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Appropriateness Criteria

Variant 1: Adult. Acute or increasing cervical pain without radiculopathy. No trauma or “red flags.” Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography cervical spine May be appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 0 0 0 3 8 7 0 0 0
References Study Quality
48 (24968795) 4
49 (9224245) 4
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 0 0 1 0 0 0 1 0
Radiography cervical spine flexion extension lateral views Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 13 2 3 0 0 0 0 0 0
References Study Quality
48 (24968795) 4
49 (9224245) 4
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 0 0 0 0 1 0 0 1
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRI cervical spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
MRI cervical spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 1 1 0 1 0 0 0 1
References Study Quality
46 (9460946) 2
1 (25659245) 4
47 (17088193) 3
MRI cervical spine without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 2 2 0 0 0 0 0 0
References Study Quality
46 (9460946) 2
1 (25659245) 4
47 (17088193) 3
Bone scan whole body with SPECT or SPECT/CT cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 1 0 0 0 0 1 0 0
References Study Quality
41 (34698290) 4
CT cervical spine with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 0 0 1 0 0 1 0
References Study Quality
42 (17379279) Inadequate
45 (28753389) 2
44 (35699680) 2
43 (20006557) 1
CT cervical spine without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 1 0 0 0 1
CT cervical spine without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 3 1 0 0 0 0 0 0
References Study Quality
42 (17379279) Inadequate
45 (28753389) 2
44 (35699680) 2
43 (20006557) 1
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
Variant 2: Adult. Acute or increasing cervical pain with radiculopathy. No trauma or “red flags.” Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography cervical spine May be appropriate Strong ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 0 0 0 3 10 3 2 0 0
References Study Quality
67 (33025192) 2
71 (35276718) 2
MRI cervical spine without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 7 5 3 0 1
References Study Quality
55 (21047885) 2
46 (9460946) 2
68 (2847516) 4
1 (25659245) 4
70 (35434382) 2
69 (19525791) 3
67 (33025192) 2
47 (17088193) 3
Radiography cervical spine flexion extension lateral views Usually not appropriate Strong ☢☢ 0.1-1mSv 1 1 11 4 1 0 1 1 0 0 0
References Study Quality
67 (33025192) 2
71 (35276718) 2
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 1 1 0 1 1 0 0 1
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRI cervical spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 1 0 0 1
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 14 1 0 0 1 0 2 0 0
References Study Quality
55 (21047885) 2
46 (9460946) 2
68 (2847516) 4
1 (25659245) 4
70 (35434382) 2
69 (19525791) 3
67 (33025192) 2
47 (17088193) 3
Bone scan whole body with SPECT or SPECT/CT cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 1 0 0 0 0 1 0
References Study Quality
41 (34698290) 4
CT cervical spine with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 1 0 1 0 0
References Study Quality
62 (16632616) 2
63 (26175589) 2
45 (28753389) 2
44 (35699680) 2
43 (20006557) 1
42 (17379279) Inadequate
CT cervical spine without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 0 0 1 0 0 0 1
CT cervical spine without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 1 4 1 0 0 0 0
References Study Quality
62 (16632616) 2
63 (26175589) 2
45 (28753389) 2
44 (35699680) 2
43 (20006557) 1
42 (17379279) Inadequate
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
CT myelography cervical spine Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 0 2 2 0 1 1 0 0
References Study Quality
66 (32058837) 4
65 (27432666) 4
64 (21616277) 4
Variant 3: Adult. Prior cervical spine surgery. Acute or increasing mechanical cervical pain or radiculopathy. No trauma or “red flags.” Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography cervical spine Usually appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 7 7 0 0 0 0 0 1 10 2 5
References Study Quality
73 (35701631) 4
79 (34113681) 4
85 (23118135) 4
92 (32405554) 4
Radiography cervical spine flexion extension lateral views Usually appropriate Limited ☢☢ 0.1-1mSv 7 7 0 0 0 0 3 0 9 4 2
References Study Quality
73 (35701631) 4
79 (34113681) 4
85 (23118135) 4
