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Appropriateness Criteria

Variant 1: Congenital aortic disease. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US echocardiography transthoracic resting Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 5 7 2
References Study Quality
19 (23395099) 4
39 (20037148) 2
20 (16687740) M
42 (25623219) 4
21 (28617686) 4
16 (22336668) 2
40 (6466514) 4
41 (25714305) 4
43 (10078071) 4
Radiography chest Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 7 7 0 0 1 1 0 5 6 1 1
References Study Quality
32 (125633) 4
34 (3490744) 2
33 (9114098) 4
35 (482591) 4
21 (28617686) 4
10 (28377475) 4
30 (25464254) 4
31 (25442062) 4
MRA chest and abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 0 5 8
References Study Quality
28 (16891235) 3
27 (18356435) 2
23 (25644073) 3
24 (25476670) 4
21 (28617686) 4
15 (27384018) 4
17 (15699283) 3
22 (16249863) 4
29 (11305558) 4
26 (25061611) 3
25 (27390537) 4
MRA chest and abdomen without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 0 2 4 4 2
References Study Quality
28 (16891235) 3
27 (18356435) 2
23 (25644073) 3
24 (25476670) 4
21 (28617686) 4
15 (27384018) 4
17 (15699283) 3
22 (16249863) 4
29 (11305558) 4
26 (25061611) 3
25 (27390537) 4
CTA chest and abdomen with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 0 0 2 7 5
References Study Quality
19 (23395099) 4
20 (16687740) M
6 (29724423) 4
10 (28377475) 4
11 (9369517) 4
12 (19125810) 3
13 (18481135) 4
14 (14975985) 3
16 (22336668) 2
18 (23488145) 4
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 0 7 6 1 0 0
References Study Quality
5 (28473082) 4
38 (-3157902) 4
37 (30318593) 4
36 (12081068) 4
US echocardiography transesophageal May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 6 4 1 1 0
References Study Quality
21 (28617686) 4
10 (28377475) 4
Aortography chest and abdomen May be appropriate Strong ☢☢☢☢ 10-30 mSv 4 4 0 0 3 6 4 2 0 0 0
References Study Quality
10 (28377475) 4
11 (9369517) 4
12 (19125810) 3
13 (18481135) 4
14 (14975985) 3
15 (27384018) 4
16 (22336668) 2
17 (15699283) 3
18 (23488145) 4
CT chest and abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 2 3 8 0 2 0 0 0 0
CT chest and abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 0 4 6 0 2 1 0 1 0
CT chest and abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 1 6 2 4 0 1 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 4 0 0 0 0 0 0
Variant 2: Inflammatory or infectious or neoplastic or metabolic nontraumatic aortic disease. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA chest and abdomen without and with IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 7 7
References Study Quality
55 (22624966) 4
70 (25169925) 4
68 (15615989) 3
50 (22624970) 4
73 (30003767) 4
44 (29313811) Good
66 (29390488) 2
46 (15136894) 4
47 (19462198) 4
67 (11148714) 4
69 (21869711) 4
71 (24396601) 4
72 (11044025) 4
MRA chest and abdomen without IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 3 5 3 0
References Study Quality
55 (22624966) 4
70 (25169925) 4
68 (15615989) 3
50 (22624970) 4
73 (30003767) 4
44 (29313811) Good
66 (29390488) 2
46 (15136894) 4
47 (19462198) 4
67 (11148714) 4
69 (21869711) 4
71 (24396601) 4
72 (11044025) 4
CTA chest and abdomen with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 0 0 2 6 6
References Study Quality
55 (22624966) 4
48 (15068950) 4
58 (21415189) 4
50 (22624970) 4
53 (29600479) 3
56 (28736805) 4
57 (28911987) 3
51 (9769819) 4
52 (9152912) 4
54 (23907804) 4
FDG-PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 2 2 4 3 2
References Study Quality
60 (10723979) 3
50 (22624970) 4
59 (18541754) 4
64 (29299706) 3
56 (28736805) 4
62 (26704559) Not Assessed
63 (17706537) 4
65 (3513252) 4
61 (21253802) 3
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 1 12 1 0 0 0
References Study Quality
50 (22624970) 4
76 (29182089) 4
74 (28795494) 4
73 (30003767) 4
