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Appropriateness Criteria

Variant 1: Child up to 3 months of age. Fever without source and clinical concern for occult pneumonia. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 1 1 1 4 7 1 0 0 1
References Study Quality
13 (3347713) 3
14 (34425771) 3
21 (-3196031) 1
23 (27106368) 4
US chest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 0 1 0 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 1 1 0 0 0 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 1 0 1 0 0 0 0 0
MRI whole body without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 0 0 1 0 0 0 0 0
MRI whole body without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 0 0 1 0 0 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 0 0 0 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 13 0 0 0 0 0 0 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 2 0 0 0 1 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 0 1 1 0 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 3 0 0 1 0 1 0 0
FDG-PET/MRI whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 0 1 0 0 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 12 1 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 0 0 1 0 0 0 0
Variant 2: Child aged 3 to 36 months. Fever without source and with low risk for occult pneumonia. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 4 4 0 2 2 5 5 1 1 0 0
References Study Quality
31 (34845493) 3
30 (34694254) 2
29 (2119118) 4
US abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 5 2 0 0 0 0 0 0
US kidneys and bladder Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 2 1 0 0 0 0 0 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 1 0 1 0 0 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 1 1 0 0 0 0 0
MRI whole body without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 0 0 1 1 0 0 0
MRI whole body without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 1 1 1 0 1 0 0 0
CT paranasal sinuses with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 0 1 1 1 0 0 0 0
CT paranasal sinuses without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 0 1 0 2 0 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 0 1 1 0 1 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 0 0 1 0 0 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 1 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 12 0 0 1 0 0 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 0 1 0 0 0 0 0
CT neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 0 0 0 2 0 0 0 0
CT neck without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 0 1 0 0 0 0 0
CT neck without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 0 0 1 0 0 0 0 0
CT paranasal sinuses without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 0 2 0 0 0 0 0
FDG-PET/MRI whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 1 0 0 1 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 12 0 0 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 15 1 0 0 0 0 0 0 0
Variant 3: Child. Fever without source and neutropenia. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest May be appropriate (Disagreement) Expert Opinion ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 0 2 1 4 2 3 2 2
References Study Quality
46 (21826781) 4
45 (22278307) 4
44 (-3196033) 4
34 (28459614) 4
CT paranasal sinuses with IV contrast May be appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 2 0 3 3 8 0 0 0 0
References Study Quality
36 (21265012) 4
35 (25929242) 3
34 (28459614) 4
CT paranasal sinuses without IV contrast May be appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 3 0 10 1 1 0 0
References Study Quality
36 (21265012) 4
35 (25929242) 3
34 (28459614) 4
CT abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 2 4 3 1 1
References Study Quality
36 (21265012) 4
35 (25929242) 3
34 (28459614) 4
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 1 4 1 4 1
References Study Quality
37 (31211850) 3
36 (21265012) 4
35 (25929242) 3
34 (28459614) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 2 2 5 7 0 0 0
References Study Quality
36 (21265012) 4
35 (25929242) 3
34 (28459614) 4
FDG-PET/MRI whole body May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 1 3 4 6 1 0 0 0
References Study Quality
40 (29235187) 4
43 (34277510) 4
FDG-PET/CT whole body May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 0 4 2 4 2 0
References Study Quality
42 (26187213) 4
41 (24869631) 3
40 (29235187) 4
39 (35115619) 4
US abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 4 7 1 1 0 0 0 0
3-phase bone scan whole body Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 0 0 0 2 0 0 0
Bone scan and WBC scan whole body Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 0 0 1 0 1 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 2 2 2 0 1 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 7 2 2 1 1 0 0 0 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 2 2 0 1 0 0 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 2 2 0 1 0 0 0 0
MRI whole body without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 2 2 0 2 1 0 0 0
MRI whole body without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 1 2 0 4 1 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 4 0 1 1 0 0 0 0
References Study Quality
36 (21265012) 4
35 (25929242) 3
34 (28459614) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 1 0 1 1 0 0 0
References Study Quality
37 (31211850) 3
36 (21265012) 4
35 (25929242) 3
34 (28459614) 4
CT neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 8 2 1 1 0 1 0 0 0
CT neck without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 1 0 1 0 0 0 0
CT neck without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 1 1 0 0 1 0 0 0
CT paranasal sinuses without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 1 0 2 0 0 0 0
References Study Quality
36 (21265012) 4
35 (25929242) 3
34 (28459614) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 7 3 2 0 0 1 0 0 0
References Study Quality
36 (21265012) 4
35 (25929242) 3
34 (28459614) 4
Fluoride PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 4 1 0 0 1 0 0 0
Variant 4: Child. Fever of unknown origin. Initial Imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 6 6 0 0 0 1 5 7 1 0 2
References Study Quality
24 (26330472) 4
MRI whole body without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 2 1 11 1 0 0 0
References Study Quality
47 (32767967) 4
63 (26892067) 4
62 (24826973) 4
61 (30900227) 4
MRI whole body without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 3 1 9 1 1 0 0
References Study Quality
47 (32767967) 4
63 (26892067) 4
62 (24826973) 4
61 (30900227) 4
FDG-PET/MRI whole body May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 2 2 4 4 1 0 0
References Study Quality
59 (24762622) 4
43 (34277510) 4
60 (31012760) 4
FDG-PET/CT whole body May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 2 4 3 3 0 1 0 0
References Study Quality
58 (32030452) 3
57 (23479196) 4
56 (30412093) Not Assessed
50 (30205705) Not Assessed
55 (31982625) 2
54 (26554525) 3
51 (28928271) 2
53 (28600002) Good
52 (31271266) 3
49 (32498991) 4
48 (27339873) Not Assessed
41 (24869631) 3
39 (35115619) 4
25 (27037917) Good
US abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 5 6 1 0 1 0 0 0
3-phase bone scan whole body Usually not appropriate Limited ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 2 0 1 0 0 0 0
References Study Quality
24 (26330472) 4
Bone scan and WBC scan whole body Usually not appropriate Limited ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 2 0 1 0 0 0 0
References Study Quality
24 (26330472) 4
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 7 3 2 0 1 0 0 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 7 3 2 0 1 0 0 0 0
CT paranasal sinuses with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 5 4 2 0 0 1 1 0 0
CT paranasal sinuses without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 1 4 0 1 0 1 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 1 4 1 0 0 1 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 1 0 1 0 0 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 1 3 1 0 1 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 0 0 1 0 1 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 1 2 1 1 1 0 0 0
CT neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 1 1 1 0 1 0 0 0
CT neck without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 1 0 0 1 0 0 0
CT neck without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 1 1 0 1 0 0 0 0
CT paranasal sinuses without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 1 0 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 1 0 0 1 1 0 0 0
Fluoride PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 4 1 0 0 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.