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Appropriateness Criteria

Variant 1: Child. Appendicular joint pain or swelling. Suspected idiopathic arthritis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography area of interest Usually appropriate Limited Varies Varies 9 9 0 0 0 0 1 0 5 2 9
References Study Quality
25 (23983057) 2
24 (35233961) 4
23 (34020469) 4
22 (29582130) 4
6 (27931964) 4
8 (23283407) 4
4 (32399709) 4
US area of interest May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 1 2 5 3 2 3
References Study Quality
32 (29437586) 3
31 (36182106) 4
30 (30223838) 1
29 (36754113) 4
27 (33374013) 2
28 (37221153) 4
4 (32399709) 4
1 (28779188) 4
21 (36472701) 2
2 (28291375) 4
26 (36614888) 4
MRI area of interest without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 2 1 6 6 1 0 0
References Study Quality
19 (27252505) 4
18 (25979714) 4
14 (22764042) 4
15 (30076429) 3
17 (26233246) 2
16 (23370941) 1
4 (32399709) 4
13 (23085866) 4
MRI area of interest without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 2 2 3 7 3 0 0 0 0
References Study Quality
4 (32399709) 4
16 (23370941) 1
21 (36472701) 2
20 (28608162) 3
US area of interest with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 2 1 2 0 1 1 0 0
References Study Quality
33 (33783575) 4
MRI whole body without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 2 1 0 0 0 1 0
MRI whole body without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 2 4 2 0 0 0 0 0
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 1 1 0 0 0 0 0
Bone scan whole body with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 1 1 0 0 0 0 0
Bone scan with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 2 1 1 0 0 0 0
FDG-PET/MRI whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 1 1 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 1 1 0 0 0 0 0
CT area of interest with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 11 3 2 0 1 0 0 0 0
CT area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 14 1 1 0 0 1 0 0 0
CT area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 13 2 1 0 1 0 0 0 0
Variant 2: Child. Back pain. Suspected idiopathic arthritis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI complete spine without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 1 0 2 4 9 0 0
References Study Quality
4 (32399709) 4
34 (24593886) 4
35 (34115188) 3
MRI spine area of interest without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 2 3 2 1 6 3
References Study Quality
4 (32399709) 4
34 (24593886) 4
Radiography complete spine May be appropriate Limited ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 1 3 6 4 2 1 0
References Study Quality
4 (32399709) 4
23 (34020469) 4
Radiography spine area of interest May be appropriate Limited Varies Varies 6 6 0 0 1 1 5 7 1 1 1
References Study Quality
4 (32399709) 4
23 (34020469) 4
MRI complete spine without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 1 3 6 4 3 0 0 0
References Study Quality
7 (38015293) 4
27 (33374013) 2
MRI spine area of interest without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 3 4 6 4 0 0 0
References Study Quality
7 (38015293) 4
27 (33374013) 2
US spine area of interest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 1 1 0 1 0 0 0
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 2 2 0 0 0 0 0
Bone scan whole body with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 2 2 0 0 0 0 0
Bone scan with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 3 1 0 1 0 0 0
FDG-PET/MRI whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 1 1 0 0 0 0 0
CT complete spine with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 1 0 1 0 0 0 0
CT complete spine without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 0 0 1 0 0 0 0
CT complete spine without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 4 0 1 1 0 0 0 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 1 1 0 0 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 11 2 2 1 0 0 1 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 13 3 0 0 0 1 0 0 0
CT spine area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 10 3 1 1 2 0 0 0 0
Variant 3: Child. Sacroiliac joint pain. Suspected idiopathic arthritis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI sacroiliac joints without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 2 0 1 4 3 7
References Study Quality
42 (30623211) 2
41 (26201675) 1
9 (34311986) 4
10 (34311987) 4
38 (25892309) 4
Radiography pelvis May be appropriate (Disagreement) Expert Opinion ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 0 1 1 2 7 3 2 1 0
References Study Quality
4 (32399709) 4
23 (34020469) 4
43 (29996925) 2
Radiography sacroiliac joints May be appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 6 6 0 0 0 2 4 3 5 1 2
References Study Quality
4 (32399709) 4
23 (34020469) 4
43 (29996925) 2
MRI sacroiliac joints and lumbar spine without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 2 1 4 9 1 0 0 0
References Study Quality
