ACR logo

Appropriateness Criteria

Variant 1: Renal failure. Acute kidney injury (AKI), unspecified. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys retroperitoneal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 1 1 6 8
References Study Quality
31 (26581096) 3
27 (26283754) 4
4 (24011084) 3
30 (23751145) 3
28 (12008814) 4
29 (21098348) 3
3 () 4
26 (416685) 2
US duplex Doppler kidneys retroperitoneal May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 3 8 2 0 0
References Study Quality
34 (27133237) 2
36 (26728776) 2
35 (25746587) Good
4 (24011084) 3
33 (23731713) 2
37 (22771884) 3
32 (22595689) 2
17 (15458458) 3
MRA abdomen without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 2 2 1 5 6 1 0 0 0
References Study Quality
4 (24011084) 3
9 (-3132600) 4
18 (21542417) 2
19 (25539255) 1
17 (15458458) 3
20 (23550187) 2
MRI abdomen and pelvis without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 2 2 3 5 5 0 0 0 0
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 3 2 2 7 2 0 1 0 0
References Study Quality
21 (27362585) 3
22 (26925411) 4
23 (10739798) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 4 9 2 0 0 0
References Study Quality
16 (22578224) 3
15 (12819916) 2
MAG3 renal scan May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 2 1 5 7 1 1 0 0 0
References Study Quality
25 (11852301) 4
Arteriography kidney Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 2 2 0 1 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
MRA abdomen without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 8 2 3 2 2 0 0 0 0
References Study Quality
4 (24011084) 3
9 (-3132600) 4
18 (21542417) 2
19 (25539255) 1
17 (15458458) 3
20 (23550187) 2
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 5 2 1 0 1 0 0 0
MRI abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 7 2 1 0 0 0 0 0
References Study Quality
21 (27362585) 3
22 (26925411) 4
23 (10739798) 4
MRU without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 6 0 4 0 0 0 0 0
MRU without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 3 2 4 1 1 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 5 3 0 0 0 0 0 0
References Study Quality
16 (22578224) 3
15 (12819916) 2
CT abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 3 0 1 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 3 5 2 2 0 1 0 0
DMSA renal scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 4 7 4 2 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] 1 1 10 4 3 0 0 0 0 0 0
References Study Quality
16 (22578224) 3
15 (12819916) 2
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 2 4 0 1 0 0 0 0
CTA abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 8 3 2 4 0 0 0 0 0
References Study Quality
9 (-3132600) 4
CTU without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 5 2 0 0 0 0 0 0
Variant 2: Renal failure. Chronic kidney disease (CKD). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys retroperitoneal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 2 3 1 1 5 5
References Study Quality
30 (23751145) 3
43 (20651174) 2
6 (25730699) 4
8 (26391748) 4
42 (27796695) 3
39 (26610178) 4
44 (-3163170) 4
US duplex Doppler kidneys retroperitoneal May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 1 1 4 5 3 1 0 0 0
References Study Quality
37 (22771884) 3
MRA abdomen without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 1 1 2 7 5 1 0 0 0
References Study Quality
9 (-3132600) 4
18 (21542417) 2
19 (25539255) 1
39 (26610178) 4
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 3 2 3 6 2 1 0 0 0
References Study Quality
21 (27362585) 3
22 (26925411) 4
9 (-3132600) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 1 10 2 2 0 0 0
References Study Quality
16 (22578224) 3
15 (12819916) 2
Arteriography kidney Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 10 3 3 1 0 0 0 0 0
References Study Quality
38 () 4
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRA abdomen without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 4 2 4 3 4 0 0 0 0
References Study Quality
9 (-3132600) 4
18 (21542417) 2
19 (25539255) 1
39 (26610178) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 2 4 2 1 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 0 4 2 4 1 0 0 0
MRI abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 9 2 4 1 1 0 0 0 0
References Study Quality
21 (27362585) 3
22 (26925411) 4
9 (-3132600) 4
MRU without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 4 0 0 1 0 0 0
MRU without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 5 1 2 1 1 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 3 0 0 1 0 0 0
CT abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 3 2 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 3 2 2 4 1 0 0 0
DMSA renal scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 2 4 1 1 1 0 0 0