92 (32405554) 4
MRI cervical spine without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 0 1 0 5 5 2 4
References Study Quality
1 (25659245) 4
46 (9460946) 2
79 (34113681) 4
89 (24183750) 4
CT cervical spine without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 2 2 7 4 3
References Study Quality
87 (12734742) 2
86 (23479714) 4
85 (23118135) 4
84 (16889148) 2
83 (26430596) 3
82 (18469691) 2
72 (27417403) 4
30 (31039024) 4
29 (31944834) 4
28 (30667316) 2
27 (33963025) 4
MRI cervical spine without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 5 9 3 1 0 0
References Study Quality
1 (25659245) 4
46 (9460946) 2
79 (34113681) 4
89 (24183750) 4
91 (2119123) 4
90 (11371319) 4
CT myelography cervical spine May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 1 2 12 1 0 0 1
References Study Quality
66 (32058837) 4
65 (27432666) 4
64 (21616277) 4
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 0 1 0 0 0 0 1 0
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 2 1 2 0 0 0 0 1
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 1
MRI cervical spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 1 0 0 0 0 0 0
Bone scan whole body with SPECT or SPECT/CT cervical spine Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 0 1 1 0 1 0 0
References Study Quality
41 (34698290) 4
81 (28681193) 2
80 (26266888) 4
79 (34113681) 4
78 (11037993) 1
CT cervical spine with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 1 2 1 1 1 0 0
References Study Quality
88 (22643393) 4
87 (12734742) 2
86 (23479714) 4
85 (23118135) 4
84 (16889148) 2
83 (26430596) 3
82 (18469691) 2
72 (27417403) 4
30 (31039024) 4
29 (31944834) 4
28 (30667316) 2
27 (33963025) 4
CT cervical spine without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 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 15 1 1 0 0 0 0 0 1
Variant 4: Adult. Suspected or known infection with acute or increasing cervical pain or radiculopathy. No trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical spine without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 5 0 12
References Study Quality
112 (24742801) 1
111 (25637321) 4
110 (24999081) 4
109 (12594568) 4
108 (15776239) 3
106 (12802004) 2
100 (20876624) 4
93 (15081128) 4
MRI cervical spine without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 1 0 4 7 4 0 1
References Study Quality
112 (24742801) 1
111 (25637321) 4
108 (15776239) 3
106 (12802004) 2
100 (20876624) 4
93 (15081128) 4
CT cervical spine with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 4 10 3 1 0 0
References Study Quality
103 (22677300) 4
97 (30527522) 4
94 (25296275) 4
CT cervical spine without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 4 13 1 0 0 0
References Study Quality
94 (25296275) 4
103 (22677300) 4
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 0 0 0 0 1 0 0 1
Radiography cervical spine Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 10 3 0 1 3 1 0 0 0
References Study Quality
113 (11316355) 4
103 (22677300) 4
100 (20876624) 4
99 (23122265) 4
94 (25296275) 4
Radiography cervical spine flexion extension lateral views Usually not appropriate Limited ☢☢ 0.1-1mSv 3 3 8 1 2 1 4 1 1 0 0
References Study Quality
113 (11316355) 4
103 (22677300) 4
100 (20876624) 4
99 (23122265) 4
94 (25296275) 4
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 0 1 1 1 0 0 0 1
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 1
MRI cervical spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 1 0 0 0 0 0
Bone scan whole body with SPECT or SPECT/CT cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 2 0 2 0 1 0 1
References Study Quality
102 (25475377) 4
101 (22889769) 2
100 (20876624) 4
CT cervical spine without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 1 1 3 0 0 0 1
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 1 0 0 0 0 0 1
CT myelography cervical spine Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 1 2 1 3 0 1 0 0
References Study Quality
66 (32058837) 4
65 (27432666) 4
64 (21616277) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 1 0 0 0 0 0 0 0
References Study Quality
105 (18525363) 4
104 (11914890) 4
102 (25475377) 4
100 (20876624) 4
Gallium scan whole body Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 9 0 4 0 3 1 1 0 0
References Study Quality
107 (1919723) 2
106 (12802004) 2
102 (25475377) 4
101 (22889769) 2
WBC scan whole body Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 3 2 0 0 0 0 0 0
References Study Quality
114 (19182734) 4
115 (29256136) 2
