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Appropriateness Criteria

Variant 1: Lower urinary tract symptoms. Suspicion of benign prostatic hyperplasia. 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 May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 0 0 0 0 0
References Study Quality
31 (10664665) 4
2 (27476123) 4
1 (25613154) 4
US pelvis (bladder and prostate) transabdominal May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 0 0 0 0 0
References Study Quality
20 (25727301) 4
25 (26607685) 3
24 (25797818) 3
29 (24770808) 3
19 (21091793) 4
28 (19057217) 4
30 (12217433) 3
2 (27476123) 4
1 (25613154) 4
21 (15780362) 1
23 (14634410) 2
22 (12670568) 1
15 (12010318) 4
26 (23789044) 3
27 (27545297) 3
TRUS prostate Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
16 (25463884) 3
14 (19350408) 3
17 (26861745) 3
6 (23541338) 4
13 (22166330) 2
18 (21475953) 4
15 (12010318) 4
Fluoroscopy voiding cystourethrography Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
Radiography abdomen Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
8 (9488069) 4
Fluoroscopy retrograde urethrography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
9 (18536872) 4
11 (2446348) 3
10 (10648665) 2
12 (20858787) 4
MRI pelvis without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 3 6 5 0 0 1 0 0 0
References Study Quality
35 (22973825) 3
2 (27476123) 4
34 (27015442) 4
37 (26295642) 4
33 (28473080) 4
36 (27487205) 2
38 (29552975) 2
MRI pelvis without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 3 3 3 2 1 2 0 0 0
References Study Quality
35 (22973825) 3
2 (27476123) 4
34 (27015442) 4
37 (26295642) 4
33 (28473080) 4
36 (27487205) 2
38 (29552975) 2
CT abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
32 (25433478) 2
31 (10664665) 4
2 (27476123) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
32 (25433478) 2
31 (10664665) 4
2 (27476123) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
32 (25433478) 2
31 (10664665) 4
2 (27476123) 4
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.