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Appropriateness Criteria

Variant 1: Child age older than 6 months. Emergent imaging for clinical presentation suggestive of acute nonsickle–cell related stroke. New focal fixed or worsening neurologic defect lasting less than 24 hours from last seen normal state. No contraindications to emergent intervention. 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 2 0 0 0 0 2 3 6 5
References Study Quality
17 (20113901) 4
26 (15703900) 4
27 (21220720) 3
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 1 0 0 0 0 1 2 15
References Study Quality
20 (19039041) 4
6 (20054007) 4
18 (19216043) 4
16 (20445969) 4
17 (20113901) 4
19 (20625171) 4
22 (12743660) 2
23 (21975501) 4
24 (25063989) 3
21 (16841210) 3
25 (28705823) 4
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 1 0 0 0 0 2 4 6 6
References Study Quality
16 (20445969) 4
MRI head perfusion with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 2 0 1 0 7 7 1 0 0
References Study Quality
29 (17066483) 3
17 (20113901) 4
19 (20625171) 4
MRI head perfusion without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 2 13 3 0 1 0
References Study Quality
29 (17066483) 3
17 (20113901) 4
19 (20625171) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 1 0 0 9 5 2 1 0 0
References Study Quality
20 (19039041) 4
6 (20054007) 4
18 (19216043) 4
16 (20445969) 4
17 (20113901) 4
19 (20625171) 4
22 (12743660) 2
23 (21975501) 4
24 (25063989) 3
21 (16841210) 3
25 (28705823) 4
CTA head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 0 0 0 7 10 0 0 0
References Study Quality
17 (20113901) 4
Arteriography cervicocerebral Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 5 1 0 0 0 0 0 0
References Study Quality
30 (24483252) 4
31 (9799310) 4
MRA head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 2 6 2 1 1 0 0 0
References Study Quality
17 (20113901) 4
26 (15703900) 4
27 (21220720) 3
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 3 4 1 0 0 0 0 0
References Study Quality
20 (19039041) 4
6 (20054007) 4
18 (19216043) 4
16 (20445969) 4
17 (20113901) 4
19 (20625171) 4
22 (12743660) 2
23 (21975501) 4
24 (25063989) 3
21 (16841210) 3
25 (28705823) 4
CT head perfusion with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 10 2 5 1 0 0 0 0 0
References Study Quality
28 (22209434) 4
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 3 0 1 0 1 0 1
References Study Quality
16 (20445969) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 4 1 2 1 0 1 0 1
References Study Quality
16 (20445969) 4
Variant 2: Child. Clinical presentation suggestive of acute stroke, not a candidate for emergent intervention. 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] 7 7 1 0 0 0 2 1 7 3 4
References Study Quality
17 (20113901) 4
26 (15703900) 4
27 (21220720) 3
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 1 0 0 0 0 1 2 15
References Study Quality
20 (19039041) 4
6 (20054007) 4
18 (19216043) 4
16 (20445969) 4
17 (20113901) 4
19 (20625171) 4
22 (12743660) 2
23 (21975501) 4
24 (25063989) 3
21 (16841210) 3
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 1 0 1 0 2 1 3 6 5
References Study Quality
16 (20445969) 4
MRI head perfusion with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 0 5 7 3 1 0 0
References Study Quality
29 (17066483) 3
17 (20113901) 4
19 (20625171) 4
MRI head perfusion without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 0 2 11 3 1 1 0
References Study Quality
29 (17066483) 3
17 (20113901) 4
19 (20625171) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 7 5 3 1 1 0
References Study Quality
20 (19039041) 4
6 (20054007) 4
18 (19216043) 4
16 (20445969) 4
17 (20113901) 4
19 (20625171) 4
22 (12743660) 2
23 (21975501) 4
24 (25063989) 3
21 (16841210) 3
CTA head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 1 12 4 0 0 0
References Study Quality
17 (20113901) 4
US duplex Doppler transcranial Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 3 2 0 0 0 0 1 0
References Study Quality
30 (24483252) 4
31 (9799310) 4
MRA head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 4 4 2 1 0 0 0 0
References Study Quality
17 (20113901) 4
26 (15703900) 4
27 (21220720) 3
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 4 5 1 0 0 0 0 0
References Study Quality
20 (19039041) 4
6 (20054007) 4
18 (19216043) 4
16 (20445969) 4
17 (20113901) 4
19 (20625171) 4
22 (12743660) 2
23 (21975501) 4
24 (25063989) 3
21 (16841210) 3
CT head perfusion with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 5 0 1 0 0 0 0 0
References Study Quality
28 (22209434) 4
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 3 2 0 1 1 0 0 1
References Study Quality
16 (20445969) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 4 1 0 0 0 0 0 0
References Study Quality
16 (20445969) 4
Variant 3: Child. Clinical presentation suggestive of acute stroke, known or suspected arteriopathy, or moyamoya. Not a candidate for emergent treatment. 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 Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 3 1 3 10
MRI head without IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 0 2 1 15
References Study Quality
45 (15703904) 4
44 (24558166) M
15 (29364767) 1
MRI head perfusion with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 2 8 5 1 1 0
References Study Quality
39 (22462697) 4
46 (24335546) 2
48 (24335813) 4
49 (24055185) 3
47 (29581340) 3
MRI head perfusion without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 0 2 11 4 0 1 0
References Study Quality
39 (22462697) 4
46 (24335546) 2
48 (24335813) 4
49 (24055185) 3
47 (29581340) 3
MRI head without and with IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 5 1 0 0 4 8 3 2 0 0
References Study Quality
45 (15703904) 4
44 (24558166) M
15 (29364767) 1