Variant 5: Adult. Diagnosis of malignancy with acute or increasing cervical pain or radiculopathy. No trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical spine without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 2 2 2 11
References Study Quality
133 (25412631) 4
1 (25659245) 4
46 (9460946) 2
136 (26339464) 4
126 (22487970) 4
123 (23470032) 4
119 (28507888) Inadequate
MRI cervical spine without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 0 4 5 5 1 2
References Study Quality
133 (25412631) 4
1 (25659245) 4
46 (9460946) 2
136 (26339464) 4
126 (22487970) 4
123 (23470032) 4
CT cervical spine with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 0 2 3 9 2 0 0 0
References Study Quality
125 (18191356) 3
127 (-3197175) 4
126 (22487970) 4
123 (23470032) 4
CT cervical spine without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 13 2 1 0 0
References Study Quality
125 (18191356) 3
126 (22487970) 4
123 (23470032) 4
FDG-PET/CT whole body May be appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 7 0 0 1 8 0 1 1 0
References Study Quality
130 (28250855) 4
129 (21887484) Good
128 (25475379) 4
126 (22487970) 4
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 0 0 0 0 1 0 0 1
Radiography cervical spine Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 10 2 2 2 1 0 0 1 0
References Study Quality
123 (23470032) 4
136 (26339464) 4
137 (22487972) 4
Radiography cervical spine flexion extension lateral views Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 16 2 0 0 0 0 0 0 0
References Study Quality
123 (23470032) 4
136 (26339464) 4
137 (22487972) 4
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 1 0 1 1 0 0 0 1
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 1 1 1 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 1 1 1 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 1 1 0 1 0 0 1
MRI cervical spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 1 0 0 0 0 0
Bone scan whole body with SPECT or SPECT/CT cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 2 1 0 0 0 0 0
References Study Quality
124 (35502272) 4
123 (23470032) 4
122 (22505821) 4
CT cervical spine without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 1 0 2 0 1 0 1
CTA neck with 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
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 14 3 1 0 0 0 0 0 0
References Study Quality
133 (25412631) 4
132 (24907940) 1
131 (27540427) 2
FDG-PET/MRI whole body Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 1 0 0 0 0 0 0
References Study Quality
133 (25412631) 4
132 (24907940) 1
131 (27540427) 2
CT myelography cervical spine Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 0 0 2 4 0 0 0 1
References Study Quality
66 (32058837) 4
65 (27432666) 4
64 (21616277) 4
Fluoride PET/CT whole body Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 1 1 1 1 1 0 0
References Study Quality
134 (28872551) 2
135 (19504092) 2
128 (25475379) 4
Variant 6: Adult. Suspected cervicogenic headache. No neurologic deficit. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 1 2 11 1 1 1 0
References Study Quality
141 (14510932) 2
147 (31495544) 2
142 (27927894) 2
140 (31820439) 4
138 (35332024) 4
Radiography cervical spine Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 10 2 1 2 2 1 0 0 0
References Study Quality
138 (35332024) 4
140 (31820439) 4
142 (27927894) 2
Radiography cervical spine flexion extension lateral views Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 15 2 0 0 0 1 0 0 0
References Study Quality
138 (35332024) 4
140 (31820439) 4
142 (27927894) 2
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 16 0 0 0 1 0 0 0 1
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 0 1 1 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 0 1 1 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 1 0 0 0 0 0 0 0
MRI cervical spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 2 0 1 0 0 0 1
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 15 0 2 0 0 0 1 0 0
References Study Quality
141 (14510932) 2
147 (31495544) 2
142 (27927894) 2
140 (31820439) 4
138 (35332024) 4
Bone scan whole body with SPECT or SPECT/CT cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 1 0 0 1 0
References Study Quality
41 (34698290) 4
81 (28681193) 2
CT cervical spine with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
References Study Quality
138 (35332024) 4
140 (31820439) 4
142 (27927894) 2
CT cervical spine without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 0 1 0 0 1
