ACR logo

Appropriateness Criteria

Variant 1: Adult. Renal transplant dysfunction. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler kidney transplant Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 0 1 1 13
References Study Quality
37 (18287435) 3
36 (2004509) 4
35 (14571160) 4
34 (28858538) 2
33 (22595689) 2
32 (12594798) 2
31 (14521886) 3
30 (9176852) 3
29 (7554736) 3
28 (24195547) 2
27 (21324840) 2
26 (12853584) 3
25 (3548286) 3
24 (2644778) 2
23 (3541027) 2
22 (3303879) 3
18 (30033070) 4
US pelvis Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 1 0 0 0 0 1 0
US pelvis with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 1 0 1 0 0 0 0
Arteriography kidney Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 0 1 1 1 0 0 0 0
Fluoroscopy antegrade pyelography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 0 3 1 0 0 0 0 0
Image-guided biopsy kidney Usually not appropriate Expert Consensus Varies Varies 1 1 9 1 4 0 1 0 1 0 0
MRA abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 2 1 0 1 0 0 0
MRA abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 1 1 1 0 0 0 0
MRA pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 1 1 2 0 0 0 0
MRA pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 2 2 1 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 1 2 1 1 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 11 0 3 2 0 0 0 0 0
MRI pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 1 1 1 2 0 0 0 0
MRI pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 2 1 1 1 0 0 0
MRU without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 0 3 0 0 0 0 0
MRU without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 0 1 2 0 0 0 0
MRV abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 1 2 1 1 0 0 0 0
MRV pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 1 1 1 1 1 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 1 2 1 3 0 1 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 0 3 1 3 1 1 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 1 3 0 3 0 1 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 0 5 0 3 1 1 0 0
DTPA renal scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 0 4 2 1 0 0 0 0
References Study Quality
18 (30033070) 4
17 (18589113) 4
16 (3891349) 4
15 (16549144) 3
14 (24152633) 3
13 (10952501) 3
MAG3 renal scan Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 0 2 4 1 0 0 0 0
References Study Quality
21 (11168310) 2
20 (24484750) 4
19 (30074536) 3
18 (30033070) 4
17 (18589113) 4
14 (24152633) 3
13 (10952501) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 8 1 2 2 3 0 0 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 0 4 1 1 0 0 0 0
CTA abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 10 0 3 1 1 1 0 0 0
CTA pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 10 0 3 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 12 1 1 1 1 0 0 0 0
CTV abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 1 3 0 1 0 0 0 0
CTV pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 1 2 0 2 0 0 0 0
Variant 2: Adult. Renal transplant dysfunction. US suspicious for, but not conclusive for arterial etiology. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA abdomen and pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 5 3 6 2 0
References Study Quality
18 (30033070) 4
63 (21601400) 2
62 (10508297) 4
61 (12354824) 3
60 (10997461) 3
MRA pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 1 2 10 2
References Study Quality
63 (21601400) 2
62 (10508297) 4
61 (12354824) 3
60 (10997461) 3
57 (24948209) 2
18 (30033070) 4
CTA abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 1 1 0 0 0 0 9 4 1
References Study Quality
18 (30033070) 4
55 (17497443) 1
CTA pelvis with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 8 8 1 0 1 0 0 1 5 4 4
References Study Quality
18 (30033070) 4
57 (24948209) 2
56 (21111553) 3
55 (17497443) 1
US pelvis with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 1 0 7 6 0 0 1
References Study Quality
69 (28583646) 3
70 (1688270) 4
Arteriography kidney May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 1 1 1 1 6 4 1 0 1
References Study Quality
54 (13679503) 4
53 (21331135) 4
52 (15943633) 2
51 (18670375) 3
50 (20682611) 4
49 (16504683) 4
48 (17629433) 2
47 (18589114) 2
46 (19473615) 2
45 (19235580) 2
44 (20601365) 2
43 (18435786) 2
42 (15590798) 2
41 (16433762) 2
40 (20824760) 2
39 (21839234) 2
38 (25220328) 4
MRA abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 1 4 9 1 0 0
References Study Quality
68 (29666993) 3
67 (24592960) 3
66 (24246390) 3
65 (19635833) 2
64 (19261926) 2
62 (10508297) 4
MRA pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 3 10 1 0 0
References Study Quality
68 (29666993) 3
67 (24592960) 3
66 (24246390) 3
65 (19635833) 2
64 (19261926) 2
62 (10508297) 4
18 (30033070) 4
DTPA renal scan May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 0 8 7 0 1 0 0
References Study Quality
16 (3891349) 4
