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Appropriateness Criteria

Variant 1: Major blunt trauma. Hemodynamically unstable. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US FAST scan chest abdomen and pelvis Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 1 2 0 2 8
References Study Quality
5 (22512989) 2
10 (19944412) 3
9 (29146418) 2
12 (10437835) 4
11 (25205343) 2
Radiography trauma series Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 0 1 0 1 0 0 2 2 8
References Study Quality
4 (22920605) 2
13 (22808568) 2
CT whole body with IV contrast May be appropriate Moderate ☢☢☢☢ 10-30 mSv 5 5 1 1 2 2 6 1 0 1 0
References Study Quality
6 (26104319) 4
7 (23894365) 4
8 (27163732) 2
CT whole body without IV contrast May be appropriate Moderate ☢☢☢☢ 10-30 mSv 4 4 2 0 4 3 4 0 1 0 0
References Study Quality
6 (26104319) 4
7 (23894365) 4
8 (27163732) 2
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 1 3 2 0 0 0 0 1
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 3 1 2 0 0 0 0 1
Variant 2: Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US FAST scan chest abdomen and pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 2 2 3 3 3
References Study Quality
5 (22512989) 2
Radiography trauma series Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 0 1 0 0 0 0 2 4 7
References Study Quality
4 (22920605) 2
13 (22808568) 2
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 9 9 1 0 0 0 0 2 1 2 8
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CT whole body without IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv 5 5 0 2 0 2 8 1 1 0 0
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
Fluoroscopy retrograde urethrography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 5 2 2 1 2 1 0 0 1
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 6 3 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 7 2 1 2 1 0 0 0 1
Variant 3: Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography trauma series Usually appropriate Strong ☢☢☢ 1-10 mSv 8 8 0 1 0 0 0 0 3 5 5
References Study Quality
4 (22920605) 2
13 (22808568) 2
CT maxillofacial without IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 1 0 0 1 1 1 0 2 8
References Study Quality
21 (22964404) 4
22 (16702454) 4
23 (15730983) 3
CT head without IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 1 0 0 0 1 1 3 2 6
CT whole body with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 0 2 0 1 3 1 0 4 3
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CT whole body without IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv 4 4 2 4 1 3 3 0 0 1 0
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CT maxillofacial with IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv 2 2 2 6 6 0 0 0 0 0 0
References Study Quality
21 (22964404) 4
22 (16702454) 4
23 (15730983) 3
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 3 6 2 1 0 1 0 0 1
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 2 2 2 0 1 1 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 6 4 4 0 0 0 0 0 0
References Study Quality
21 (22964404) 4
22 (16702454) 4
23 (15730983) 3
Variant 4: Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US FAST scan chest abdomen and pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 4 1 2 3 3
References Study Quality
5 (22512989) 2
Radiography trauma series Usually appropriate Strong ☢☢☢ 1-10 mSv 8 8 0 1 0 0 0 0 2 5 6
References Study Quality
4 (22920605) 2
13 (22808568) 2
Radiography extremity Usually appropriate Expert Consensus Varies Varies 9 9 0 0 1 0 0 0 1 1 11
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 8 8 0 0 0 1 2 3 1 3 4
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CT whole body without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 0 2 3 2 3 1 1 2 0
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CT extremity with IV contrast May be appropriate Expert Consensus Varies Varies 4 4 1 2 4 3 3 1 0 0 0
CT extremity without IV contrast May be appropriate Expert Consensus Varies Varies 5 5 0 2 3 0 8 1 0 0 0
CTA extremity area of interest with IV contrast May be appropriate (Disagreement) Expert Opinion Varies Varies 5 n/a 0 0 0 0 0 0 0 0 0
CT extremity without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 2 2 6 2 2 1 2 1 0 0 0
Variant 5: Major blunt trauma. Hemodynamically stable. Suspected bowel trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US FAST scan chest abdomen and pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 1 0 0 1 0 4 5 3
References Study Quality
5 (22512989) 2
Radiography trauma series Usually appropriate Strong ☢☢☢ 1-10 mSv 8 8 1 0 0 0 0 0 2 6 5
References Study Quality
4 (22920605) 2
13 (22808568) 2
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 1 0 0 0 1 0 1 2 9
References Study Quality
25 (23624596) Inadequate
19 (2783289) 3
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 8 8 0 1 0 0 0 0 1 8 4
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 2 2 2 2 4 1 1 0 0
References Study Quality
25 (23624596) Inadequate
19 (2783289) 3
CT whole body without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 0 2 2 4 3 1 1 1 0
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CTA abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 6 6 0 0 1 0 5 2 2 2 2
References Study Quality
27 (19458997) 4
26 (24056401) 2
US abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 3 6 0 0 0 0 0 0
References Study Quality
29 (15278707) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 0 3 2 1 0 0 1 0
References Study Quality
28 (-3147030) 4
MRI abdomen and pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 1 3 0 1 1 1 0 0
