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Appropriateness Criteria

Variant 1: Adult. Chronic dyspnea. Unclear etiology. 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 Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 1 0 0 0 0 0 0 1 16
References Study Quality
29 (2802893) 3
28 (21215608) 2
3 (22962929) 4
2 (15864893) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 6 8 4 0 0 0
References Study Quality
26 (25447621) 3
28 (21215608) 2
27 (14872104) 4
US chest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 5 0 0 0 0 0 0 0
References Study Quality
32 (26687671) 4
31 (36740691) 2
30 (31927551) 4
Fluoroscopy chest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 3 0 1 1 0 0 1 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 3 1 1 0 0 1 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 3 1 0 1 1 0 0 0
CT chest with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 3 4 2 0 1 0 0 0
References Study Quality
2 (15864893) 4
3 (22962929) 4
6 (36436973) 4
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 6 2 1 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 0 0 1 0 0 0 0
Variant 2: Adult. Chronic dyspnea. Suspected chronic obstructive pulmonary disease (COPD). 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 Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 1 0 0 0 0 0 1 2 14
References Study Quality
62 (19631518) 4
61 (11194777) 4
19 (26333307) 4
39 (36907372) 4
CT chest without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 1 2 2 3 3 6
References Study Quality
57 (16537852) 3
46 (18351420) 3
53 (19938970) 3
34 (25961632) 4
37 (26098755) 2
43 (23220894) 2
44 (25442794) 3
45 (24710855) 3
47 (25474145) 3
48 (24703520) 3
49 (24334816) 2
50 (22514236) 3
51 (27776670) 3
55 (25844673) 3
56 (22016483) 2
54 (29458372) 1
52 (30256767) 2
42 (1535900) 4
41 (35866756) 2
40 (30759006) 4
39 (36907372) 4
38 (27168432) 2
36 (37210745) 1
35 (32017932) 1
US chest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 9 4 3 0 0 0 1 0 1
References Study Quality
63 (32614240) 1
Fluoroscopy chest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 3 1 1 1 1 0 1 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 1 1 2 0 0 0 0
MRI chest without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 8 4 2 1 2 1 0 0 0
References Study Quality
58 (26744928) 3
59 (21392914) 2
60 (25575114) 3
19 (26333307) 4
16 (27882425) 2
CT chest with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 3 2 0 0 0 0 0
References Study Quality
33 (27865580) 4
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 3 1 0 0 0 0 0
V/Q scan lung Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 3 1 1 0 0 0 0 1
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 1 0 0 0 1 0 0
Variant 3: Adult. Chronic dyspnea. Suspected small airways disease. 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 Usually appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 8 8 0 0 1 1 2 1 4 3 6
CT chest without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 1 1 2 6 7
References Study Quality
14 (23764129) 4
15 (27296816) 4
64 (32885932) 4
65 (32005432) 4
US chest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 2 0 0 0 0 0 1
Fluoroscopy chest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 2 2 0 0 0 0 1 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 1 0 1 1 0 0 0
MRI chest without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 15 2 1 0 0 0 0 0 0
References Study Quality
18 (31036773) 2
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 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 4 2 1 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 1 0 0 0 0 1 0 0
Variant 4: Adult. Chronic dyspnea. Known or suspected prior COVID-19 infection. 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 Usually appropriate Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 1 0 0 0 0 0 2 3 12
References Study Quality
78 (33497317) 1
84 (34473811) 2
85 (33172844) 4
CT chest without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 1 0 0 3 4 10
References Study Quality
81 (33901788) 2
80 (32734297) 2
79 (34148855) 4
78 (33497317) 1
77 (34284567) 2
76 (33798931) 4
75 (34536697) 1
74 (33964245) 2
73 (34032292) 2
72 (36782191) 2
71 (33419891) 2
70 (34957743) 2
69 (37404150) Good
68 (37216955) 4
67 (32474479) 2
66 (33175876) 2
13 (35226158) 2
12 (36427055) 1
11 (34374591) 4
7 (34794591) 4
US chest Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 6 2 2 5 1 1 0 0 1
References Study Quality
90 (36103083) 1
89 (34091869) 2
88 (36564240) 2
87 (35429016) 2
86 (35906952) 4
Fluoroscopy chest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 1 1 0 0 0 0 1 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 0 2 0 2 0 1 0 0
MRI chest without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 8 1 4 2 1 2 0 0 0
References Study Quality
22 (35762891) 2
21 (36596692) 2
20 (36749209) 2
83 (34251585) 1
82 (36253228) 2
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 3 4 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 13 1 3 1 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 1 0 0 0 0
Variant 5: Adult. Chronic dyspnea. Suspected disease of the pleura or chest wall. 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 Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 1 0 0 2 6 9
References Study Quality
97 (8796649) 3
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 1 2 5 3 6
References Study Quality
91 (25077699) 4
92 (26076488) 2
CT chest without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 2 2 6 2 5
References Study Quality
93 (9017800) 4
91 (25077699) 4
92 (26076488) 2
US chest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 2 4 0 5 0 0 0 0
References Study Quality
99 (-3197610) 4
Fluoroscopy chest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 2 1 0 1 0 0 1 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 1 7 2 2 0 0 0 0
MRI chest without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 1 6 2 2 0 0 0 0
References Study Quality
94 (2028857) 4
95 (26502346) 2
96 (26214770) 3
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 2 1 1 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 3 4 1 1 0 1 0 0
Variant 6: Adult. Chronic dyspnea. Suspected diaphragm dysfunction. 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 Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 1 0 0 0 0 0 1 5 11
References Study Quality
106 (17368210) 2
CT chest with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 3 11 4 0 0 0 0
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 12 2 1 0 0
References Study Quality
100 (28549021) 2
US chest Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 6 2 4 4 2 0 0 0 0
References Study Quality
108 (23382111) 4
107 (24211983) 3
109 (25165390) 2
110 (26994409) 2
111 (23110443) 3
112 (27701744) 3
113 (24700122) 3
114 (26620221) 2
115 (26357011) 3
116 (25971723) 2
117 (27167428) 3
Fluoroscopy chest Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 9 0 4 1 2 1 0 1 0
References Study Quality
101 (22411950) 4
102 (23778774) 2
MRI chest without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 3 3 1 3 1 1 0 0
References Study Quality
103 (35273448) 1
MRI chest without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 2 2 1 2 0 0 0 0
References Study Quality
104 (17145404) 3
105 (27391236) 3
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 3 2 0 0 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.