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Appropriateness Criteria

Variant 1: Child. Traumatic visual loss. Suspected orbital injury. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT orbits without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 0 0 0 4 13
References Study Quality
12 (18936032) 4
13 (21607931) 4
MRI head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 1 2 2 5 6 1 0 0 0
MRI orbits without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 1 2 6 6 0 0 1
References Study Quality
12 (18936032) 4
CT head without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 2 4 9 1 1 0 0
Radiography orbit Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 3 3 6 2 2 3 2 1 0 0 0
References Study Quality
12 (18936032) 4
13 (21607931) 4
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 4 0 2 1 0 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 4 1 1 0 0 1 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 6 0 0 0 0 0 0 0
MRI orbits without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 2 4 1 0 0 1 1 0
References Study Quality
12 (18936032) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 2 2 2 0 1 1 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 4 0 0 0 0 0 0 0
CT orbits with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 6 2 5 0 4 0 0 0 0
References Study Quality
13 (21607931) 4
12 (18936032) 4
CT orbits without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 7 0 0 0 0 0 0 0
References Study Quality
12 (18936032) 4
13 (21607931) 4
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 1 2 0 0 0 0 0
Variant 2: Child. Nontraumatic acute vision loss without papilledema. 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 and orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 2 0 1 1 1 11
References Study Quality
19 (31896804) 4
MRI complete spine without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 6 7 3 0 0
References Study Quality
20 (25695963) 4
21 (12601106) 3
22 (23858328) 4
MRI head and orbits without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 13 2 0 0 0
References Study Quality
19 (31896804) 4
MRI head without and with IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 6 8 2 0 0
References Study Quality
18 (8505818) 2
17 (26822746) 4
MRI head without IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 5 0 0 1 4 6 5 1 0 0
References Study Quality
18 (8505818) 2
17 (26822746) 4
MRI orbits without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 3 3 10 1 0 0
References Study Quality
19 (31896804) 4
CT head without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 2 3 1 3 6 0 2 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 2 1 3 0 0 0 1 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 4 2 0 0 1 0 0 1
MRI complete spine without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 3 10 3 0 1 0 0 0 0
References Study Quality
20 (25695963) 4
21 (12601106) 3
22 (23858328) 4
MRI orbits without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 4 4 4 2 0 0 0 0
References Study Quality
19 (31896804) 4
CT head and orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 4 1 2 0 0 0 0 1
CT head and orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 0 2 1 0 1 0 0
CT head and orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 4 2 2 0 0 1 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 3 1 1 1 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 11 1 0 2 0 0 1 1 0
CT orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 5 0 1 1 0 0 0 1
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 1 2 0 3 0 0 0 0
CT orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 1 0 1 0 0 1 0
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 6 0 0 0 0 0 1 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 5 0 1 0 0 0 1 0
Variant 3: Child with isolated nystagmus. 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 0 0 0 0 1 0 6 7 3
References Study Quality
29 (27518079) 3
MRI head and orbits without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 6 6 2 1 0
References Study Quality
27 (-3195267) 4
MRI head and orbits without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 4 12 1 0 0 0
References Study Quality
27 (-3195267) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 3 3 10 1 0 0
References Study Quality
29 (27518079) 3
MRI orbits without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 1 4 4 7 1 0 0 0
References Study Quality
29 (27518079) 3
MRI orbits without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 4 2 2 3 3 1 1 0 0
References Study Quality
29 (27518079) 3
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 8 0 0 0 0 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 3 1 1 3 1 0 0 0
CT head and orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 4 0 1 1 0 0 0 0
CT head and orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 1 1 0 0 0 0 1
CT head and orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 4 1 0 1 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 5 0 2 0 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 1 0 0 0 0 0 1
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 4 2 0 1 0 0 0 0
CT orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 4 0 1 1 0 0 0 0
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 3 1 0 0 0 0 0 1
CT orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 1 1 1 0 0 0 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 3 0 0 0 1 1 0 0
Variant 4: Child. Congenital or developmental abnormality leading to decreased visual acuity or vision loss. No leukocoria. Unilateral or bilateral. 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 and orbits without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 1 10 4
References Study Quality
2 (26208421) 4
34 (25128595) 2
33 (23972277) 2
32 (28982953) 4
MRI head and orbits without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 5 3 1 0 4 1 0 0
References Study Quality
2 (26208421) 4
34 (25128595) 2
33 (23972277) 2
32 (28982953) 4
MRI head without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 3 4 8 1 1 0
MRI orbits without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 1 0 10 4 1 0 0
References Study Quality
2 (26208421) 4
34 (25128595) 2
33 (23972277) 2
32 (28982953) 4
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 1 1 0 0 1 0 1
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 4 0 1 1 1 1 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 3 8 0 1 0 0 0 0
MRI orbits without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 3 5 7 2 0 0 0 0 0
References Study Quality
2 (26208421) 4
34 (25128595) 2
33 (23972277) 2
32 (28982953) 4
CT head and orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 3 2 0 1 1 0 0 0
CT head and orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 1 1 0 0 0 0 1
CT head and orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 3 1 0 4 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 4 1 0 1 1 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 4 2 1 0 0 0 0 1
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 3 2 2 0 1 0 0 0
CT orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 5 1 0 1 1 0 0 0
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 4 1 0 1 0 0 0 1
CT orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 4 2 0 1 1 0 0 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 0 0 0 1 1 0 0
Variant 5: Child. Vision loss and suspected optic pathway tumor, with or without a history of neurofibromatosis type 1. 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 and orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 1 1 3 10
References Study Quality
39 (30904949) 2
38 (29789890) 3