40 (27376529) 2
MRI sacroiliac joints and lumbar spine without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 4 11 1 0 0 0
References Study Quality
7 (38015293) 4
US sacroiliac joints Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 1 0 0 0 0
MRI sacroiliac joints without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 3 2 1 5 2 0 0 0
References Study Quality
41 (26201675) 1
38 (25892309) 4
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 3 1 0 0 0 0 0
Bone scan with SPECT or SPECT/CT sacroiliac joints Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 2 3 2 0 1 0 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 1 0 0 0 1 0 0
CT pelvis without IV contrast Usually not appropriate Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 2 2 1 0 0 1 0
References Study Quality
37 (36629936) 4
39 (30976556) 4
FDG-PET/MRI whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 1 1 0 0 0 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 0 0 0 0 1 0 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 1 1 0 0 0 0 0
Variant 4: Child. Temporomandibular joint pain. Suspected idiopathic arthritis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI temporomandibular joint without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 2 2 2 10
References Study Quality
11 (29134239) 4
45 (36944679) 4
46 (29766249) 4
Radiography temporomandibular joint Usually not appropriate Limited ☢☢ 0.03-0.3 mSv [ped] 2 2 6 3 2 5 1 0 0 0 0
References Study Quality
22 (29582130) 4
47 (36782277) 3
US head and neck Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 0 2 0 2 0 0 0 0
References Study Quality
48 (31396836) 4
MRI temporomandibular joint without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 4 7 0 0 0 0 0 0
References Study Quality
4 (32399709) 4
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 0 1 1 0 0 0 1 0
CT maxillofacial without IV contrast Usually not appropriate Expert Opinion ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 1 1 1 1 1 0 0 0
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 1 0 0 0 0 0 0
Bone scan with SPECT or SPECT/CT maxillofacial Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 0 1 0 2 0 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 0 0 0 0 0 1 0 0
FDG-PET/MRI whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 1 1 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 1 0 0 0 0 0
Variant 5: Child. Appendicular joint pain or swelling. Idiopathic arthritis. Follow-up imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US area of interest Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 0 1 1 5 3 2 4
References Study Quality
53 (36530040) 4
52 (37117764) 4
1 (28779188) 4
32 (29437586) 3
2 (28291375) 4
26 (36614888) 4
MRI area of interest without and with IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 1 3 4 7
References Study Quality
50 (34286915) 4
19 (27252505) 4
4 (32399709) 4
18 (25979714) 4
16 (23370941) 1
Radiography area of interest May be appropriate (Disagreement) Expert Opinion Varies Varies 5 5 4 5 1 3 1 2 1 0 0
References Study Quality
22 (29582130) 4
25 (23983057) 2
MRI area of interest without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 1 6 2 7 1 0 0
References Study Quality
4 (32399709) 4
16 (23370941) 1
21 (36472701) 2
20 (28608162) 3
US area of interest with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 2 0 0 1 1 0 0
MRI whole body without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 5 4 1 2 0 0 0 0
References Study Quality
51 (34465447) 4
MRI whole body without IV contrast Usually not appropriate Expert Opinion O 0 mSv O 0 mSv [ped] 3 3 5 3 2 4 1 2 0 0 0
References Study Quality
7 (38015293) 4
51 (34465447) 4
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 1 1 0 0 0 0 0
Bone scan whole body with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 0 2 1 0 0 0 0 0
Bone scan with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 1 0 2 0 0 0 0
FDG-PET/MRI whole body Usually not appropriate Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 1 3 2 1 0 0 0
References Study Quality
49 (20523983) 1
FDG-PET/CT whole body Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 4 1 2 2 1 0 0 0
References Study Quality
49 (20523983) 1
CT area of interest with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 12 2 2 0 0 0 0 1 0
CT area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 14 0 2 0 0 0 0 1 0
CT area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 15 0 1 0 0 1 0 0 0
Variant 6: Child. Back pain. Idiopathic arthritis. Follow-up imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI complete spine without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 1 5 1 5 4
References Study Quality
7 (38015293) 4
MRI spine area of interest without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 2 1 2 6 5
References Study Quality
7 (38015293) 4
MRI complete spine without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 2 8 5 1 0 0
References Study Quality
7 (38015293) 4
27 (33374013) 2
