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Appropriateness Criteria

Variant 1: Child. Palpable abdominal mass. Suspected neoplasm. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 5 9
References Study Quality
1 (35718001) 3
Radiography abdomen Usually appropriate Strong ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 7 7 0 1 0 0 1 3 7 1 2
CT abdomen and pelvis with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 0 0 1 1 9 1 2
References Study Quality
27 (36220725) 4
20 (23192775) 2
1 (35718001) 3
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
US pelvis transabdominal May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 1 6 3 2 1 1
References Study Quality
1 (35718001) 3
MRI abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 3 5 3 0 2 1 0 0
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
29 (25135711) 2
CT chest abdomen pelvis with IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 0 0 7 6 0 0 1
References Study Quality
27 (36220725) 4
20 (23192775) 2
1 (35718001) 3
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
US abdomen with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 4 1 0 1 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 1 3 7 1 3 0 0 0 0
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
29 (25135711) 2
MRI abdomen without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 4 4 5 0 2 0 0 0 0
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
29 (25135711) 2
MRI abdomen without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 3 6 4 2 0 0 0 0 0
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
29 (25135711) 2
CT abdomen and pelvis without IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 2 6 1 2 0 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
CT abdomen with IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 8 2 1 0 0 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
1 (35718001) 3
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
CT abdomen without IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 4 4 1 2 0 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 1 0 1 0 0 0 0
References Study Quality
21 (28534182) 2
25 (34548851) Good
33 (27048532) 2
32 (26901021) 2
FDG-PET/MRI whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 2 0 1 0 0 0 0
References Study Quality
21 (28534182) 2
25 (34548851) Good
33 (27048532) 2
32 (26901021) 2
MIBG scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 1 0 1 0 0 0 0
References Study Quality
16 (31541036) 2
35 (27054367) 0
25 (34548851) Good
8 (26417712) 4
9 (23341514) 4
7 (23440556) 0
12 (28383813) 4
11 (26049371) 2
MIBG scan whole body with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv Varies 1 1 13 1 1 0 1 0 0 0 0
References Study Quality
16 (31541036) 2
35 (27054367) 0
25 (34548851) Good
8 (26417712) 4
9 (23341514) 4
7 (23440556) 0
12 (28383813) 4
11 (26049371) 2
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 4 8 3 0 0 0 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
CT abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 6 2 2 3 2 1 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 8 5 2 0 0 0 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 3 3 1 2 1 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 1 0 1 0 0 0 0
References Study Quality
10 (24563179) 1
31 (27609791) 3
37 (24481823) 2
42 (34372894) Good
25 (34548851) Good
39 (28072621) 3
40 (30683766) 4
38 (25572088) 4
32 (26901021) 2
36 (23955198) 4
8 (26417712) 4
41 (33629142) 4
11 (26049371) 2
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 3 1 0 1 0 0 0 0
References Study Quality
34 (37160439) 4
10 (24563179) 1
37 (24481823) 2
31 (27609791) 3
25 (34548851) Good
39 (28072621) 3
40 (30683766) 4
38 (25572088) 4
42 (34372894) Good
32 (26901021) 2
36 (23955198) 4
8 (26417712) 4
41 (33629142) 4
11 (26049371) 2
Variant 2: Child. Palpable abdominal mass. Suspected neoplasm. Radiography negative. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 1 5 9
CT abdomen and pelvis with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 0 0 1 2 1 4 3 4
References Study Quality
27 (36220725) 4
20 (23192775) 2
1 (35718001) 3
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
US pelvis transabdominal May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 1 0 2 3 2 5 1 0
MRI abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 3 5 2 2 2 0 0 1
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
29 (25135711) 2
CT abdomen without and with IV contrast May be appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 5 1 2 2 4 2 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
CT chest abdomen pelvis with IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 0 0 7 4 2 0 1
References Study Quality
27 (36220725) 4
20 (23192775) 2
1 (35718001) 3
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
US abdomen with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 5 0 1 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 0 3 8 1 3 0 0 0 0
References Study Quality
13 (23666206) 3
30 (27406610) 2
29 (25135711) 2
MRI abdomen without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 1 3 8 2 0 0 1 0 0
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
29 (25135711) 2
MRI abdomen without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 2 3 8 2 0 0 0 0 0
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
29 (25135711) 2
