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Appropriateness Criteria

Variant 1: Child. Isolated microscopic hematuria (nonpainful, nontraumatic) without proteinuria. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Arteriography kidneys Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 0 0 0 0 0 0 0
US kidneys and bladder Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 3 8 0 1 0 1 0 0
References Study Quality
4 (15844394) 4
14 (15313065) 4
21 (2958464) 3
11 (2047140) 4
7 (8977964) 4
8 (7855959) 4
9 (8041670) 4
20 (7696121) 4
Voiding urosonography Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 2 1 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 9 2 2 1 0 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 2 2 0 0 1 0 0 0
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 4 0 0 0 0 0 0 0
References Study Quality
14 (15313065) 4
21 (2958464) 3
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 5 0 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 4 1 0 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 10 3 0 0 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 9 4 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 11 2 0 0 0 1 0 0 0
Variant 2: Child. Isolated microscopic hematuria (nonpainful, nontraumatic) with proteinuria. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys and bladder Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 0 4 3 4 2
References Study Quality
23 (16869009) 4
Arteriography kidneys Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 0 0 0 0 0 0 0
Voiding urosonography Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 1 1 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 7 6 0 0 1 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 1 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 2 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 1 5 0 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 10 3 0 0 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 9 3 1 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 11 2 0 0 0 0 1 0 0
Variant 3: Child. Isolated macroscopic hematuria (nonpainful, nontraumatic). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys and bladder Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 6 7
References Study Quality
4 (15844394) 4
14 (15313065) 4
11 (2047140) 4
30 (20080447) 4
27 (8042248) 4
28 (8102287) 4
29 (3052954) 4
31 (25787072) 4
32 (25627663) 4
Arteriography kidneys Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 1 0 1 0 0 0 0
Voiding urosonography Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 6 4 1 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 2 4 8 1 0 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 4 2 1 0 0 0 0 0
References Study Quality
14 (15313065) 4
34 (15204378) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 6 6 2 0 0 0 0 0
References Study Quality
25 (17051355) 3
27 (8042248) 4
28 (8102287) 4
29 (3052954) 4
35 (17459998) 4
36 (8439476) 3
33 (16882045) 4
37 (17106691) 4
38 (15772835) 4
39 (21791722) 4
40 (20627282) 4
41 (21920714) 4
MRI abdomen and pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 2 2 2 2 1 0 0 0
References Study Quality
25 (17051355) 3
27 (8042248) 4
28 (8102287) 4
29 (3052954) 4
35 (17459998) 4
36 (8439476) 3
33 (16882045) 4
37 (17106691) 4
38 (15772835) 4
39 (21791722) 4
40 (20627282) 4
41 (21920714) 4
CT abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 4 9 0 0 0 0 0 0
References Study Quality
33 (16882045) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 3 7 2 0 0 0 0 0
References Study Quality
33 (16882045) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 4 5 1 0 0 0 1 0
References Study Quality
33 (16882045) 4
Variant 4: Child. Painful hematuria (nontraumatic). Suspected urolithiasis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys and bladder Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 0 0 0
References Study Quality
64 (21722946) 4
48 (15587558) 3
49 (16145452) 3
59 (11373210) 3
60 (17874239) 3
61 (19041171) 4
62 (21460031) 3
63 (26797359) 2
58 (26301788) 2
CT abdomen and pelvis without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 0 0 0
References Study Quality
44 (11956719) 4
48 (15587558) 3
50 (18328883) 4
49 (16145452) 3
51 (18303544) 4
53 (18647908) M
54 (17377025) 2
55 (8571915) 2
52 (9146582) 3
57 (22891359) 3
56 (19098193) 1
47 (9205218) 2
Radiography abdomen and pelvis May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 0 0 0 0 0 0 0
References Study Quality
48 (15587558) 3
47 (9205218) 2
Arteriography kidneys Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
Voiding urosonography Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 7 3 0 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
References Study Quality
44 (11956719) 4
48 (15587558) 3
50 (18328883) 4
49 (16145452) 3
51 (18303544) 4
53 (18647908) M
54 (17377025) 2
55 (8571915) 2
52 (9146582) 3
57 (22891359) 3
56 (19098193) 1
47 (9205218) 2
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
44 (11956719) 4
48 (15587558) 3
50 (18328883) 4
49 (16145452) 3
51 (18303544) 4
53 (18647908) M
54 (17377025) 2
55 (8571915) 2
52 (9146582) 3
57 (22891359) 3
56 (19098193) 1
47 (9205218) 2
Variant 5: Child. Traumatic hematuria (macroscopic). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
72 (14713834) 4
67 (11775191) 4
68 (11987100) 4
70 (8911380) 4
71 (11992916) 4
73 (15454790) 4
78 (15290488) 4
79 (20708220) 3
82 (10541103) 3
81 (10628460) 3
83 (7717239) 3
84 (17056919) 3
Fluoroscopy retrograde urethrography May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 0 0 0 0 0 0 0
References Study Quality
76 (8632293) 4
CT pelvis with bladder contrast (CT cystography) May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 0 0 0 0 0 0
References Study Quality
80 (14521207) 4
72 (14713834) 4
67 (11775191) 4
68 (11987100) 4
70 (8911380) 4
71 (11992916) 4
73 (15454790) 4
78 (15290488) 4
79 (20708220) 3
82 (10541103) 3
81 (10628460) 3
83 (7717239) 3
84 (17056919) 3
Arteriography kidneys Usually not appropriate Limited ☢☢☢☢ 3-10 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
References Study Quality
91 (12559307) 4
92 (16291147) 4
US kidneys and bladder Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
References Study Quality
89 (16928927) 1
85 (3306591) 3
86 (18203940) 4
87 (14657314) 3
90 (18195385) 1
88 (7644308) 3
Voiding urosonography Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 5 1 1 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 3 9 2 0 0 0 1 0 0
Radiography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
81 (10628460) 3
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
72 (14713834) 4
67 (11775191) 4
68 (11987100) 4
70 (8911380) 4
71 (11992916) 4
73 (15454790) 4
78 (15290488) 4
79 (20708220) 3
82 (10541103) 3
81 (10628460) 3
83 (7717239) 3
84 (17056919) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
80 (14521207) 4
72 (14713834) 4
67 (11775191) 4
68 (11987100) 4
70 (8911380) 4
71 (11992916) 4
73 (15454790) 4
78 (15290488) 4
79 (20708220) 3
82 (10541103) 3
81 (10628460) 3
83 (7717239) 3
84 (17056919) 3
Variant 6: Child. Traumatic hematuria (microscopic). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 0 0 0 0
References Study Quality
72 (14713834) 4
67 (11775191) 4
70 (8911380) 4
71 (11992916) 4
79 (20708220) 3
95 (19250706) 3
US kidneys and bladder May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 0 0 0 0 0 0 0 0 0
Fluoroscopy retrograde urethrography May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 2 3 2 3 3 1 0 0 0
CT pelvis with bladder contrast (CT cystography) May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 3 5 4 1 0
References Study Quality
82 (10541103) 3
81 (10628460) 3
83 (7717239) 3
Arteriography kidneys Usually not appropriate Expert Consensus ☢☢☢☢ 3-10 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
Voiding urosonography Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 3 11 0 0 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
72 (14713834) 4
67 (11775191) 4
70 (8911380) 4
71 (11992916) 4
79 (20708220) 3
95 (19250706) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
72 (14713834) 4
67 (11775191) 4
70 (8911380) 4
71 (11992916) 4
79 (20708220) 3
95 (19250706) 3
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.