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Appropriateness Criteria

Variant 1: Child. Uncomplicated acute sinusitis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography paranasal sinuses Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 17 0 0 0 1 0 0 0 0
MRI paranasal sinuses without and with 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 paranasal sinuses without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 0 0 0 1 0 0
CT paranasal sinuses with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 3 0 0 0 0 0 0 0
CT paranasal sinuses without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 0 0 0 0 0 0 2
CT paranasal sinuses without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 1 0 0 0 0 0 0 0
Variant 2: Child. Persistent sinusitis (worsening course or severe presentation, or not responding to treatment), or recurrent sinusitis, or chronic sinusitis, or define paranasal sinus anatomy before functional endoscopic sinus surgery. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT paranasal sinuses without IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 4 0 2 2 10
References Study Quality
52 (8327669) 4
49 (1787970) 4
1 (11533355) 4
9 (16416688) 4
57 (16015392) 4
19 (1626907) 4
20 (2000009) 4
23 (16025049) 4
47 (2816644) 4
45 (1529853) 4
46 (1528599) 4
41 (8361320) 4
42 (8247570) 4
43 (15907892) 4
48 (8361292) 4
44 (1590190) 4
50 (2251468) 4
51 (8373095) 4
55 (12111059) 4
56 (15855126) 3
17 (22297923) 4
54 (17767608) 4
53 (22762849) 4
58 (19418533) 3
Radiography paranasal sinuses Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 11 3 2 1 1 0 0 0 0
References Study Quality
62 (2685721) 4
47 (2816644) 4
45 (1529853) 4
46 (1528599) 4
61 (-3091644) 4
63 (589833) 4
64 (11069741) 2
16 (19839249) 3
17 (22297923) 4
54 (17767608) 4
MRI paranasal sinuses without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 4 3 0 0 0 0 0 0
References Study Quality
59 (95100004) 4
61 (-3091644) 4
60 (3363145) 4
MRI paranasal sinuses without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 9 2 4 1 2 1 0 0 0
References Study Quality
59 (95100004) 4
61 (-3091644) 4
60 (3363145) 4
CT paranasal sinuses with IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 4 4 0 0 0 0 0 0
References Study Quality
52 (8327669) 4
49 (1787970) 4
1 (11533355) 4
9 (16416688) 4
57 (16015392) 4
19 (1626907) 4
20 (2000009) 4
23 (16025049) 4
47 (2816644) 4
45 (1529853) 4
46 (1528599) 4
41 (8361320) 4
42 (8247570) 4
43 (15907892) 4
48 (8361292) 4
44 (1590190) 4
50 (2251468) 4
51 (8373095) 4
55 (12111059) 4
56 (15855126) 3
17 (22297923) 4
54 (17767608) 4
53 (22762849) 4
58 (19418533) 3
CT paranasal sinuses without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 3 1 0 0 0 0 0
References Study Quality
52 (8327669) 4
49 (1787970) 4
1 (11533355) 4
9 (16416688) 4
57 (16015392) 4
19 (1626907) 4
20 (2000009) 4
23 (16025049) 4
47 (2816644) 4
45 (1529853) 4
46 (1528599) 4
41 (8361320) 4
42 (8247570) 4
43 (15907892) 4
48 (8361292) 4
44 (1590190) 4
50 (2251468) 4
51 (8373095) 4
55 (12111059) 4
56 (15855126) 3
54 (17767608) 4
53 (22762849) 4
58 (19418533) 3
Variant 3: Child. Sinusitis with clinical concern of orbital or intracranial complications. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT head and paranasal sinuses with IV contrast Usually appropriate Limited ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 0 0 1 8 9
References Study Quality
65 (3174990) 3
23 (16025049) 4
MRI head and paranasal sinuses without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 2 0 1 6 8
References Study Quality
25 (11889374) 3
21 (16982973) 4
61 (-3091644) 4
MRA head with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 2 2 0 7 7 1 0 0 0
References Study Quality
66 (19001644) 4
MRA head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 1 3 13 1 0 0 0
References Study Quality
66 (19001644) 4
MRV head with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 8 5 2 2 0
References Study Quality
21 (16982973) 4
22 (21416657) 4
19 (1626907) 4
20 (2000009) 4
23 (16025049) 4
MRV head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 2 0 1 2 9 4 1 0 0
References Study Quality
21 (16982973) 4
22 (21416657) 4
19 (1626907) 4
20 (2000009) 4
23 (16025049) 4
MRV head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 2 0 1 3 9 3 1 0 0
References Study Quality
21 (16982973) 4
22 (21416657) 4
19 (1626907) 4
20 (2000009) 4
23 (16025049) 4
CTA head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 3 13 2 0 0 0
References Study Quality
66 (19001644) 4
CTV head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 8 3 5 0 0
References Study Quality
25 (11889374) 3
22 (21416657) 4
23 (16025049) 4
Radiography paranasal sinuses Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 2 0 0 0 0 0 0 0
CT head and paranasal sinuses without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 4 2 0 0 0 0 0
References Study Quality
65 (3174990) 3
23 (16025049) 4
CT head and paranasal sinuses without IV contrast Usually not appropriate Limited ☢☢☢ 0.3-3 mSv [ped] 3 3 3 5 5 1 2 2 0 0 0
References Study Quality
65 (3174990) 3
23 (16025049) 4
MRI head and paranasal sinuses without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 2 7 4 3 0 0 0 0
References Study Quality
25 (11889374) 3
21 (16982973) 4
61 (-3091644) 4
Variant 4: Child. Suspected invasive fungal sinusitis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI paranasal sinuses without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 1 0 1 3 12
References Study Quality
25 (11889374) 3
21 (16982973) 4
61 (-3091644) 4
70 (22006778) 2
CT paranasal sinuses with IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 1 0 0 0 0 2 6 9
References Study Quality
65 (3174990) 3
23 (16025049) 4
68 (24923371) 3
69 (23271503) 4
67 (21400253) 2
MRA head with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 1 1 4 5 7 1 0 0 0
MRA head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 1 3 3 9 2 0 0 0
MRV head with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 0 1 0 8 5 1 2 0
MRV head without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 2 4 0 7 3 0 0 0
MRV head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 1 4 0 12 1 0 0 0
CTA head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 1 5 0 9 2 0 0 0
CTV head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 0 9 2 5 0 0
Radiography paranasal sinuses Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 17 1 0 0 0 0 0 0 0
MRI paranasal sinuses without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 1 5 3 5 1 0 0 0
References Study Quality
25 (11889374) 3
21 (16982973) 4
61 (-3091644) 4
70 (22006778) 2
CT paranasal sinuses without IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 3 0 8 0 7 0 0 0 1
References Study Quality
65 (3174990) 3
23 (16025049) 4
68 (24923371) 3
69 (23271503) 4
67 (21400253) 2
CT paranasal sinuses without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 5 0 1 0 0 0 0
References Study Quality
65 (3174990) 3
23 (16025049) 4
68 (24923371) 3
69 (23271503) 4
67 (21400253) 2
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.