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Appropriateness Criteria

Variant 1: Routine chest imaging for hospital admission. No clinical concern for cardiopulmonary 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 not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 7 5 4 1 0 0 0 0 0
References Study Quality
11 (31897494) 2
12 (20928990) 4
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 0 0 0 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 2 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 14 0 0 0 1 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 14 0 0 0 2 0 0 0 0
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
9 (31407223) 2
10 (26781150) 4
CTA chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 0 0 1 1 0 0 0 0
CTA chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 1 0 0 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] 1 1 15 0 1 0 0 0 0 0 0
Variant 2: Routine preoperative chest imaging for noncardiothoracic surgery. No history of chronic cardiopulmonary disease or cardiothoracic surgery. 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 not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 4 7 5 0 1 0 0 0 0
References Study Quality
20 (21959515) 2
19 (2383834) 4
18 (8269561) M
17 (15983140) 4
16 (28810091) 4
15 (24716201) 4
14 (15525886) 4
13 (21911881) 4
6 (6645012) 4
5 (87976) 4
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 0 0 0 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 1 0 0 0 0 0 0
CT chest with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 1 1 1 1 1 0 0
References Study Quality
15 (24716201) 4
14 (15525886) 4
13 (21911881) 4
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 0 0 0 1 0 0 0
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 4 0 0 0 0 0 0 0
References Study Quality
15 (24716201) 4
14 (15525886) 4
13 (21911881) 4
CTA chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 0 1 0 0 0 0 0
CTA chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 1 0 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 14 1 0 1 0 0 0 0 0
Variant 3: Routine preoperative chest imaging for noncardiothoracic surgery. History of chronic cardiopulmonary disease or cardiothoracic surgery. 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 Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 1 0 2 7 1 6 0 0
References Study Quality
29 (22407474) 4
25 (22273990) 4
28 (21722852) 4
27 (22156267) 4
26 (16618955) 2
24 (29708905) 4
23 (8004892) 4
22 (3383317) 4
21 (29477256) 4
20 (21959515) 2
15 (24716201) 4
14 (15525886) 4
13 (21911881) 4
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 1 2 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 2 0 0 0 0 0
CT chest with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 6 5 0 0 0 0 0 0
References Study Quality
15 (24716201) 4
14 (15525886) 4
13 (21911881) 4
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 1 0 0 1 1 0 0
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 6 5 1 2 0 0 0 0
References Study Quality
15 (24716201) 4
14 (15525886) 4
13 (21911881) 4
CTA chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 1 1 0 1 0 0 0
CTA chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 2 0 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] 1 1 13 1 0 1 1 0 0 0 0
Variant 4: Routine chest imaging. History of chronic cardiopulmonary disease with stable clinical findings. Surveillance chest 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 0 0 1 2 7 5 2 0 0
References Study Quality
33 (28473092) 4
32 (32370962) 4
30 (34794591) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 1 2 13 0 0 0 0
References Study Quality
33 (28473092) 4
32 (32370962) 4
31 (33075377) 4
30 (34794591) 4
MRI chest without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 9 3 2 1 0 1 0 0 0
References Study Quality
34 (32870136) 4
MRI chest without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 9 3 2 1 0 1 0 0 0
References Study Quality
34 (32870136) 4
35 (24361974) 4
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 1 3 1 2 1 0 0 1
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 2 0 0 1 0 0 1
CTA chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 2 1 2 0 1 0 0
CTA chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 1 4 0 1 0 1 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 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.