CT head without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 0 0 6 9 2 0 1
References Study Quality
43 (9885601) 2
CTA head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 0 0 1 6 8 2 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 3 3 0 0 1 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 7 1 6 3 0 1 0 0 0
MRI head with IV contrast Usually not appropriate Moderate O 0 mSv O 0 mSv [ped] 2 2 8 2 5 3 0 0 0 0 0
References Study Quality
45 (15703904) 4
44 (24558166) M
15 (29364767) 1
CT head perfusion with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 7 1 3 1 5 1 0 1 0
References Study Quality
28 (22209434) 4
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 5 2 1 0 0 0 0 0
References Study Quality
43 (9885601) 2
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 5 1 1 0 0 0 0 0
References Study Quality
43 (9885601) 2
SPECT or SPECT/CT brain perfusion Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 5 0 1 0 0 0 0
References Study Quality
39 (22462697) 4
Variant 4: Child. Known or suspected cervicocranial arterial dissection based on clinical or imaging findings. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA head and neck without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 1 0 0 0 1 1 8 7
References Study Quality
52 (21979145) 4
53 (19351813) 3
MRI head and neck without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 1 6 10
References Study Quality
52 (21979145) 4
50 (25987283) 4
53 (19351813) 3
CTA head and neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 0 3 1 9 5
References Study Quality
52 (21979145) 4
50 (25987283) 4
Arteriography cervicocerebral May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 0 0 2 5 8 0 2 0
References Study Quality
52 (21979145) 4
53 (19351813) 3
MRA head and neck with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 0 0 0 1 1 5 4 5
References Study Quality
52 (21979145) 4
53 (19351813) 3
MRI head and neck with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 0 5 5 4 1 2 0
References Study Quality
52 (21979145) 4
50 (25987283) 4
53 (19351813) 3
MRI head and neck without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 1 4 8 4 0 0
References Study Quality
52 (21979145) 4
50 (25987283) 4
53 (19351813) 3
CT head without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 1 0 0 2 3 12 0 0 0
References Study Quality
52 (21979145) 4
43 (9885601) 2
US duplex Doppler transcranial and carotid artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 4 0 0 0 0 1 0
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 5 7 6 0 0 0 0 1 0
References Study Quality
52 (21979145) 4
43 (9885601) 2
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 5 5 1 0 0 0 0 1
References Study Quality
52 (21979145) 4
43 (9885601) 2
Variant 5: Child. Clinical presentation suggestive of acute stroke, known or suspected central nervous system 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 2 2 3 3 9
References Study Quality
17 (20113901) 4
MRI head without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 1 9 4 4
MRI head without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 1 2 9 6
CTA head with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 3 7 4 4
References Study Quality
17 (20113901) 4
Arteriography cervicocerebral May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 2 7 6 2 0 0
References Study Quality
17 (20113901) 4
MRA head with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 0 6 10 1 0 0
References Study Quality
17 (20113901) 4
MRI head with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 0 2 3 6 3 1 0 0
CT head without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 1 0 0 2 5 9 1 0 0
References Study Quality
56 (15986347) 4
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 5 6 0 0 1 0 0 1
References Study Quality
56 (15986347) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 4 1 0 0 0 1 0
References Study Quality
56 (15986347) 4
Variant 6: Child. Nontraumatic intraparenchymal hemorrhage (hematoma) found on CT or MRI. Unknown etiology. 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] 7 7 1 0 0 0 0 2 10 2 3
References Study Quality
61 (26795616) 4
60 (22816607) 4
MRA head without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 2 0 0 0 1 1 4 11
MRI head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 1 9 4 3
References Study Quality
24 (25063989) 3
CTA head with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 1 0 0 0 2 6 3 7
MRA head with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 5 7 5 1 0
MRI head with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 0 0 2 6 5 2 1 0
References Study Quality
24 (25063989) 3
MRI head without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 1 2 6 3 5 0 0
References Study Quality
24 (25063989) 3
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 7 2 7 1 1 0 0 0 0
References Study Quality
59 (24156863) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 6 1 0 1 0 0 0 0
References Study Quality
59 (24156863) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 4 5 0 1 0 1 1 0
References Study Quality
59 (24156863) 4
Variant 7: Child. Nontraumatic subarachnoid hemorrhage (SAH) detected by noncontrast 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] 7 7 0 0 1 1 1 3 4 1 8
References Study Quality
51 (24156864) 4
60 (22816607) 4
MRA head without IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 9 9 0 0 2 0 0 1 2 2 12
References Study Quality
67 (24326447) Good
51 (24156864) 4
68 (9933265) M
CTA head with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 2 8 8
References Study Quality
66 (21990495) Good
65 (22143927) 2
MRA head with IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 4 9 3 2 0
References Study Quality
67 (24326447) Good
51 (24156864) 4
68 (9933265) M
