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Appropriateness Criteria

Variant 1: Occupational exposure, screening, and surveillance of lung 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 Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 1 0 0 0 0 0 0 2 9
References Study Quality
44 (-3093342) 4
39 (28408654) 2
42 (27965042) 3
8 (25654743) 1
40 (24507420) 2
41 (24254651) 2
43 (24038345) 2
45 (23535192) 3
7 (23485572) 3
9 (25052085) 4
11 (20884728) 4
46 (20207319) 2
47 (21622551) 2
CT chest without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 5 5 1 0 0
References Study Quality
12 (28033378) 1
49 (25810444) 2
48 (23863542) 2
MRI chest without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 7 2 2 0 0 0 1 0 0
References Study Quality
53 (18356432) 2
50 (28067202) 2
51 (27107755) 2
52 (26981454) 2
MRI chest without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 7 1 3 0 0 0 0 1 0
References Study Quality
53 (18356432) 2
50 (28067202) 2
51 (27107755) 2
52 (26981454) 2
CT chest with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 4 1 1 0 0 1 0
References Study Quality
12 (28033378) 1
49 (25810444) 2
48 (23863542) 2
CT chest without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 3 1 0 0 0 0 0 1
References Study Quality
12 (28033378) 1
49 (25810444) 2
48 (23863542) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 1 0 0 0 0 0 1
Variant 2: Occupational exposure, suspected interstitial lung 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 Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 1 0 0 0 0 1 0 2 7
References Study Quality
55 (27481079) 2
21 (25043510) 2
24 (26689234) 3
54 (25171783) 3
CT chest without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 1 0 0 5 6
References Study Quality
71 (28370144) 2
69 (28614400) 2
6 (27680410) 3
63 (27031972) 4
70 (26901505) 3
64 (26334510) 2
62 (26231253) 3
72 (25810443) 2
68 (25537566) 3
56 (23293132) 3
59 (25286915) 1
73 (25106847) 2
58 (24953093) 2
67 (24811526) 2
60 (24804337) 4
66 (24480143) 4
34 (24360514) 4
57 (24331259) 2
43 (24038345) 2
26 (19997848) 2
61 (24739899) 1
65 (12818850) 2
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 3 2 1 0 0 1 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 2 4 0 0 0 0 1 0
CT chest with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 1 6 1 2 0 1 0 0
References Study Quality
71 (28370144) 2
69 (28614400) 2
6 (27680410) 3
63 (27031972) 4
70 (26901505) 3
64 (26334510) 2
62 (26231253) 3
72 (25810443) 2
68 (25537566) 3
56 (23293132) 3
59 (25286915) 1
73 (25106847) 2
58 (24953093) 2
67 (24811526) 2
60 (24804337) 4
66 (24480143) 4
34 (24360514) 4
57 (24331259) 2
43 (24038345) 2
26 (19997848) 2
61 (24739899) 1
65 (12818850) 2
CT chest without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 2 3 0 0 0 0 0 1
References Study Quality
71 (28370144) 2
69 (28614400) 2
6 (27680410) 3
63 (27031972) 4
70 (26901505) 3
64 (26334510) 2
62 (26231253) 3
72 (25810443) 2
68 (25537566) 3
56 (23293132) 3
59 (25286915) 1
73 (25106847) 2
58 (24953093) 2
67 (24811526) 2
60 (24804337) 4
66 (24480143) 4
34 (24360514) 4
57 (24331259) 2
43 (24038345) 2
26 (19997848) 2
61 (24739899) 1
65 (12818850) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 6 3 1 0 0 0 0 0 1
Variant 3: Occupational exposure, suspected interstitial lung disease based on radiography. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT chest without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 1 0 0 0 0 0 0 3 7
References Study Quality
63 (27031972) 4
62 (26231253) 3
72 (25810443) 2
56 (23293132) 3
73 (25106847) 2
60 (24804337) 4
66 (24480143) 4
34 (24360514) 4
57 (24331259) 2
43 (24038345) 2
61 (24739899) 1
Image-guided transthoracic needle biopsy Usually not appropriate Expert Consensus Varies Varies 1 1 7 3 0 0 0 0 0 0 1
MRI chest without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 2 1 3 2 2 0 1 0 0
References Study Quality
75 (20027548) 1
53 (18356432) 2
51 (27107755) 2
52 (26981454) 2
MRI chest without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 4 1 2 3 0 1 0 0 0
References Study Quality
