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Appropriateness Criteria

Variant 1: Adult. Suspected autosomal dominant polycystic kidney disease. Positive family history. 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] 9 9 0 0 0 0 1 0 1 2 6
References Study Quality
28 (36333536) 4
34 (35476147) 4
31 (25547671) 3
43 (32523956) 4
9 (26718156) 4
MRI abdomen without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 1 7 1 3
References Study Quality
40 (38530430) 4
24 (31270136) 2
22 (28550374) 4
27 (39477840) 4
43 (32523956) 4
9 (26718156) 4
MRI abdomen without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 0 4 1 0 3 2 0 0
References Study Quality
40 (38530430) 4
24 (31270136) 2
27 (39477840) 4
43 (32523956) 4
9 (26718156) 4
CT abdomen with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 0 4 6 0 1 1
References Study Quality
9 (26718156) 4
31 (25547671) 3
CT abdomen without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 5 4 0 0 1
References Study Quality
9 (26718156) 4
31 (25547671) 3
CT abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 3 2 2 0 0 0 0
References Study Quality
9 (26718156) 4
31 (25547671) 3
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 0 1 1 3 0 0 0 0
References Study Quality
9 (26718156) 4
31 (25547671) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 8 2 3 0 0 0 0 0 0
References Study Quality
9 (26718156) 4
31 (25547671) 3
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 7 2 3 0 1 0 0 0 0
References Study Quality
9 (26718156) 4
31 (25547671) 3
WBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 9 0 0 0 1 0 0 0 0
Variant 2: Adult. Known autosomal dominant polycystic kidney disease. Surveillance of total kidney volume.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 1 5 2 4
References Study Quality
40 (38530430) 4
24 (31270136) 2
22 (28550374) 4
17 (27341140) 4
27 (39477840) 4
43 (32523956) 4
23 (30666443) 4
21 (39049998) 4
39 (32969110) 4
25 (33821360) 4
26 (38344736) 4
MRI abdomen without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 5 1 2 0 1 2 1 0 0
References Study Quality
40 (38530430) 4
24 (31270136) 2
22 (28550374) 4
17 (27341140) 4
27 (39477840) 4
43 (32523956) 4
23 (30666443) 4
21 (39049998) 4
39 (32969110) 4
25 (33821360) 4
26 (38344736) 4
CT abdomen without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 4 3 2 0 1
References Study Quality
32 (33141305) 4
16 (28515418) 4
29 (35633387) 4
31 (25547671) 3
US kidneys retroperitoneal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 1 3 0 1 0 0 0 0
References Study Quality
28 (36333536) 4
34 (35476147) 4
31 (25547671) 3
43 (32523956) 4
CT abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 4 1 0 0 0 1 0
References Study Quality
32 (33141305) 4
16 (28515418) 4
31 (25547671) 3
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 3 1 1 0 1 0 0
References Study Quality
32 (33141305) 4
16 (28515418) 4
29 (35633387) 4
31 (25547671) 3
CT abdomen with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 2 3 2 0 0 1 0 0
References Study Quality
32 (33141305) 4
16 (28515418) 4
31 (25547671) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 8 1 3 0 0 0 0 0 0
References Study Quality
32 (33141305) 4
16 (28515418) 4
31 (25547671) 3
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 8 2 2 0 0 0 0 0 0
References Study Quality
32 (33141305) 4
16 (28515418) 4
31 (25547671) 3
WBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 8 0 1 0 1 0 0 0 0
Variant 3: Adult. Known autosomal dominant polycystic kidney disease. Suspected complication. Normal kidney function. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 1 4 2 1
References Study Quality
40 (38530430) 4
43 (32523956) 4
38 (27829402) 4
41 (27529555) 4
36 (26454062) 4
37 (32700112) 4
35 (24919173) 2
39 (32969110) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 2 0 0 2 5
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
MRI abdomen without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 2 1 3 2 3 1 0
References Study Quality
40 (38530430) 4
43 (32523956) 4
38 (27829402) 4
41 (27529555) 4
36 (26454062) 4
37 (32700112) 4
35 (24919173) 2
39 (32969110) 4
CT abdomen and pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 3 2 0 3 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
CT abdomen with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 3 1 3 2 0 1 2 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
CT abdomen without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 3 1 1 2 3 0 0 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
US kidneys retroperitoneal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 3 2 2 1 0 0 0 0
References Study Quality
42 (30517147) 4
41 (27529555) 4
WBC scan with SPECT or SPECT/CT abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 5 0 1 3 0 0 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 6 2 3 1 0 0 0 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 2 4 0 0 0 1 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 2 3 0 2 0 0 0 0
References Study Quality
46 (32556485) 4
43 (32523956) 4
36 (26454062) 4
45 (29653972) 4
37 (32700112) 4
44 (27014954) 2
35 (24919173) 2
Gallium scan whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 6 1 1 2 0 0 0 0 0
Variant 4: Adult. Known autosomal dominant polycystic kidney disease. Suspected complications. Reduced kidney function. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 0 1 4 1 3
References Study Quality
40 (38530430) 4
43 (32523956) 4
38 (27829402) 4
41 (27529555) 4
36 (26454062) 4
37 (32700112) 4
35 (24919173) 2
39 (32969110) 4
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 2 3 2 0 2
References Study Quality
40 (38530430) 4
43 (32523956) 4
38 (27829402) 4
41 (27529555) 4
36 (26454062) 4
37 (32700112) 4
35 (24919173) 2
39 (32969110) 4
CT abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 5 3 3 0 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 1 2 6 2 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
US kidneys retroperitoneal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 3 0 1 2 0 0 0 0
References Study Quality
42 (30517147) 4
41 (27529555) 4
CT abdomen with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 5 0 0 1 0 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 1 2 3 0 0 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
WBC scan with SPECT or SPECT/CT abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 6 1 2 0 0 1 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 6 1 2 0 0 1 0 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 6 0 3 0 0 1 0 0 0
References Study Quality
43 (32523956) 4
42 (30517147) 4
35 (24919173) 2
41 (27529555) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 2 3 0 1 0 1 0 0
References Study Quality
46 (32556485) 4
43 (32523956) 4
36 (26454062) 4
45 (29653972) 4
37 (32700112) 4
44 (27014954) 2
35 (24919173) 2
Gallium scan whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 6 0 2 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.