MAG3 renal scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 2 5 2 1 0 0 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 10 5 2 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 3 3 1 0 0 0 0 0
CTA abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 7 2 3 5 0 0 0 0 0
CTU without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 3 3 0 0 0 0 0 0
Variant 3: Renal failure. Kidney disease of unknown duration. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys retroperitoneal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 2 0 1 3 11
References Study Quality
31 (26581096) 3
27 (26283754) 4
4 (24011084) 3
30 (23751145) 3
28 (12008814) 4
29 (21098348) 3
3 () 4
26 (416685) 2
US duplex Doppler kidneys retroperitoneal May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 0 4 7 2 2 2 0
References Study Quality
34 (27133237) 2
36 (26728776) 2
35 (25746587) Good
4 (24011084) 3
33 (23731713) 2
37 (22771884) 3
32 (22595689) 2
17 (15458458) 3
MRA abdomen without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 3 0 4 8 1 0 1 0 0
References Study Quality
4 (24011084) 3
19 (25539255) 1
17 (15458458) 3
20 (23550187) 2
MRI abdomen and pelvis without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 2 4 2 4 4 0 0 1 0
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 2 4 2 7 1 0 0 1 0
References Study Quality
21 (27362585) 3
22 (26925411) 4
23 (10739798) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 4 8 2 1 0 0
References Study Quality
16 (22578224) 3
15 (12819916) 2
Arteriography kidney Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 2 3 0 0 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRA abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 1 2 6 1 0 0 0 0
References Study Quality
4 (24011084) 3
9 (-3132600) 4
18 (21542417) 2
19 (25539255) 1
17 (15458458) 3
20 (23550187) 2
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 1 4 3 0 0 0 0 0
MRI abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 2 5 1 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 8 4 2 3 0 0 0 0 0
MRU without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 3 1 3 2 2 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 5 2 0 0 0 0 0 0
CT abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 4 2 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 4 3 2 2 1 1 0 0
DMSA renal scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 4 2 3 1 0 0 0 0
MAG3 renal scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 3 4 2 1 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 9 6 2 0 0 0 0 0 0
References Study Quality
16 (22578224) 3
15 (12819916) 2
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 4 2 0 1 0 0 0 0
CTA abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 1 1 9 2 3 3 0 0 0 0 0
References Study Quality
9 (-3132600) 4
CTU without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 3 4 0 0 0 0 0 0
Variant 4: Renal failure. Neurogenic bladder. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys retroperitoneal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 2 2 3 1 8
References Study Quality
54 (23073657) 4
56 (29339880) 4
53 (29072046) 4
48 (26304502) 4
49 (26067125) 4
52 (24706504) 3
55 (22177149) 4
MRI abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 2 2 3 4 4 1 1 0 0
References Study Quality
50 (26266405) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 4 8 3 0 0 0
References Study Quality
16 (22578224) 3
DMSA renal scan May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 1 2 3 7 3 1 0 0 0
References Study Quality
52 (24706504) 3
51 (21484032) 2
US duplex Doppler kidneys retroperitoneal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 1 5 2 3 1 0 0 1
Fluoroscopy voiding cystourethrography Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 7 6 2 0 0 0 0 0 0
Fluoroscopy cystography Usually not appropriate Expert Opinion ☢☢☢ 1-10 mSv 1 1 9 4 1 1 0 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 9 3 1 3 1 0 0 0 0
References Study Quality
50 (26266405) 4
MRI abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 2 1 2 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 3 5 1 1 0 1 0 0
MRU without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 1 2 2 0 0 0 0
MRU without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 1 1 4 1 0 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 1 1 1 0 0 0 0
CT abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 3 1 1 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 2 5 4 1 0 1 0 0
References Study Quality
16 (22578224) 3
MAG3 renal scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 2 4 2 0 0 0 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 10 4 1 1 1 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 4 1 1 1 0 0 0 0
CTA abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 10 4 0 1 2 0 0 0 0
CTU without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 4 1 1 1 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.