US duplex Doppler kidney transplant Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 2 4 4 0 0 0 1 0
US pelvis Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 2 1 0 1 1 0 0
Image-guided biopsy kidney Usually not appropriate Expert Consensus Varies Varies 1 1 10 0 4 0 1 0 1 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 0 0 1 0 1 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 2 2 2 0 1 0 0 0
MRI pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 5 0 0 0 0 2 0 0
MRI pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 3 2 1 1 1 0 0 0
MRU without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 0 3 0 1 0 0 0 0
MRU without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 0 3 0 1 0 0 0 0
MRV abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 0 2 0 2 0 0 0 0
MRV pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 2 1 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 10 0 3 0 1 1 0 0 1
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 2 0 1 1 0 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 1 1 0 0 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 2 1 1 0 0 0 0
MAG3 renal scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 6 0 7 1 0 0 1 1 0
References Study Quality
58 (7715893) 3
59 (28969763) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 14 0 0 1 1 0 0 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 3 1 1 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 12 0 2 1 1 0 0 0 0
CTV abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 12 0 2 1 1 0 0 0 0
CTV pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 12 0 2 1 1 0 0 0 0
Variant 3: Adult. Renal transplant dysfunction. US suspicious for, but not conclusive for venous etiology. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRV abdomen and pelvis without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 0 1 1 10 3
MRV pelvis without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 1 0 0 1 0 2 2 4 6
CTV abdomen and pelvis with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 8 8 1 0 0 1 0 0 4 8 2
CTV pelvis with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 7 7 0 1 0 1 3 3 1 5 2
US duplex Doppler kidney transplant May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 6 0 2 2 5 0 1 0 0
US pelvis with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 6 2 2 2 1 2 0 1 0
MRI pelvis without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 2 1 5 4 3 0 1 0 0
US pelvis Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 0 1 0 1 0 0 0
Arteriography kidney Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 15 0 0 1 0 0 0 0 0
References Study Quality
71 (16687747) 2
Image-guided biopsy kidney Usually not appropriate Expert Consensus Varies Varies 1 1 15 0 0 0 0 0 1 0 0
MRA abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 0 1 0 0
MRA abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 0 3 0 1 1 1 0 0
MRA pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 0 4 0 1 0 0 1 0
MRA pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 0 4 0 1 0 1 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 7 1 5 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] 1 1 9 1 2 0 2 2 0 0 0
MRI pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 1 2 2 0 2 0 0 0
MRU without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 2 2 1 0 0 0 0
MRU without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 3 1 1 0 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 5 2 2 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 1 1 3 0 0 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 2 4 1 0 0 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 2 0 2 1 0 0 0
DTPA renal scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 1 4 0 0 0 1 0 0
References Study Quality
59 (28969763) 4
MAG3 renal scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 0 0 0 0 1 0 0
References Study Quality
59 (28969763) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 14 1 0 1 0 0 0 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 1 1 0 0 0 0 0
CTA abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 13 2 0 0 0 0 1 0 0
CTA pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 14 1 0 0 0 0 1 0 0
CTU without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 12 0 2 0 1 0 1 0 0
Variant 4: Adult. Renal transplant dysfunction. US suspicious for, but not conclusive for extrinsic etiology. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen and pelvis without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 9 4 1 0 0
MRI abdomen and pelvis without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 10 3 0 1 0
MRI pelvis without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 5 7 1 2 0
MRI pelvis without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 10 4 1 0 0
MRU without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 5 8 0 1 0
References Study Quality
73 (12227682) 3
MRU without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 2 3 8 1 1 0 0
References Study Quality