References Study Quality
138 (35332024) 4
140 (31820439) 4
142 (27927894) 2
CT cervical spine without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 3 1 0 2 0 0 0 0
References Study Quality
138 (35332024) 4
140 (31820439) 4
142 (27927894) 2
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 0 1 0 2 0 0 0 1
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 1 0 0 0 0 0 1
Variant 7: Adult. Chronic cervical pain without radiculopathy. No trauma or “red flags.” Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography cervical spine May be appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 1 0 0 3 8 4 2 0 0
References Study Quality
67 (33025192) 2
MRI cervical spine without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 1 3 12 1 0 0 0
References Study Quality
1 (25659245) 4
46 (9460946) 2
47 (17088193) 3
60 (25430861) 4
148 (34929370) 2
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 0 0 1 0 0 0 0 1
Radiography cervical spine flexion extension lateral views Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 11 2 0 1 3 1 0 0 0
References Study Quality
67 (33025192) 2
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 1 0 0 0 1 0 0 1
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 1
MRI cervical spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 2 0 0 0 0 0 1
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 13 0 2 1 0 0 0 0 2
References Study Quality
1 (25659245) 4
46 (9460946) 2
47 (17088193) 3
60 (25430861) 4
148 (34929370) 2
Bone scan whole body with SPECT or SPECT/CT cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 0 1 0 0 1 0 0
References Study Quality
41 (34698290) 4
150 (23412368) 3
151 (25985461) 4
CT cervical spine with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
CT cervical spine 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 0 0 1
CT cervical spine without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 3 2 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 0 2 0 0 0 0 0 1
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 0 1 0 0 0 0 1
Variant 8: Adult. Chronic cervical pain with radiculopathy. No trauma or “red flags.” Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical spine without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 3 1 5 3 5
References Study Quality
1 (25659245) 4
160 (33530213) 2
159 (30343168) 2
158 (27548342) 2
157 (29095415) 2
156 (36317351) 1
155 (30324384) 2
70 (35434382) 2
69 (19525791) 3
68 (2847516) 4
67 (33025192) 2
60 (25430861) 4
55 (21047885) 2
47 (17088193) 3
46 (9460946) 2
Radiography cervical spine May be appropriate (Disagreement) Expert Opinion ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 0 1 1 2 9 3 2 0 0
References Study Quality
67 (33025192) 2
71 (35276718) 2
CT cervical spine without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 2 13 2 0 0 0
References Study Quality
153 (35765137) 1
63 (26175589) 2
62 (16632616) 2
45 (28753389) 2
44 (35699680) 2
43 (20006557) 1
42 (17379279) Inadequate
Discography cervical spine Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 16 0 0 0 1 0 1 0 0
References Study Quality
40 (18204385) 4
Radiography cervical spine flexion extension lateral views Usually not appropriate Strong ☢☢ 0.1-1mSv 1 1 11 1 2 0 3 1 0 0 0
References Study Quality
67 (33025192) 2
71 (35276718) 2
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 1 0 1 1 0 0 0 1
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
MRI cervical spine with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 0 1 0 1
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 16 2 0 0 0 0 0 0 0
References Study Quality
1 (25659245) 4
160 (33530213) 2
159 (30343168) 2
158 (27548342) 2
157 (29095415) 2
156 (36317351) 1
155 (30324384) 2
70 (35434382) 2
69 (19525791) 3
68 (2847516) 4
60 (25430861) 4
55 (21047885) 2
47 (17088193) 3
46 (9460946) 2
Bone scan whole body with SPECT or SPECT/CT cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 0 0 1 0 1 0 0
References Study Quality
41 (34698290) 4
150 (23412368) 3
151 (25985461) 4
CT cervical spine with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
CT cervical spine without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 0 0 1 0 0 0 1
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 1 0 0 0 0 0 1
CT myelography cervical spine Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 2 0 0 0 1 0 0 0
References Study Quality
66 (32058837) 4
65 (27432666) 4
64 (21616277) 4
154 (23179977) 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.