
28 (-3194388) 4
25 (33958108) 4
Variant 3: Visible nasal deformity or palpable nasal deformity or tenderness to palpation of the nose or epistaxis. Suspect nasal injury. Initial imaging following primary survey.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT maxillofacial without IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 1 0 0 0 2 0 0 3 13
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
21 (24183372) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
93 (16633172) 4
95 (14707621) 4
US maxillofacial May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 1 8 9 0 0 0 1
References Study Quality
90 (24986427) 2
89 (21808205) 2
38 (21377837) 4
85 (19470811) 2
86 (17179332) 4
87 (8648487) 4
88 (14648259) 2
Radiography paranasal sinuses May be appropriate Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 4 4 7 1 1 6 4 0 0 0 0
References Study Quality
91 (18118920) 2
92 (3734598) 2
93 (16633172) 4
94 (8143411) 2
MRI maxillofacial with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 0 0 0 0 0 1 0
MRI maxillofacial without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 3 0 0 0 0 1 0 0
MRI maxillofacial without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 2 0 0 0 1 1 0 0
CT maxillofacial with IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 16 3 0 0 0 0 0 0 0
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
21 (24183372) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
93 (16633172) 4
95 (14707621) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 2 0 1 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 15 2 0 1 0 1 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 3 0 0 0 0 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 16 3 0 0 0 0 0 0 0
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
21 (24183372) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
93 (16633172) 4
95 (14707621) 4
Variant 4: Trismus or malocclusion or gingival hemorrhage or mucosal hemorrhage or loose teeth or fractured teeth or displaced teeth. Suspect mandibular injury. Initial imaging following primary survey.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT maxillofacial without IV contrast Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 4 15
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
101 (28314422) 4
3 (25415101) 4
21 (24183372) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
99 (15915103) 2
100 (11335803) 2
102 (16037795) 4
103 (11037164) 4
Radiography mandible May be appropriate Strong ☢☢ 0.1-1mSv 4 4 1 1 1 7 8 0 0 1 0
References Study Quality
42 (27618328) 4
101 (28314422) 4
110 (24183373) 4
111 (22538545) 4
31 (30007759) 4
99 (15915103) 2
102 (16037795) 4
106 (3462360) 4
107 (8199151) 4
108 (2231144) 4
109 (18272555) 2
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 2 0 1 0 0 0 0 0
References Study Quality
9 (25086804) 4
46 (21111135) 4
83 (21167087) 4
Arteriography cervicocerebral Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 2 1 1 0 0 0 0
References Study Quality
71 (24355656) 3
72 (22695428) 3
27 (-3101271) 4
70 (24458034) 3
29 (31054754) 4
26 (29101988) 4
9 (25086804) 4
105 (17656282) 2
112 (16456458) 2
28 (-3194388) 4
25 (33958108) 4
MRA head and neck with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 1 3 1 3 0 0 0 0
References Study Quality
66 (27893647) 2
72 (22695428) 3
69 (12435934) 1
27 (-3101271) 4
68 (18635617) 2
29 (31054754) 4
26 (29101988) 4
9 (25086804) 4
105 (17656282) 2
112 (16456458) 2
28 (-3194388) 4
25 (33958108) 4
67 (29025722) 4
MRA head and neck without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 1 2 1 3 0 0 0 0
References Study Quality
66 (27893647) 2
72 (22695428) 3
69 (12435934) 1
27 (-3101271) 4
68 (18635617) 2
29 (31054754) 4
26 (29101988) 4
9 (25086804) 4
105 (17656282) 2
112 (16456458) 2
28 (-3194388) 4
25 (33958108) 4
67 (29025722) 4
MRA head and neck without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 1 2 1 3 0 0 0 0
References Study Quality
66 (27893647) 2
72 (22695428) 3
69 (12435934) 1
27 (-3101271) 4
68 (18635617) 2
29 (31054754) 4
26 (29101988) 4
9 (25086804) 4
105 (17656282) 2
112 (16456458) 2
28 (-3194388) 4
25 (33958108) 4
67 (29025722) 4