74 (18055152) 3
CT abdomen and pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 9 2 1 1 2
CT abdomen and pelvis without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 10 2 0 3 0
CT pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 4 8 2 1 0
CT pelvis without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 9 3 2 0 0
CT abdomen and pelvis without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 3 1 4 1 5 1 1 0 0
CT pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 3 1 4 1 1 5 1 0 0
CTU without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 0 1 3 7 4 0 1 0
References Study Quality
72 (12207185) 3
US duplex Doppler kidney transplant Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 1 5 1 0 0 0 0 0
US pelvis Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 2 2 0 1 1 1 0 0
US pelvis with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 3 3 0 2 1 1 0 0
References Study Quality
11 (32412688) 4
75 (24118471) 3
Arteriography kidney Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 0 2 1 0 1 0 0 0
Fluoroscopy antegrade pyelography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 0 2 1 2 0 1 0 0
Image-guided biopsy kidney Usually not appropriate Expert Consensus Varies Varies 1 1 12 0 3 0 1 0 0 0 0
MRA abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 3 0 1 1 0 0 0
MRA abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 3 0 1 1 0 0 0
MRA pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 0 2 0 1 1 0 0 0
MRA pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 0 2 1 0 1 0 0 0
MRV abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 0 3 0 1 1 1 0 0
MRV pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 1 1 0 0 0 0 0
DTPA renal scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 7 0 2 3 2 2 0 0 0
MAG3 renal scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 0 2 2 3 0 1 0 0
CTA abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 9 0 3 2 1 1 0 0 0
CTA pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 10 0 4 0 0 2 0 0 0
CTV abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 10 0 3 0 2 1 0 0 0
CTV pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 13 1 0 1 0 1 0 0 0
Variant 5: Adult. Renal transplant dysfunction. US unremarkable or indeterminate. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Image-guided biopsy kidney Usually appropriate Limited Varies Varies 7 7 1 0 0 0 2 0 6 3 4
References Study Quality
18 (30033070) 4
79 (14508363) 4
78 (15996250) 3
77 (10096531) 3
76 (22231130) 4
US duplex Doppler kidney transplant Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 3 0 1 0 0 0 0
US pelvis Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 2 0 0 1 1 0 0
US pelvis with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 1 2 0 4 1 0 0 0
References Study Quality
12 (29632989) 4
84 (28885208) 4
83 (21792579) 4
82 (33941759) 4
81 (33184930) 3
80 (19460520) 2
Arteriography kidney Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 0 0 0 1 1 1 0 0
Fluoroscopy antegrade pyelography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 0 2 1 0 1 1 0 0
MRA abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 0 2 1 1 2 0 0 0
MRA abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 0 3 0 0 2 0 0 0
MRA pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 1 2 1 2 2 0 0 0
MRA pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 2 2 1 0 2 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 7 0 3 4 2 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 7 1 2 4 2 0 0 0 0
MRI pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 7 1 2 0 6 0 0 0 0
MRI pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 7 1 2 0 6 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 1 5 1 1 0 0 0 0
MRU without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 1 0 1 0 0 0 0
MRV abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 0 0 1 0 0 0 0
MRV pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 1 0 1 0 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 0 7 0 0 2 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 4 0 0 1 1 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 0 2 5 0 2 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 0 6 0 0 1 0 0 0
DTPA renal scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 1 2 0 2 1 1 0 0
MAG3 renal scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 0 1 0 0 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] 2 2 8 2 4 0 0 1 1 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 0 2 5 0 2 0 0 0
CTA abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 10 0 4 0 0 2 0 0 0
CTA pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 13 2 0 0 0 0 1 0 0
CTU without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 8 6 1 0 0 0 1 0 0
CTV abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 10 0 3 0 1 1 0 1 0
CTV pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 10 0 2 0 2 1 0 1 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.