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Appropriateness Criteria

Variant 1: Adult or child. Chylothorax: traumatic or iatrogenic etiology. Pretreatment planning.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Lymphangiography chest abdomen pelvis Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 3 3 6 3
References Study Quality
16 (9756057) 4
48 (17508245) 3
49 (1892021) 4
23 (35081648) 3
53 (21557160) 4
52 (19029221) 3
51 (21161658) 4
50 (21498367) 3
9 (23580112) 4
8 (18207415) 4
5 (20042200) 3
11 (19040982) 4
22 (28956103) 4
Lymphangiography chest and abdomen Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 0 3 7 5
References Study Quality
53 (21557160) 4
52 (19029221) 3
51 (21161658) 4
50 (21498367) 3
49 (1892021) 4
48 (17508245) 3
23 (35081648) 3
22 (28956103) 4
16 (9756057) 4
11 (19040982) 4
9 (23580112) 4
8 (18207415) 4
5 (20042200) 3
MR lymphangiography chest abdomen pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 4 9 3
References Study Quality
27 (33001788) 4
31 (29571786) 4
30 (32208098) 2
37 (17414769) 4
42 (27555355) 3
MR lymphangiography chest and abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 1 5 6 3
References Study Quality
42 (27555355) 3
37 (17414769) 4
31 (29571786) 4
30 (32208098) 2
27 (33001788) 4
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 0 0 4 7 3 2 0 0
References Study Quality
66 (23571057) 4
Radiography chest abdomen pelvis May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 2 4 2 6 2 0 0 0
References Study Quality
66 (23571057) 4
MRI chest without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 2 0 8 4 2 0 0
References Study Quality
64 (20578016) 3
63 (22976916) 2
62 (20013098) 4
61 (21264660) 4
MRI chest without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 10 2 2 0 0
References Study Quality
65 (32662762) 3
64 (20578016) 3
63 (22976916) 2
62 (20013098) 4
61 (21264660) 4
Lymphoscintigraphy chest abdomen pelvis May be appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 0 1 12 2 0 0 0
References Study Quality
60 (25070312) 4
59 (26183818) 3
58 (23027205) 2
57 (9669413) 4
Lymphoscintigraphy chest and abdomen May be appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 1 1 2 9 3 0 0 0
References Study Quality
60 (25070312) 4
59 (26183818) 3
58 (23027205) 2
57 (9669413) 4
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 1 5 6 2 1 0 0
References Study Quality
36 (21412101) 3
44 (17114559) 4
45 (11814747) 4
CT chest without and with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 1 1 9 3 2 0 0 0
References Study Quality
36 (21412101) 3
46 (22253338) 4
45 (11814747) 4
44 (17114559) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 1 3 6 5 1 0 0 0
References Study Quality
47 (24393538) 2
45 (11814747) 4
44 (17114559) 4
36 (21412101) 3
CT chest abdomen pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 2 6 5 0 1 0
References Study Quality
36 (21412101) 3
44 (17114559) 4
45 (11814747) 4
CT chest abdomen pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 1 0 3 3 5 3 1 0 0
References Study Quality
36 (21412101) 3
44 (17114559) 4
45 (11814747) 4
46 (22253338) 4
CT chest abdomen pelvis without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 0 3 8 2 1 1 0 0
References Study Quality
36 (21412101) 3
44 (17114559) 4
45 (11814747) 4
47 (24393538) 2
US chest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 5 1 4 1 0 0 1 0
References Study Quality
68 (8184046) 3
US chest abdomen pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 3 7 5 0 1 0 0 0 0
References Study Quality
68 (8184046) 3
69 (22440590) 2
31 (29571786) 4
Variant 2: Adult or child. Chylothorax: nontraumatic or unknown etiology. Pretreatment planning.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Lymphangiography chest abdomen pelvis Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 2 0 10 4 0
References Study Quality
49 (1892021) 4
48 (17508245) 3
16 (9756057) 4
73 (32879418) 3
32 (28494978) 4
Lymphangiography chest and abdomen Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 1 1 6 6 1
References Study Quality
73 (32879418) 3
49 (1892021) 4
48 (17508245) 3
32 (28494978) 4
16 (9756057) 4
MR lymphangiography chest abdomen pelvis Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 4 9 3
References Study Quality
33 (34165621) 2
32 (28494978) 4
31 (29571786) 4
30 (32208098) 2
27 (33001788) 4
MR lymphangiography chest and abdomen Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 1 1 8 5
References Study Quality
42 (27555355) 3
37 (17414769) 4
33 (34165621) 2
32 (28494978) 4
31 (29571786) 4
30 (32208098) 2
27 (33001788) 4
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 0 0 5 5 5 1 0 0
References Study Quality
66 (23571057) 4
Radiography chest abdomen pelvis May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 0 0 2 7 5 1 0 0 0
References Study Quality
66 (23571057) 4
MRI chest without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 6 4 3 0 0
References Study Quality
39 (14665492) 2
38 (15143230) 4
37 (17414769) 4
36 (21412101) 3
35 (15615947) 4
MRI chest without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 8 2 3 0 0
References Study Quality
65 (32662762) 3
39 (14665492) 2
38 (15143230) 4
37 (17414769) 4
36 (21412101) 3
35 (15615947) 4
Lymphoscintigraphy chest abdomen pelvis May be appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 3 2 8 2 1 0 0
References Study Quality
60 (25070312) 4
59 (26183818) 3
58 (23027205) 2
57 (9669413) 4
Lymphoscintigraphy chest and abdomen May be appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 0 4 11 1 0 0 0
References Study Quality
60 (25070312) 4
59 (26183818) 3
58 (23027205) 2
57 (9669413) 4
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 1 1 0 4 6 2 2 0
References Study Quality
36 (21412101) 3
70 (31685101) 4
71 (30392593) 4
CT chest without and with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 6 7 1 1 0 0
References Study Quality
36 (21412101) 3
46 (22253338) 4
70 (31685101) 4
71 (30392593) 4
CT chest abdomen pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 1 0 3 2 8 0 1 0
References Study Quality
36 (21412101) 3
70 (31685101) 4
71 (30392593) 4
CT chest abdomen pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 1 1 1 3 6 3 1 0 0
References Study Quality
36 (21412101) 3
46 (22253338) 4
70 (31685101) 4
71 (30392593) 4
CT chest abdomen pelvis without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 2 1 5 3 3 1 1 0 0
References Study Quality
71 (30392593) 4
70 (31685101) 4
47 (24393538) 2
45 (11814747) 4
44 (17114559) 4
36 (21412101) 3
US chest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 10 2 0 0 0 0 0 0
References Study Quality
68 (8184046) 3
US chest abdomen pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 2 8 5 0 1 0 0 0 0
References Study Quality
69 (22440590) 2
68 (8184046) 3
31 (29571786) 4
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 6 3 0 0 0 0 0
References Study Quality
71 (30392593) 4
70 (31685101) 4
47 (24393538) 2
45 (11814747) 4
44 (17114559) 4
36 (21412101) 3
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.