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 11 5 0 0 1
References Study Quality
63 (19357386) 4
60 (22816607) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 1 11 5 0 0 0
References Study Quality
63 (19357386) 4
60 (22816607) 4
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 8 1 5 3 1 0 0 0 0
References Study Quality
63 (19357386) 4
60 (22816607) 4
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 4 6 1 0 1 1 0 0
References Study Quality
59 (24156863) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 2 6 2 0 1 0 0 0
References Study Quality
59 (24156863) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 9 3 5 1 0 0 0 0 0
References Study Quality
59 (24156863) 4
Variant 8: Child. Clinical presentation suggestive of acute stroke, known or suspected high-flow vascular anomaly. 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 Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 1 0 0 0 1 1 7 9
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 1 3 5 8
References Study Quality
24 (25063989) 3
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 0 0 0 2 6 3 7
References Study Quality
59 (24156863) 4
CTA head with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 0 1 3 7 7
Arteriography cervicocerebral May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 5 4 4 2 0 0 0 3 0
References Study Quality
59 (24156863) 4
71 (24286156) 2
MRA head with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 4 1 5 8 0 0
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 4 11 1 1 1
References Study Quality
24 (25063989) 3
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 3 5 2 3 0 0 0 0
References Study Quality
24 (25063989) 3
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 6 6 0 0 0 0 0 0
References Study Quality
59 (24156863) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 9 1 0 0 0 0 0 0
References Study Quality
59 (24156863) 4
Variant 9: Child. Clinical presentation suggestive of acute stroke, known or suspected low-flow vascular anomaly. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 3 4 10
References Study Quality
75 (26272978) 4
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 2 0 0 0 3 3 5 4 3
References Study Quality
61 (26795616) 4
MRA head without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 5 2 6 0 1 0 2 0 2
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 3 6 5 1 1
References Study Quality
75 (26272978) 4
CTA head with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 6 2 5 1 1 3 0 0 0
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 4 1 0 0 0 0 0
References Study Quality
61 (26795616) 4
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 2 5 1 3 1 0 0 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 4 2 3 1 0 1 0 0
References Study Quality
75 (26272978) 4
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 9 4 4 1 0 0 0 0 0
References Study Quality
61 (26795616) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 3 4 0 4 0 0 1 1
References Study Quality
61 (26795616) 4
Variant 10: Child. Clinical presentation suggestive of acute stroke, known or suspected cortical vein or dural venous sinus thrombosis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 1 0 0 1 1 3 5 7
References Study Quality
77 (23212594) 4
80 (22948810) 4
81 (25938564) 2
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 0 1 4 3 7 0 3
References Study Quality
77 (23212594) 4
80 (22948810) 4
81 (25938564) 2
MRV head with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 1 3 3 11
References Study Quality
80 (22948810) 4
MRV head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 7 3 7
References Study Quality
80 (22948810) 4
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 0 0 0 5 5 3 5
References Study Quality
77 (23212594) 4
80 (22948810) 4
79 (20437556) 1
CTV head with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 1 0 0 1 2 2 5 8
US duplex Doppler transcranial Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 4 3 1 1 0 0 2 0
MRI head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 3 3 0 3 2 0 0 0
References Study Quality
77 (23212594) 4
80 (22948810) 4
81 (25938564) 2
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 6 1 5 1 4 0 1 0 0
References Study Quality
77 (23212594) 4
80 (22948810) 4
79 (20437556) 1
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 4 2 2 1 0 1 0 0
References Study Quality
77 (23212594) 4
80 (22948810) 4
79 (20437556) 1
Variant 11: Child. Clinical presentation suggestive of acute stroke, sickle cell disease. New focal fixed or worsening neurologic defect. 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 Moderate O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 1 1 0 6 9
References Study Quality
39 (22462697) 4
84 (8733975) 4
26 (15703900) 4
44 (24558166) M
85 (24914136) 1
MRI head without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 1 1 0 3 13
CT head without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 0 0 0 1 11 3 3
References Study Quality
26 (15703900) 4
US duplex Doppler transcranial Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 4 2 0 3 1 0 0 0
References Study Quality
26 (15703900) 4
MRA head with IV contrast Usually not appropriate Moderate O 0 mSv O 0 mSv [ped] 2 2 6 6 1 3 2 0 0 0 0
References Study Quality
39 (22462697) 4
84 (8733975) 4
26 (15703900) 4
44 (24558166) M
85 (24914136) 1
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 4 3 1 0 1 0 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 5 4 0 0 0 1 0 0
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 5 5 1 1 0 0 1 0
References Study Quality
26 (15703900) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 2 2 0 0 1 1 0
References Study Quality
26 (15703900) 4
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 5 2 2 2 1 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.