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Appropriateness Criteria

Variant 1: Child. Suspect ingested or aspirated foreign body. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography neck chest abdomen and pelvis Usually appropriate Limited ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 0 0 0 1 4 3 7
References Study Quality
17 (26495798) 4
47 (32896338) 4
45 (30188872) 4
46 (27576682) 4
44 (32032915) 4
43 (10549750) 4
37 (22593662) 4
21 (33745769) 4
12 (25611037) 4
38 (26475838) 4
Radiography chest Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 1 0 0 4 0 10
References Study Quality
54 (24074659) 4
53 (37201356) 3
49 (12596126) 4
50 (19092566) 4
52 (25592250) 4
51 (25384489) 4
21 (33745769) 4
17 (26495798) 4
47 (32896338) 4
45 (30188872) 4
46 (27576682) 4
48 (22841172) 2
44 (32032915) 4
43 (10549750) 4
15 (27876259) 4
Radiography neck Usually appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 8 8 0 0 0 1 0 2 3 2 7
References Study Quality
17 (26495798) 4
Radiography abdomen and pelvis Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 2 0 0 4 1 8
References Study Quality
43 (10549750) 4
38 (26475838) 4
37 (22593662) 4
21 (33745769) 4
12 (25611037) 4
Fluoroscopy single contrast esophagram May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 0 1 1 8 6 0 0 0 0
References Study Quality
42 (30642867) 4
41 (24951194) 4
37 (22593662) 4
38 (26475838) 4
39 (25309769) 4
40 (15100114) 4
21 (33745769) 4
4 (34661860) 4
11 (21948341) 4
36 (32515607) 3
CT chest without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 0 3 5 4 3 0 0
References Study Quality
36 (32515607) 3
35 (23896013) 3
34 (24290578) 4
32 (18936020) 4
33 (19036175) 1
31 (21409389) 4
22 (-3197700) 4
30 (14680912) 4
27 (17033800) 3
23 (36621123) Good
29 (37473440) Good
28 (21129123) 2
25 (23884842) 4
26 (-3199260) 4
21 (33745769) 4
4 (34661860) 4
18 (29106868) 3
19 (29728167) 3
16 (25683940) 3
Radiography chest decubitus view Usually not appropriate Limited ☢ <0.03 mSv [ped] 2 2 4 5 4 1 2 0 0 0 0
References Study Quality
58 (12648322) 4
57 (8578349) 4
55 (17413429) 4
48 (22841172) 2
56 (8035283) 4
US abdomen 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
59 (36714638) 3
Radiography abdomen Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 3 4 3 2 2 1 1 0 0
Fluoroscopy upper GI series Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 5 1 4 2 2 0 1 0 0
References Study Quality
42 (30642867) 4
41 (24951194) 4
37 (22593662) 4
38 (26475838) 4
39 (25309769) 4
40 (15100114) 4
21 (33745769) 4
4 (34661860) 4
11 (21948341) 4
10 (38623937) 4
12 (25611037) 4
14 (18407800) 4
36 (32515607) 3
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 2 2 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 3 1 0 1 0 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 3 1 1 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 1 1 0 1 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 2 1 1 0 1 0 0 0
CT chest abdomen pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 2 2 1 1 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 2 1 1 0 1 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 2 2 1 0 1 0 0 0
Variant 2: Child. Suspect ingested foreign body. Initial radiographs 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
CT chest without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 0 0 0 0 8 6 1
References Study Quality
40 (15100114) 4
36 (32515607) 3
34 (24290578) 4
32 (18936020) 4
33 (19036175) 1
35 (23896013) 3
21 (33745769) 4
4 (34661860) 4
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 0 11 3 1 0 0
References Study Quality
64 (38417932) 4
63 (33440112) 4
60 (32212088) 4
59 (36714638) 3
62 (22987870) 4
61 (27927131) 4
Fluoroscopy single contrast esophagram May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 1 0 5 2 2 4 1
References Study Quality
42 (30642867) 4
41 (24951194) 4
37 (22593662) 4
38 (26475838) 4
39 (25309769) 4
40 (15100114) 4
21 (33745769) 4
4 (34661860) 4
11 (21948341) 4
36 (32515607) 3
CT abdomen and pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 2 2 7 3 1 0 0 0
Fluoroscopy upper GI series Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 0 3 7 3 2 1 0 0 0
References Study Quality
38 (26475838) 4
37 (22593662) 4
21 (33745769) 4
11 (21948341) 4
12 (25611037) 4
14 (18407800) 4
10 (38623937) 4
36 (32515607) 3
39 (25309769) 4
40 (15100114) 4
42 (30642867) 4
41 (24951194) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 1 3 2 0 1 0 1 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 3 4 0 0 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 1 3 1 1 0 1 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 8 1 3 2 0 0 1 0 0
CT chest abdomen pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 6 3 0 0 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 7 1 4 1 1 0 1 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 1 1 2 1 1 0 1 0
Variant 3: Child. Suspect aspirated foreign body. Initial radiographs 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
CT chest without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 1 0 4 2 7
References Study Quality
31 (21409389) 4
30 (14680912) 4
27 (17033800) 3
29 (37473440) Good
28 (21129123) 2
26 (-3199260) 4
22 (-3197700) 4
4 (34661860) 4
18 (29106868) 3
19 (29728167) 3
23 (36621123) Good
16 (25683940) 3
Radiography chest decubitus view Usually not appropriate Limited ☢ <0.03 mSv [ped] 3 3 0 4 6 5 1 0 0 0 0
References Study Quality
58 (12648322) 4
57 (8578349) 4
55 (17413429) 4
48 (22841172) 2
56 (8035283) 4
Fluoroscopy single contrast esophagram Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 8 1 3 1 1 0 1 0 0
Fluoroscopy upper GI series Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 0 3 1 1 0 1 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 7 2 1 0 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 1 3 1 1 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.