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Appropriateness Criteria

Variant 1: Adult. Penetrating torso trauma, hypotensive. 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 Expert Consensus ☢☢☢ 1-10 mSv 9 9 1 0 0 0 1 0 3 2 7
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 0 0 3 0 3 3 3
References Study Quality
25 (-3196632) 2
24 (29369452) 4
CTA chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 0 1 0 0 2 2 2 4 2
References Study Quality
29 (31903225) 4
28 (26802856) 4
27 (22824572) 4
MRI chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 1 0 0 0 0 0 0
MRI chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 0 1 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] 1 1 9 3 1 0 0 0 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 2 6 0 3 0 0 0 0
Variant 2: Adult. Ballistic penetrating torso trauma, unknown trajectory, normotensive. 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 Expert Consensus ☢☢☢ 1-10 mSv 9 9 1 0 0 0 0 0 3 3 7
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 0 1 1 2 9
References Study Quality
3 (34019436) 4
15 (31666333) 2
2 (26492022) 4
30 (30343384) 4
CTA chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 0 0 0 0 6 2 5
References Study Quality
29 (31903225) 4
33 (31283454) 4
CT chest abdomen pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 4 2 1 1 4 1 1 0 0
References Study Quality
31 (23480864) 4
MRI chest abdomen 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 chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 1 0 0 0 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 2 4 2 3 0 0 0 0
References Study Quality
32 (26945375) 2
Variant 3: Adult. Ballistic penetrating torso trauma, limited to chest, normotensive. 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 2 3 8
References Study Quality
43 (23536101) 4
42 (34607700) 2
41 (33441251) 2
CT chest with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 0 1 1 3 8
References Study Quality
40 (23471527) 2
39 (32467475) 2
38 (25384283) 4
37 (27324324) 3
28 (26802856) 4
CTA chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 3 3 7
References Study Quality
38 (25384283) 4
CT abdomen and pelvis with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 0 7 2 1 1 0
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 3 2 2 2 4 1 0 0 0
References Study Quality
36 (35945464) 4
CTA abdomen and pelvis with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 1 0 0 3 2 1 2 3 1
References Study Quality
29 (31903225) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 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 13 1 0 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 2 0 0 0 1 0 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 0 0 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 2 3 2 1 0 0 0 0
References Study Quality
36 (35945464) 4
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 1 1 3 1 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 8 2 0 1 2 0 0 1 0
Variant 4: Adult. Ballistic penetrating torso trauma, limited to abdomen and pelvis, normotensive. 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 Expert Consensus ☢☢☢ 1-10 mSv 8 8 1 0 0 1 0 0 3 3 6
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 2 3 9
References Study Quality
47 (15128986) 2
46 (29412018) 2
45 (25023337) 4
44 (32889613) 2
10 (26984429) 2
9 (35322323) 2
CTA abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv 9 9 0 0 0 1 4 0 1 1 7
References Study Quality
29 (31903225) 4
33 (31283454) 4
CT chest with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 0 5 4 1 1 0
References Study Quality
2 (26492022) 4
CTA chest with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 0 0 0 4 0 4 2 1
References Study Quality
29 (31903225) 4
48 (17257952) 2
CT abdomen and pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 2 2 2 4 3 0 0 0 0
References Study Quality
31 (23480864) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 0 0 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 12 1 0 0 0 1 0 0 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 1 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 12 1 1 0 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 4 2 2 1 0 0 0
References Study Quality
36 (35945464) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 1 1 1 2 1 0 0 0
References Study Quality
31 (23480864) 4
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 2 3 3 0 0 0 0 0
References Study Quality
36 (35945464) 4
Variant 5: Adult. Nonballistic penetrating torso trauma, unknown trajectory, normotensive. 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 Limited ☢☢☢ 1-10 mSv 9 9 1 0 0 0 1 0 2 2 8
References Study Quality
50 (26463290) 4
CT chest abdomen pelvis with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 1 3 2 8
References Study Quality
49 (31140225) 2
30 (30343384) 4
29 (31903225) 4
15 (31666333) 2
2 (26492022) 4
CTA chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 0 0 0 1 0 1 5 2 4
References Study Quality
29 (31903225) 4
33 (31283454) 4
MRI chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 0 0 2 0 0 0 0
MRI chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 0 0 1 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 6 5 1 0 1 0 0 0 0
References Study Quality
31 (23480864) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 1 4 2 2 1 0 0 0
References Study Quality
36 (35945464) 4
Variant 6: Adult. Nonballistic penetrating torso trauma, limited to chest, normotensive. 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 Limited ☢☢☢ 1-10 mSv 9 9 1 0 0 0 1 0 1 2 9
References Study Quality
50 (26463290) 4
51 (31407022) 2
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 3 5 5
References Study Quality
37 (27324324) 3
51 (31407022) 2
CTA chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 3 2 1 1 5
References Study Quality
29 (31903225) 4
33 (31283454) 4
CT abdomen and pelvis with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 3 0 0 1 6 2 1 0 0
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 0 0 4 5 2 0 0 0
References Study Quality
36 (35945464) 4
CTA abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 4 4 0 1 5 1 6 0 0 0 0
References Study Quality
29 (31903225) 4
33 (31283454) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 1 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 12 1 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 10 2 0 1 1 0 0 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 0 0 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 1 0 3 0 0 0 0
References Study Quality
36 (35945464) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 4 2 0 0 0 0 0 0
References Study Quality
31 (23480864) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 6 1 4 1 2 0 0 0 0
References Study Quality
31 (23480864) 4
Variant 7: Adult. Nonballistic penetrating torso trauma, limited to abdomen and pelvis, normotensive. 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 Expert Consensus ☢☢☢ 1-10 mSv 9 9 1 0 0 1 1 0 2 2 7
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 3 2 9
References Study Quality
49 (31140225) 2
46 (29412018) 2
24 (29369452) 4
10 (26984429) 2
9 (35322323) 2
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 4 2 1 2 4 1 0 0 0
References Study Quality
36 (35945464) 4
CT chest with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 0 3 3 4 2 0 0 0
CTA chest with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 2 2 6 0 0 2 0
References Study Quality
29 (31903225) 4
33 (31283454) 4
CTA abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 6 6 0 0 0 0 6 2 1 1 3
References Study Quality
33 (31283454) 4
29 (31903225) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 0 0 1 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 12 1 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 12 1 1 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 12 1 1 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] 2 2 7 1 3 2 1 0 0 0 0
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 2 3 1 1 0 0 0 0
References Study Quality
31 (23480864) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 5 3 0 0 0 0 0 0
References Study Quality
31 (23480864) 4
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.