MRI spine area of interest without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 0 2 5 4 5 0 0
References Study Quality
7 (38015293) 4
27 (33374013) 2
Radiography complete spine Usually not appropriate Limited ☢☢☢ 0.3-3 mSv [ped] 2 2 5 5 1 4 1 0 1 0 0
References Study Quality
4 (32399709) 4
7 (38015293) 4
22 (29582130) 4
US spine area of interest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 1 1 1 0 0 0 0
Radiography spine area of interest Usually not appropriate Limited Varies Varies 2 2 4 5 3 1 2 1 1 0 0
References Study Quality
4 (32399709) 4
7 (38015293) 4
22 (29582130) 4
54 (34945094) 2
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 1 2 0 0 0 0 0
Bone scan whole body with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 0 3 0 0 0 0 0
Bone scan with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 0 2 1 0 0 0 0
FDG-PET/MRI whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 1 1 2 0 0 0 0
CT complete spine with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 3 0 0 1 0 0 0
CT complete spine without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 1 0 1 0 0 0 0
CT complete spine without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 1 0 1 0 0 0 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 2 0 2 0 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Expert Opinion Varies Varies 1 1 12 0 1 2 0 1 1 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 14 0 1 1 0 0 0 1 0
CT spine area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 12 1 1 2 1 0 0 0 0
Variant 7: Child. Sacroiliac joint pain. Idiopathic arthritis. Follow-up imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI sacroiliac joints without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 1 0 5 1 1 8
References Study Quality
42 (30623211) 2
41 (26201675) 1
9 (34311986) 4
10 (34311987) 4
38 (25892309) 4
MRI sacroiliac joints and lumbar spine without and with IV contrast May be appropriate Expert Opinion O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 6 3 2 3 1
References Study Quality
55 (24127385) 2
MRI sacroiliac joints and lumbar spine without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 3 6 5 2 0 0
References Study Quality
7 (38015293) 4
US sacroiliac joints Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 0 1 1 0 0 0 0
Radiography pelvis Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 5 3 4 4 0 0 1 0 0
References Study Quality
4 (32399709) 4
43 (29996925) 2
Radiography sacroiliac joints Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 6 2 3 3 2 0 1 0 0
References Study Quality
4 (32399709) 4
43 (29996925) 2
MRI sacroiliac joints without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 2 7 6 0 1 0 0 0 0
References Study Quality
38 (25892309) 4
41 (26201675) 1
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 1 1 0 0 0 0 0
Bone scan with SPECT or SPECT/CT sacroiliac joints Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 3 1 1 1 0 0 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 1 2 1 0 1 0 0
CT pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 0 3 4 1 2 0 0 0
References Study Quality
37 (36629936) 4
39 (30976556) 4
FDG-PET/MRI whole body Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 2 4 1 4 0 0 0 0
References Study Quality
49 (20523983) 1
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 0 1 1 0 0 0 1 0
FDG-PET/CT whole body Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 4 1 2 0 0 0 0
References Study Quality
49 (20523983) 1
Variant 8: Child. Temporomandibular joint pain. Idiopathic arthritis. Follow-up imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI temporomandibular joint without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 2 6 8
References Study Quality
11 (29134239) 4
45 (36944679) 4
CT maxillofacial without IV contrast May be appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 5 1 2 7 2 0 0 0 0
References Study Quality
4 (32399709) 4
56 (27649720) 3
57 (36515761) 4
Radiography temporomandibular joint Usually not appropriate Expert Opinion ☢☢ 0.03-0.3 mSv [ped] 3 3 3 1 6 4 1 1 0 1 0
References Study Quality
47 (36782277) 3
US head and neck Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 2 1 2 0 0 0 0 0
References Study Quality
48 (31396836) 4
MRI temporomandibular joint without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 1 5 4 2 1 0 1 0
References Study Quality
4 (32399709) 4
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 0 1 3 2 0 0 1 0
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 1 0 0 0 0 0
Bone scan with SPECT or SPECT/CT maxillofacial Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 0 0 1 2 0 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 0 1 0 0 0 1 0
FDG-PET/MRI whole body Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 2 0 3 2 0 1 0 0
References Study Quality
49 (20523983) 1
FDG-PET/CT whole body Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 2 1 4 1 0 0 0 0
References Study Quality
49 (20523983) 1
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.