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Appropriateness Criteria

Variant 1: Child. Congenital scoliosis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography complete spine Usually appropriate Limited ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 1 0 0 1 16
References Study Quality
12 (24782912) 4
21 (17945129) 4
22 (21057122) 4
23 (15114284) 4
MRI complete spine without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 0 0 1 2 0 3 7 4
References Study Quality
24 (23197014) 4
11 (15292418) 3
CT spine area of interest without IV contrast May be appropriate (Disagreement) Expert Opinion Varies Varies 5 5 1 2 2 3 6 3 0 0 0
References Study Quality
27 (19907198) 4
26 (21150659) 2
25 (19644327) 4
Bone scan complete spine Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 1 1 17 1 0 0 0 0 0 0 0
MRI complete spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 5 4 0 1 1 0 0 0
References Study Quality
24 (23197014) 4
11 (15292418) 3
CT spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 16 2 0 0 0 0 0 0 0
References Study Quality
27 (19907198) 4
26 (21150659) 2
25 (19644327) 4
CT spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 16 2 0 0 0 0 0 0 0
References Study Quality
27 (19907198) 4
26 (21150659) 2
25 (19644327) 4
Variant 2: Child (0 to 9 years of age). Early onset idiopathic scoliosis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography complete spine Usually appropriate Limited ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 0 0 0 0 18
References Study Quality
12 (24782912) 4
28 (23223957) 4
MRI complete spine without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 2 1 5 3 5 2
References Study Quality
30 (19454995) 4
28 (23223957) 4
9 (16845359) 4
29 (20173173) 4
Bone scan complete spine Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 1 1 16 2 0 0 0 0 0 0 0
MRI complete spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 4 2 1 1 2 0 0 0
References Study Quality
30 (19454995) 4
28 (23223957) 4
9 (16845359) 4
29 (20173173) 4
CT spine area of interest with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 16 2 0 0 0 0 0 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 16 2 0 0 0 0 0 0 0
CT spine area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 11 2 2 1 1 0 1 0 0
Variant 3: Adolescent (10 to 17 years of age). Adolescent idiopathic scoliosis. No risk factors. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography complete spine Usually appropriate Strong ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 0 0 0 0 18
References Study Quality
2 (22009775) 4
29 (20173173) 4
31 (21191550) 4
33 (21221052) 3
34 (15507812) 3
36 (21336177) 2
32 (17572623) 2
35 (24220308) 3
37 (17978661) 3
38 (18007242) 3
39 (17108820) 3
Bone scan complete spine Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 1 1 17 1 0 0 0 0 0 0 0
MRI complete spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 6 1 0 0 1 0 0 0
References Study Quality
5 (20479697) 4
4 (15466727) 3
MRI complete spine without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 5 3 1 0 0 0 0 0
References Study Quality
5 (20479697) 4
4 (15466727) 3
CT spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 17 1 0 0 0 0 0 0 0
References Study Quality
16 (18458587) 3
17 (22020579) 3
40 (22362109) 3
41 (20173177) 4
CT spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 17 0 1 0 0 0 0 0 0
References Study Quality
16 (18458587) 3
17 (22020579) 3
40 (22362109) 3
41 (20173177) 4
CT spine area of interest without IV contrast Usually not appropriate Limited Varies Varies 1 1 13 2 0 1 0 1 0 0 1
References Study Quality
16 (18458587) 3
17 (22020579) 3
40 (22362109) 3
41 (20173177) 4
Variant 4: Adolescent (10 to 17 years of age). Adolescent idiopathic scoliosis. Risk factors. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography complete spine Usually appropriate Strong ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 0 0 0 1 17
References Study Quality
2 (22009775) 4
29 (20173173) 4
31 (21191550) 4
33 (21221052) 3
34 (15507812) 3
36 (21336177) 2
32 (17572623) 2
35 (24220308) 3
37 (17978661) 3
38 (18007242) 3
39 (17108820) 3
MRI complete spine without IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 5 4 1 5 3
References Study Quality
45 (23472665) 4
3 (19308396) 4
7 (19506867) 4
9 (16845359) 4
5 (20479697) 4
43 (20081514) 4
8 (23143092) 4
42 (23064856) 4
6 (21178850) 3
44 (21194284) 4
46 (25421548) 2
4 (15466727) 3
47 (21194283) 3
Bone scan complete spine Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 1 1 15 3 0 0 0 0 0 0 0
MRI complete spine without and with IV contrast Usually not appropriate Moderate O 0 mSv O 0 mSv [ped] 2 2 7 3 2 3 2 0 1 0 0
References Study Quality
45 (23472665) 4
3 (19308396) 4
7 (19506867) 4
9 (16845359) 4
5 (20479697) 4
43 (20081514) 4
8 (23143092) 4
42 (23064856) 4
6 (21178850) 3
44 (21194284) 4
46 (25421548) 2
4 (15466727) 3
47 (21194283) 3
CT spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 16 1 1 0 0 0 0 0 0
References Study Quality
16 (18458587) 3
17 (22020579) 3
40 (22362109) 3
41 (20173177) 4
CT spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 16 1 0 0 0 1 0 0 0
References Study Quality
16 (18458587) 3
17 (22020579) 3
40 (22362109) 3
41 (20173177) 4
CT spine area of interest without IV contrast Usually not appropriate Limited Varies Varies 1 1 10 2 2 1 2 0 0 1 0
References Study Quality
16 (18458587) 3
17 (22020579) 3
40 (22362109) 3
41 (20173177) 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.