37 (31739524) 4
36 (28257299) 4
MRI head without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 11 6 0 0 0
MRI orbits without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 0 1 0 9 4 1 0 0
Radiography orbit Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 12 2 1 0 0 0 0 0 1
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 2 3 2 0 0 0 1 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 3 3 2 0 0 1 0 0
MRI head and orbits without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 5 6 0 3 0 0 0 0
References Study Quality
39 (30904949) 2
38 (29789890) 3
37 (31739524) 4
36 (28257299) 4
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 5 5 0 2 0 0 0 0
MRI orbits without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 4 4 0 1 0 0 0 0
CT head and orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 3 2 0 1 1 1 0 0
CT head and orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 0 1 1 0 0 0 1
CT head and orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 4 1 1 2 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 3 1 1 2 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 3 2 0 1 0 0 0 1
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 3 0 4 0 0 0 0 0
CT orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 4 1 1 0 2 0 0 0
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 4 0 1 1 0 0 0 1
CT orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 5 0 2 0 1 0 0 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 2 0 0 0 1 0 0
Variant 6: Child. Six months of age or older. Papilledema detected on the ophthalmologic examination or signs of raised intracranial pressure. 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 and orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 2 8 7
References Study Quality
42 (23966248) 4
43 (27585209) 4
MRI head and orbits without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 0 11 3 3
References Study Quality
42 (23966248) 4
43 (27585209) 4
MRI head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 0 0 9 5 2
References Study Quality
43 (27585209) 4
42 (23966248) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 5 10 1 0 1
References Study Quality
43 (27585209) 4
42 (23966248) 4
MRV head with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 3 5 8 0 1 0
References Study Quality
43 (27585209) 4
42 (23966248) 4
MRV head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 6 9 0 1 0
References Study Quality
43 (27585209) 4
42 (23966248) 4
MRV head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 6 7 3 0 1
References Study Quality
43 (27585209) 4
42 (23966248) 4
CT head without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 0 0 10 3 2 1 0
CTV head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 7 8 0 0 0
References Study Quality
42 (23966248) 4
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 3 0 2 1 1 1 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 4 0 2 1 1 1 0 0
MRI orbits without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 1 5 3 1 0 0 1 0
MRI orbits without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 1 6 3 0 0 1 0 0
CT head and orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 10 0 0 0 0 0 0 0
CT head and orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 8 0 0 0 0 0 0 0
CT head and orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 7 1 3 2 1 1 1 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 7 1 1 3 4 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 6 3 0 0 0 0 0 0
CT orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 8 0 0 0 0 0 0 0
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 1 3 1 1 0 0 0 1
CT orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 3 2 0 1 1 1 0 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 3 2 0 0 2 0 0 0
Variant 7: Child. Suspected orbital or periorbital infection. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT orbits with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 0 0 0 6 11
References Study Quality
46 (24288398) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 10 3 1 0 0
References Study Quality
46 (24288398) 4
MRI orbits without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 3 9 3 0 0
References Study Quality
46 (24288398) 4
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 1 1 12 3 0 0 0
References Study Quality
46 (24288398) 4
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 5 1 1 0 0 1 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 4 0 2 0 1 0 0 0
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 10 0 0 0 0 0 0 0
References Study Quality
46 (24288398) 4
MRI orbits without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 3 6 1 0 0 0 0 0
References Study Quality
46 (24288398) 4
MRV head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 5 3 0 0 0 0 0 0
MRV head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 8 0 0 0 0 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 5 4 0 0 0 0 0 0
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 8 0 0 0 0 0 0 0
References Study Quality
46 (24288398) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 3 3 0 1 1 1 0 0
References Study Quality
46 (24288398) 4
CT orbits without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 5 4 4 1 2 0 0 1 0
References Study Quality
46 (24288398) 4
CT orbits without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 4 7 5 1 0 0 0 0 0
References Study Quality
46 (24288398) 4
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 3 2 1 0 1 0 0 1
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 3 3 1 3 1 0 0 0
Variant 8: Child. Leukocoria or suspected intraocular mass. 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 and orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 1 0 0 0 1 1 0 13
References Study Quality
2 (26208421) 4
50 (23117972) 3
49 (25195185) 4
48 (25924174) 2
47 (22218144) 3
MRI orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 0 10 6 1
References Study Quality
2 (26208421) 4
48 (25924174) 2
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 2 1 3 4 6 1 0 0 0
References Study Quality
48 (25924174) 2
MRI orbits without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 6 1 7 3 0 0 0
References Study Quality
2 (26208421) 4
48 (25924174) 2
CT head and orbits with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 2 4 0 6 5 0 0 0 0
CT head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 5 1 0 2 9 0 0 0 0
CT orbits with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 5 1 0 4 7 0 0 0 0
References Study Quality
2 (26208421) 4
CT orbits without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 1 1 1 13 1 0 0 0
References Study Quality
2 (26208421) 4
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 2 0 0 1 0 1 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 2 0 1 0 0 0 0
MRI head and orbits without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 5 4 1 1 0 0 0 1
References Study Quality
2 (26208421) 4
50 (23117972) 3
49 (25195185) 4
48 (25924174) 2
47 (22218144) 3
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 0 4 2 2 1 1 0 0
References Study Quality
48 (25924174) 2
CT head and orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 0 0 0 0 0 0 0
CT head and orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 2 1 2 0 0 1 1 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 0 0 0 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 1 1 1 0 1 0 1 0
CT orbits without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 2 2 0 3 1 0 1 0
References Study Quality
2 (26208421) 4
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 2 0 0 0 1 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.