References Study Quality
28 (-3147030) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 6 5 3 0 0 0 0 0 0
References Study Quality
25 (23624596) Inadequate
19 (2783289) 3
Variant 6: Major blunt trauma. Hemodynamically stable. Suspected urinary system, including urethra trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US FAST scan chest abdomen and pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 4 2 1 3 3
References Study Quality
5 (22512989) 2
41 (15798158) 3
42 (9323670) 3
35 (-3091864) 4
Fluoroscopy retrograde urethrography Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 2 1 1 1 1 8
References Study Quality
47 (28126218) 4
Radiography trauma series Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 0 1 0 0 0 0 3 3 7
References Study Quality
4 (22920605) 2
13 (22808568) 2
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 0 0 3 5 5
References Study Quality
25 (23624596) Inadequate
19 (2783289) 3
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 8 8 1 0 0 0 0 1 3 4 5
References Study Quality
20 (26122129) 4
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CTA abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 1 0 0 0 2 1 5 4 1
References Study Quality
27 (19458997) 4
26 (24056401) 2
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 2 0 4 8 0 0 0 0
References Study Quality
25 (23624596) Inadequate
19 (2783289) 3
CT whole body without IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv 5 5 0 3 2 2 5 2 0 0 0
References Study Quality
20 (26122129) 4
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CTU without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 0 2 0 0 2 2 2 3 4
US abdomen and pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 5 6 0 0 0 0 0 1
References Study Quality
29 (15278707) 4
41 (15798158) 3
42 (9323670) 3
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 3 1 5 2 2 1 0 0 0
References Study Quality
46 (1757139) 4
43 (6616359) 4
44 (6359436) 4
45 (6632094) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 3 2 1 0 0 1 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 4 1 2 0 0 0 0 0
MRU without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 5 2 0 1 0 1 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 4 4 5 1 0 0 0 1 0
References Study Quality
25 (23624596) Inadequate
19 (2783289) 3
Variant 7: Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography trauma series Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 1 0 0 0 0 0 0 4 9
References Study Quality
4 (22920605) 2
13 (22808568) 2
52 (21146014) 3
51 (17045268) 3
50 (16494179) 3
53 (15290469) 3
CT chest with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 1 0 0 0 1 0 1 2 9
References Study Quality
20 (26122129) 4
49 (12355007) 2
48 (26169926) 3
8 (27163732) 2
CTA chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 1 0 0 2 1 2 1 7
References Study Quality
20 (26122129) 4
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 9 9 0 1 0 0 0 0 1 5 7
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
17 (28610777) Good
US FAST scan chest abdomen and pelvis May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 1 0 2 2 2 2 4
References Study Quality
5 (22512989) 2
CT chest without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 2 9 0 1 0 0
References Study Quality
20 (26122129) 4
49 (12355007) 2
48 (26169926) 3
8 (27163732) 2
CT whole body without IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv 5 5 0 3 0 3 7 1 0 0 0
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
17 (28610777) Good
US chest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 4 3 1 4 1 0 0 0
References Study Quality
49 (12355007) 2
MRI chest without and with 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
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 1 4 0 0 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 7 0 0 0 0 0 0
References Study Quality
20 (26122129) 4
49 (12355007) 2
48 (26169926) 3
8 (27163732) 2
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US FAST scan chest abdomen and pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 2 1 1 1 8
References Study Quality
5 (22512989) 2
54 (15516618) 3
US pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 1 1 0 0 0 1 3 8
References Study Quality
55 (20198552) 4
Radiography trauma series Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 1 0 1 1 5 2 4
References Study Quality
4 (22920605) 2
13 (22808568) 2
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 0 0 5 5 3
References Study Quality
25 (23624596) Inadequate
19 (2783289) 3
CT whole body with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 1 0 0 3 3 3 1 3
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 1 4 2 5 1 0 0 0
References Study Quality
25 (23624596) Inadequate
19 (2783289) 3
CTA chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 1 0 1 2 6 3 1 0
References Study Quality
20 (26122129) 4
CT whole body without IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv 4 4 0 4 1 3 5 1 0 0 0
References Study Quality
20 (26122129) 4
14 (19321199) 3
19 (2783289) 3
16 (25250591) Good
15 (23949104) 3
18 (22458247) 4
8 (27163732) 2
17 (28610777) Good
CTA abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 6 6 0 0 1 2 2 5 3 0 1
References Study Quality
27 (19458997) 4
26 (24056401) 2
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 3 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 7 3 3 1 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 7 3 2 2 0 0 0 0 0
References Study Quality
25 (23624596) Inadequate
19 (2783289) 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.