75 (29982780) 4
44 (29313811) Good
5 (28473082) 4
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 1 0 6 7 1 0 0 0
References Study Quality
21 (28617686) 4
10 (28377475) 4
CT chest and abdomen with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 5 5 0 0 1 0 11 3 0 0 0
References Study Quality
45 (18664851) 3
48 (15068950) 4
49 (17374865) 4
50 (22624970) 4
46 (15136894) 4
47 (19462198) 4
CT chest and abdomen without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 6 6 0 0 0 0 6 9 0 0 0
References Study Quality
45 (18664851) 3
48 (15068950) 4
49 (17374865) 4
50 (22624970) 4
46 (15136894) 4
47 (19462198) 4
CT chest and abdomen without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv 5 5 0 1 0 6 7 1 0 0 0
References Study Quality
45 (18664851) 3
48 (15068950) 4
49 (17374865) 4
50 (22624970) 4
46 (15136894) 4
47 (19462198) 4
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 3 7 4 0 1 0 0 0 0
US echocardiography transthoracic resting Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 2 6 5 2 0 0 0 0 0
Aortography chest and abdomen Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 2 6 7 0 0 0 0 0 0
References Study Quality
44 (29313811) Good
Variant 3: Degenerative or atherosclerotic aortic disease. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 3 3 6 3 0
References Study Quality
5 (28473082) 4
Radiography chest Usually appropriate Moderate ☢ <0.1 mSv ☢ <0.03 mSv [ped] 7 7 0 1 0 1 3 2 7 0 1
References Study Quality
35 (482591) 4
111 (26467382) 3
112 (26978394) 3
113 (26603153) 2
114 (25524604) 4
MRA chest and abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 1 2 9 2
References Study Quality
102 (8633452) 2
101 (11930077) 3
106 (20013276) 3
42 (25623219) 4
95 (25173340) 4
105 (18496046) 1
107 (8021526) 1
110 (26251355) 4
99 (27989994) 4
100 (9166568) 4
103 (9714107) 3
104 (8656981) 3
108 (18607152) 4
109 (16445985) 4
MRA chest and abdomen without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 0 2 8 2 1
References Study Quality
102 (8633452) 2
101 (11930077) 3
106 (20013276) 3
42 (25623219) 4
95 (25173340) 4
105 (18496046) 1
107 (8021526) 1
110 (26251355) 4
99 (27989994) 4
100 (9166568) 4
103 (9714107) 3
104 (8656981) 3
108 (18607152) 4
109 (16445985) 4
CTA chest and abdomen with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 9 9 0 0 0 0 0 0 0 2 12
References Study Quality
88 (19427980) 1
95 (25173340) 4
86 (18254665) 2
90 (18810452) 3
91 (19704327) 4
92 (21327586) 3
93 (19325064) 4
94 (29880113) 4
96 (29261347) 3
97 (28546046) 4
98 (28484713) 3
89 (28437714) 3
99 (27989994) 4
87 (26654390) 4
US echocardiography transthoracic resting May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 6 7 1 0 0
References Study Quality
42 (25623219) 4
95 (25173340) 4
115 (29433798) Good
117 (28086801) 4
116 (20823280) 4
CT chest and abdomen with IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv 5 5 0 0 1 3 8 3 0 0 0
References Study Quality
85 (20359588) 4
77 (19770313) 4
78 (28193267) 2
83 (26659376) 3
82 (25302677) 3
81 (24812323) 3
80 (27741978) 4
84 (26666465) 2
79 (27334925) 2
CT chest and abdomen without IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv 5 5 0 1 0 5 7 2 0 0 0
References Study Quality
85 (20359588) 4
77 (19770313) 4
78 (28193267) 2
83 (26659376) 3
82 (25302677) 3
81 (24812323) 3
80 (27741978) 4
84 (26666465) 2
79 (27334925) 2
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 1 3 7 1 0 1 1 0 0
Aortography chest and abdomen Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 3 5 3 1 0 2 0 0 0
CT chest and abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 3 3 0 1 8 3 1 0 1 0 0
References Study Quality
85 (20359588) 4
77 (19770313) 4
78 (28193267) 2
83 (26659376) 3
82 (25302677) 3
81 (24812323) 3
80 (27741978) 4
84 (26666465) 2
79 (27334925) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 5 4 1 0 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.