75 (20027548) 1
53 (18356432) 2
51 (27107755) 2
52 (26981454) 2
CT chest with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 2 5 2 1 1 1 0 0 0
References Study Quality
63 (27031972) 4
62 (26231253) 3
72 (25810443) 2
56 (23293132) 3
73 (25106847) 2
60 (24804337) 4
66 (24480143) 4
34 (24360514) 4
57 (24331259) 2
43 (24038345) 2
61 (24739899) 1
CT chest without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 2 0 0 0 0 0 1
References Study Quality
63 (27031972) 4
62 (26231253) 3
72 (25810443) 2
56 (23293132) 3
73 (25106847) 2
60 (24804337) 4
66 (24480143) 4
34 (24360514) 4
57 (24331259) 2
43 (24038345) 2
61 (24739899) 1
74 (25790222) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 6 3 1 0 0 0 0 0 1
Variant 4: Occupational exposure, suspected airway 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 Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 8 8 1 0 0 0 2 0 1 2 5
References Study Quality
55 (27481079) 2
21 (25043510) 2
24 (26689234) 3
54 (25171783) 3
CT chest without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 1 0 0 1 0 2 2 5
References Study Quality
76 (19204469) 4
77 (27245779) 2
79 (25888313) 4
33 (24169053) 4
78 (23978646) 4
91 (27816444) 2
MRI chest without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 3 2 3 2 0 1 0 0 0
References Study Quality
95 (19932577) 2
96 (29174189) 2
97 (26322908) 3
98 (11891971) 2
99 (17984769) 2
100 (29470939) 2
MRI chest without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 4 1 2 2 1 1 0 0 0
References Study Quality
95 (19932577) 2
96 (29174189) 2
97 (26322908) 3
98 (11891971) 2
99 (17984769) 2
100 (29470939) 2
CT chest with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 4 5 0 0 1 0 0 0
References Study Quality
76 (19204469) 4
77 (27245779) 2
79 (25888313) 4
33 (24169053) 4
78 (23978646) 4
91 (27816444) 2
CT chest without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 6 2 1 1 0 0 0 0 1
References Study Quality
76 (19204469) 4
77 (27245779) 2
79 (25888313) 4
33 (24169053) 4
78 (23978646) 4
91 (27816444) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 3 0 0 0 0 0 0 1
Variant 5: Confirmed occupational lung disease, suspected thoracic neoplasm.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Image-guided transthoracic needle biopsy Usually appropriate Strong Varies Varies 7 7 0 0 0 0 1 4 3 3 0
References Study Quality
104 (17047960) 4
125 (12461267) 3
113 (28361545) 2
118 (19937406) 4
123 (3871271) 4
124 (8659351) 2
CT chest with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 1 0 1 3 5
References Study Quality
103 (25837734) 4
106 (25383951) 1
105 (19357540) 4
104 (17047960) 4
108 (17050560) 2
109 (25077699) 4
101 (21625073) 4
102 (24242366) 3
107 (23355760) 1
111 (28024694) 3
110 (29571785) 2
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 6 6 0 1 0 1 2 2 4 0 1
References Study Quality
126 (17923365) 2
MRI chest without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 0 2 5 3 0 0 0
References Study Quality
117 (15308938) 2
114 (20651171) 3
113 (28361545) 2
116 (26434850) 2
115 (28932538) 2
MRI chest without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 1 0 5 4 2 0 0 0 0
References Study Quality
117 (15308938) 2
114 (20651171) 3
113 (28361545) 2
116 (26434850) 2
115 (28932538) 2
CT chest without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 1 4 2 3 0
References Study Quality
103 (25837734) 4
106 (25383951) 1
105 (19357540) 4
104 (17047960) 4
108 (17050560) 2
109 (25077699) 4
101 (21625073) 4
102 (24242366) 3
107 (23355760) 1
111 (28024694) 3
110 (29571785) 2
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 0 6 2 3 0
References Study Quality
122 (20514576) 3
120 (19875971) 3
119 (19395909) 4
118 (19937406) 4
121 (23206832) 4
CT chest without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 1 3 0 2 0 1 0 0
References Study Quality
103 (25837734) 4
106 (25383951) 1
105 (19357540) 4
104 (17047960) 4
108 (17050560) 2
109 (25077699) 4
101 (21625073) 4
102 (24242366) 3
107 (23355760) 1
111 (28024694) 3
110 (29571785) 2
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.