MRI cervical spine with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 16 2 1 0 0 0 0 0 0
References Study Quality
29 (31054754) 4
58 (31783411) 4
7 (18090013) 2
MRI cervical spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 15 3 1 0 0 0 0 0 0
References Study Quality
29 (31054754) 4
58 (31783411) 4
7 (18090013) 2
MRI cervical spine without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 4 2 1 2 0 0 0 0
References Study Quality
29 (31054754) 4
58 (31783411) 4
7 (18090013) 2
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 16 2 0 0 0 1 0 0 0
References Study Quality
8 (32224001) 2
2 (31345487) 4
25 (33958108) 4
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 16 2 0 0 0 1 0 0 0
References Study Quality
8 (32224001) 2
2 (31345487) 4
25 (33958108) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 3 0 1 1 0 1 0 0
References Study Quality
8 (32224001) 2
2 (31345487) 4
25 (33958108) 4
MRI maxillofacial with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 14 1 2 0 0 1 0 1 0
References Study Quality
31 (30007759) 4
50 (21371800) 4
2 (31345487) 4
104 (17223310) 2
105 (17656282) 2
MRI maxillofacial without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 16 3 0 0 0 0 0 0 0
References Study Quality
31 (30007759) 4
50 (21371800) 4
2 (31345487) 4
104 (17223310) 2
105 (17656282) 2
MRI maxillofacial without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 13 2 1 2 1 0 0 0 0
References Study Quality
31 (30007759) 4
50 (21371800) 4
2 (31345487) 4
104 (17223310) 2
105 (17656282) 2
CT maxillofacial with IV contrast Usually not appropriate Strong ☢☢ 0.1-1mSv 1 1 11 2 2 0 2 0 1 1 0
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
101 (28314422) 4
3 (25415101) 4
21 (24183372) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
99 (15915103) 2
100 (11335803) 2
102 (16037795) 4
103 (11037164) 4
CT cervical spine with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 2 0 0 0 0 0 0
References Study Quality
51 (19509621) 2
29 (31054754) 4
20 (29154774) 4
54 (31377860) 2
19 (27527678) 4
12 (27070668) 4
52 (23954483) 4
53 (19996802) 4
55 (19231780) 2
56 (3965740) 4
57 (21042121) 4
97 (1593318) 4
CT cervical spine without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 1 1 1 0 0 0 0 0
References Study Quality
51 (19509621) 2
29 (31054754) 4
20 (29154774) 4
54 (31377860) 2
19 (27527678) 4
12 (27070668) 4
52 (23954483) 4
53 (19996802) 4
55 (19231780) 2
56 (3965740) 4
57 (21042121) 4
97 (1593318) 4
CT cervical spine without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 1 3 1 5 1 0 1 0
References Study Quality
51 (19509621) 2
29 (31054754) 4
20 (29154774) 4
54 (31377860) 2
19 (27527678) 4
12 (27070668) 4
52 (23954483) 4
53 (19996802) 4
55 (19231780) 2
56 (3965740) 4
57 (21042121) 4
97 (1593318) 4
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 3 2 0 1 0 0 0 0
References Study Quality
98 (29325790) 4
53 (19996802) 4
57 (21042121) 4
97 (1593318) 4
25 (33958108) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 2 0 1 0 0 0 0
References Study Quality
98 (29325790) 4
53 (19996802) 4
57 (21042121) 4
97 (1593318) 4
25 (33958108) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 7 1 3 1 5 2 0 0 0
References Study Quality
98 (29325790) 4
53 (19996802) 4
57 (21042121) 4
97 (1593318) 4
25 (33958108) 4
CT maxillofacial without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 16 0 3 0 0 0 0 0 0
References Study Quality
40 (29320322) 4
30 (30454777) 4
47 (28941512) 4
42 (27618328) 4
44 (27761894) 4
101 (28314422) 4
3 (25415101) 4
21 (24183372) 4
37 (22472677) 4
38 (21377837) 4
31 (30007759) 4
41 (29922866) 4
43 (29903561) 4
39 (28941507) 4
13 (27348349) 4
48 (25639172) 4
15 (23498333) 4
45 (21617475) 4
46 (21111135) 4
2 (31345487) 4
99 (15915103) 2
100 (11335803) 2
102 (16037795) 4
103 (11037164) 4
CTA head and neck with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 1 3 4 0 0 0 0
References Study Quality
66 (27893647) 2
72 (22695428) 3
27 (-3101271) 4
65 (16297680) 4
64 (15706217) 4
29 (31054754) 4
26 (29101988) 4
9 (25086804) 4
21 (24183372) 4
61 (22491644) 4
62 (11493789) 2
63 (12560700) 4
105 (17656282) 2
112 (16456458) 2
28 (-3194388) 4
25 (33958108) 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.