CT abdomen and pelvis without IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 4 3 2 1 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
CT abdomen with IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 2 6 5 2 0 0 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
1 (35718001) 3
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
CT abdomen without IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 5 2 3 0 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 3 0 0 0 0 0 0
References Study Quality
31 (27609791) 3
21 (28534182) 2
33 (27048532) 2
32 (26901021) 2
25 (34548851) Good
FDG-PET/MRI whole body Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 3 4 1 0 0 0 0 0
References Study Quality
21 (28534182) 2
25 (34548851) Good
33 (27048532) 2
32 (26901021) 2
MIBG scan whole body Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 3 2 0 2 0 0 0 0
References Study Quality
16 (31541036) 2
35 (27054367) 0
25 (34548851) Good
8 (26417712) 4
9 (23341514) 4
7 (23440556) 0
12 (28383813) 4
11 (26049371) 2
MIBG scan whole body with SPECT or SPECT/CT area of interest Usually not appropriate Strong ☢☢☢ 1-10 mSv Varies 1 1 9 3 2 0 2 0 0 0 0
References Study Quality
16 (31541036) 2
35 (27054367) 0
25 (34548851) Good
8 (26417712) 4
9 (23341514) 4
7 (23440556) 0
12 (28383813) 4
11 (26049371) 2
CT abdomen and pelvis without and with IV contrast Usually not appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 4 8 2 0 1 0 0 0 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 1 6 0 4 1 0 1 0
References Study Quality
27 (36220725) 4
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 2 4 2 3 0 0 0 0
References Study Quality
20 (23192775) 2
22 (26454401) 4
29 (25135711) 2
23 (27015902) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 5 2 0 0 0 0 0 0
References Study Quality
10 (24563179) 1
37 (24481823) 2
42 (34372894) Good
25 (34548851) Good
8 (26417712) 4
39 (28072621) 3
40 (30683766) 4
38 (25572088) 4
32 (26901021) 2
36 (23955198) 4
41 (33629142) 4
11 (26049371) 2
FDG-PET/CT whole body Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 2 0 1 0 0 0 0
References Study Quality
34 (37160439) 4
10 (24563179) 1
37 (24481823) 2
31 (27609791) 3
25 (34548851) Good
39 (28072621) 3
40 (30683766) 4
38 (25572088) 4
42 (34372894) Good
32 (26901021) 2
36 (23955198) 4
8 (26417712) 4
41 (33629142) 4
11 (26049371) 2
Variant 3: Child. Palpable abdominal wall mass. Suspected abdominal wall neoplasm. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 1 2 3 9
References Study Quality
1 (35718001) 3
CT abdomen and pelvis with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 0 0 2 2 5 4 1
MRI abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 1 1 2 3 3 2 2
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 0 4 6 4 0 0 0
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
MRI abdomen without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 0 4 5 3 1 1 1
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
MRI abdomen without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 1 4 8 1 1 0 0 0
References Study Quality
10 (24563179) 1
13 (23666206) 3
30 (27406610) 2
CT chest abdomen pelvis with IV contrast May be appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 0 4 9 1 0 0 0
US abdomen with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 4 2 0 0 0 0 0 0
US pelvis transabdominal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 3 4 1 0 0 0 0 0
References Study Quality
1 (35718001) 3
Radiography abdomen Usually not appropriate Strong ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 4 3 3 0 5 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 2 2 2 3 1 0 0 0
CT abdomen with IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 4 4 0 1 1 0 0 0
CT abdomen without IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 2 5 3 2 0 0 0 0
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 2 0 0 0 0 0 0
References Study Quality
21 (28534182) 2
25 (34548851) Good
33 (27048532) 2
32 (26901021) 2
FDG-PET/MRI whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 2 1 0 0 0 0 0
References Study Quality
21 (28534182) 2
25 (34548851) Good
33 (27048532) 2
32 (26901021) 2
MIBG scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 1 1 0 0 0 0 0
References Study Quality
35 (27054367) 0
25 (34548851) Good
8 (26417712) 4
12 (28383813) 4
9 (23341514) 4
7 (23440556) 0
MIBG scan whole body with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv Varies 1 1 12 2 1 1 0 0 0 0 0
References Study Quality
35 (27054367) 0
25 (34548851) Good
8 (26417712) 4
12 (28383813) 4
9 (23341514) 4
7 (23440556) 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 8 2 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 8 2 0 0 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 5 2 4 1 2 1 0 1 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 3 3 2 2 1 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 3 0 0 0 0 0 0
References Study Quality
10 (24563179) 1
31 (27609791) 3
37 (24481823) 2
42 (34372894) Good
25 (34548851) Good
39 (28072621) 3
40 (30683766) 4
38 (25572088) 4
32 (26901021) 2
36 (23955198) 4
8 (26417712) 4
41 (33629142) 4
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 2 1 0 0 0 0 0
References Study Quality
10 (24563179) 1
31 (27609791) 3
37 (24481823) 2
42 (34372894) Good
25 (34548851) Good
39 (28072621) 3
40 (30683766) 4
38 (25572088) 4
32 (26901021) 2
36 (23955198) 4
8 (26417712) 4
41 (33629142) 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.