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Appropriateness Criteria

Variant 1: Suspected large-vessel vasculitis (LVV). 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 abdomen pelvis with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 0 3 8 7
References Study Quality
76 (26720837) 2
29 (29313811) Good
73 (28322426) 2
22 (29358285) 4
53 (29666047) 1
75 (28757178) 4
74 (25665823) 3
54 (26553537) 4
MRA chest abdomen pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 2 0 1 1 3 7 6
References Study Quality
76 (26720837) 2
29 (29313811) Good
73 (28322426) 2
22 (29358285) 4
53 (29666047) 1
75 (28757178) 4
74 (25665823) 3
54 (26553537) 4
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 1 1 11 4 1
References Study Quality
32 (24643395) 3
34 (29927635) 3
CT chest abdomen pelvis without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 0 0 1 0 4 4 5 4 1
References Study Quality
32 (24643395) 3
34 (29927635) 3
FDG-PET/CT whole body Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 0 1 7 5 5
References Study Quality
35 (27472684) 2
55 (27367985) 3
42 (26376404) 2
59 (25671403) 3
48 (25254211) 2
58 (24875577) 2
44 (24008434) 4
70 (28916549) 1
36 (28736805) 4
37 (28911987) 3
63 (28180963) 2
47 (29131857) 3
45 (27068039) 4
22 (29358285) 4
60 (28856429) 4
46 (29145713) 1
61 (29465347) 3
43 (25695092) 2
51 (27925577) 1
15 (30066157) 3
72 (29671039) 1
38 (29362158) 3
71 (24665112) 1
66 (29903537) 3
53 (29666047) 1
33 (29637252) 4
62 (29799393) 2
49 (25860208) 4
34 (29927635) 3
64 (28109928) 1
57 (26250689) 2
56 (29427822) 4
13 (30887249) 4
14 (30848549) 2
50 (30120746) 4
52 (-3185009) 4
54 (26553537) 4
65 (32145885) 4
67 (31081519) 1
68 (31649025) 2
69 (30976984) 3
CTA chest abdomen pelvis with IV contrast Usually appropriate Strong ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 0 0 2 7 11
References Study Quality
27 (24925329) 4
35 (27472684) 2
26 (29600479) 3
29 (29313811) Good
36 (28736805) 4
37 (28911987) 3
28 (25399944) 4
31 (23873881) 2
39 (27931962) 4
32 (24643395) 3
38 (29362158) 3
25 (25654393) 2
33 (29637252) 4
34 (29927635) 3
30 (29880442) 3
24 (25405825) 4
40 (29531788) 4
US duplex Doppler upper extremity May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 0 1 8 8 1 0 0
References Study Quality
83 (26764900) 4
85 (25659455) 2
78 (29982780) 4
23 (28460064) 4
77 (28503707) 2
81 (26016760) 1
84 (27059104) 1
2 (29982778) 4
79 (30526899) 4
40 (29531788) 4
80 (24106211) 3
82 (29862043) 4
Arteriography chest abdomen pelvis May be appropriate Limited Varies Varies 4 4 4 1 2 3 7 0 1 1 0
References Study Quality
22 (29358285) 4
MRA chest abdomen pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 4 9 3 0 0
References Study Quality
76 (26720837) 2
29 (29313811) Good
73 (28322426) 2
22 (29358285) 4
53 (29666047) 1
75 (28757178) 4
74 (25665823) 3
54 (26553537) 4
MRA neck with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 1 1 6 1 5 4 0
References Study Quality
68 (31649025) 2
MRA neck without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 2 1 11 2 0 2 0
References Study Quality
68 (31649025) 2
MRA neck without IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 4 4 1 0 3 8 5 1 0 1 0
References Study Quality
68 (31649025) 2
MRI chest abdomen pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 2 0 6 3 5 3 0
References Study Quality
76 (26720837) 2
CTA coronary arteries with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 7 8 2 0 0
References Study Quality
41 (24009351) 3
US duplex Doppler aorta abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 3 8 1 0 0 0 0 0
References Study Quality
77 (28503707) 2
US duplex Doppler chest abdomen pelvis Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 8 4 0 0 0 0 0 0
References Study Quality
78 (29982780) 4
US duplex Doppler iliofemoral arteries Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 7 1 4 5 2 0 0 0 0
US duplex Doppler lower extremity Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 0 8 3 5 0 1 0 0
References Study Quality
77 (28503707) 2
MRA coronary arteries without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 7 1 1 0 1 0 0 0
MRA coronary arteries without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 4 2 0 1 1 1 0 0
MRI chest abdomen pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 0 10 0 5 3 0 0 0
References Study Quality
76 (26720837) 2
MRI heart function and morphology without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 6 6 1 0 0 0 0 0
MRI heart function and morphology without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 4 0 1 0 1 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 8 2 6 1 2 1 0 0 0
References Study Quality
32 (24643395) 3
34 (29927635) 3
Variant 2: Suspected medium-vessel vasculitis (MVV). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Arteriography chest abdomen pelvis Usually appropriate Limited Varies Varies 7 7 1 0 0 1 0 3 8 5 1
References Study Quality
86 (30698353) 4
87 (25241888) 4
CTA chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 1 0 0 1 2 2 2 7 5
References Study Quality
89 (24824975) 4
88 (26692417) 4
MRA chest abdomen pelvis with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 8 5 2 3 0
MRA chest abdomen pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 1 6 7 1 1 3 0
MRA chest abdomen pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 8 1 5 1 2 1 0
MRI chest abdomen pelvis without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 4 5 0 2 6 1 0 1 0
MRI heart function and morphology without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 4 5 0 3 5 2 0 0 0
CTA coronary arteries with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 2 0 4 4 7 2 0
References Study Quality
7 (27056781) 4
90 (27443748) 4
CT chest abdomen pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 6 10 1 0 1
References Study Quality
88 (26692417) 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 0 0 9 8 0 0 1
References Study Quality
88 (26692417) 4
US duplex Doppler aorta abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 8 2 0 0 0 0 0 0
US duplex Doppler chest abdomen pelvis Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 9 1 1 0 0 0 0 0
US duplex Doppler iliofemoral arteries Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 10 1 0 0 0 0 0 0
US duplex Doppler lower extremity Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 10 1 0 0 0 0 0 0
US duplex Doppler upper extremity Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 9 2 0 0 0 0 0 0
MRA coronary arteries without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 5 5 1 0 1 0 0 0
MRA coronary arteries without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 7 1 0 0 0 0 0 0
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 7 5 0 0 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 7 5 0 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 10 0 0 0 0 0 0 0
MRI chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 2 4 2 1 2 0 0 0
MRI heart function and morphology without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 3 0 2 5 1 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 3 5 4 0 1 0 1 0
References Study Quality
88 (26692417) 4
FDG-PET/CT whole body Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 7 5 0 0 0 0 0 0
References Study Quality
91 (29035930) 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.