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Appropriateness Criteria

Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 0 1 1 2 18
References Study Quality
35 (24625611) 4
36 (28027791) 4
34 (19884165) 3
31 (24503676) 4
33 (25623219) 4
MRA chest abdomen pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 0 2 12 6
References Study Quality
51 (24399340) 2
50 (20200628) 2
49 (20171907) 1
48 (24740558) 3
45 (27553926) 1
44 (28388971) 2
43 (31054559) 4
41 (7824707) 2
40 (28987425) 4
39 (20013276) 3
38 (22386146) 2
34 (19884165) 3
33 (25623219) 4
37 (17968882) 3
46 (30664117) 2
47 (28905233) 2
MRA chest abdomen pelvis without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 2 0 13 5 1
References Study Quality
52 (30694008) 3
53 (22415593) 3
51 (24399340) 2
45 (27553926) 1
37 (17968882) 3
39 (20013276) 3
44 (28388971) 2
50 (20200628) 2
CTA chest and abdomen with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 6 6 0 0 1 0 7 10 3 0 1
MRA chest and abdomen without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 4 10 4 3 1
MRA chest and abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 6 9 3 3 0
CT chest abdomen pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 12 2 7 0 0
CT chest abdomen pelvis without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 0 0 1 11 6 3 1 0
CT chest abdomen pelvis without IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 3 6 11 1 1 0 0
References Study Quality
30 (30835189) 1
33 (25623219) 4
31 (24503676) 4
29 (22451563) 2
CT chest and abdomen with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 4 4 0 2 9 2 6 2 1 0 0
CT chest and abdomen without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 4 4 0 2 8 4 6 1 1 0 0
Aortography chest abdomen pelvis Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 5 4 7 2 2 2 0 0 0
References Study Quality
27 (29613964) 4
28 (12694105) 2
CT chest and abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 2 4 6 3 5 1 1 0 0
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 3 3 5 5 9 2 1 0 0 0 0
References Study Quality
55 (14715319) 1
54 (26724510) 4
53 (22415593) 3
US duplex Doppler aorta abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 5 9 3 1 0 0 0 0
References Study Quality
43 (31054559) 4
56 (15838577) 3
US echocardiography transthoracic resting Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 8 9 1 1 0 0 0 0
References Study Quality
58 (25529153) 4
33 (25623219) 4
57 (20823280) 4
Radiography chest abdomen pelvis Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 9 6 7 0 0 0 0 0 0
References Study Quality
55 (14715319) 1
54 (26724510) 4
53 (22415593) 3
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA chest abdomen pelvis with IV contrast Usually appropriate Strong ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 1 0 0 0 0 1 0 2 18
References Study Quality
68 (31705825) 3
72 (29080918) 2
71 (26344681) 3
70 (17306951) 1
69 (26497024) 3
67 (22021522) 2
66 (22459348) 2
65 (31635962) 2
64 (30855116) 4
63 (22176725) 4
62 (12618702) 1
61 (23392427) 1
31 (24503676) 4
14 (26792544) 1
9 (23062495) 2
60 (19803256) 4
MRA chest abdomen pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 0 4 11 5
References Study Quality
73 (23047141) 2
72 (29080918) 2
71 (26344681) 3
68 (31705825) 3
65 (31635962) 2
14 (26792544) 1
9 (23062495) 2
38 (22386146) 2
62 (12618702) 1
64 (30855116) 4
67 (22021522) 2
70 (17306951) 1
MRA chest abdomen pelvis without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 4 2 11 3 1
References Study Quality
61 (23392427) 1
63 (22176725) 4
74 (29162027) 2
CT chest abdomen pelvis with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 3 8 2 3 1 3 0 0
CT chest abdomen pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 2 3 7 2 4 2 1 1 0
CTA chest and abdomen with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 2 4 6 2 3 3 2 0 0
MRA chest and abdomen without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 2 6 4 2 4 1 0 0
Aortography chest abdomen pelvis Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 2 7 5 2 4 1 1 0 0
References Study Quality
27 (29613964) 4
59 (19251176) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 8 3 4 0 0 0 0
CT chest and abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 3 4 7 5 2 1 0 0 0
CT chest and abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 3 4 7 4 3 1 0 0 0
CT chest and abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 5 4 7 4 2 0 0 0 0
MRA chest and abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 2 8 6 1 1 0 0 0
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 11 6 3 0 1 0 1 0 0
US duplex Doppler aorta abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 5 5 1 3 0 0 0 0
US echocardiography transthoracic resting Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 5 4 2 2 0 0 1 1
References Study Quality
33 (25623219) 4
Radiography chest abdomen pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 4 3 0 0 0 0 0 0
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA chest abdomen pelvis with IV contrast Usually appropriate Strong ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 1 0 0 1 0 3 17
References Study Quality
83 (20924762) 3
84 (28662928) 4
82 (27542700) 4
81 (27436027) 1
80 (23465175) 4
79 (23403221) 4
78 (19104821) 2
32 (23711975) 3
17 (24246537) 3
14 (26792544) 1
77 (24480084) 2
MRA chest abdomen pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 2 1 6 8 4
References Study Quality
88 (27357219) 1
87 (14718808) 2
86 (16630731) 3
85 (18307209) 4
84 (28662928) 4
83 (20924762) 3
82 (27542700) 4
80 (23465175) 4
79 (23403221) 4
78 (19104821) 2
20 (30792053) 2
17 (24246537) 3
14 (26792544) 1
76 (29460048) 4
MRA chest abdomen pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 8 9 3 0 0
References Study Quality
89 (31075419) 3
Aortography chest abdomen pelvis May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 0 3 1 4 10 4 0 0 0
References Study Quality
27 (29613964) 4
76 (29460048) 4
75 (10751479) 1
CT chest abdomen pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 15 5 1 0 0
CT chest abdomen pelvis without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 0 1 2 13 3 1 2 0
CTA chest and abdomen with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 2 2 7 2 3 5 1 0 0
MRA chest and abdomen without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 3 5 4 5 2 1 0 0
CT chest abdomen pelvis without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 2 2 6 4 6 1 1 0 0
References Study Quality
32 (23711975) 3
77 (24480084) 2
76 (29460048) 4
MRA chest and abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 2 4 4 6 5 0 1 0 0
CT chest and abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 2 4 7 4 4 1 0 0 0
CT chest and abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 2 4 7 3 5 0 0 1 0
CT chest and abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 2 4 9 0 6 1 0 0 0
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 3 3 7 3 8 2 1 0 1 0 0
References Study Quality
90 (14656185) 4
76 (29460048) 4
Radiography chest abdomen pelvis Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 8 3 7 2 1 0 0 0 1
References Study Quality
90 (14656185) 4
76 (29460048) 4
US duplex Doppler aorta abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 4 8 5 0 0 0 0 0
References Study Quality
93 (12514572) 3
92 (29850415) 4
91 (11107086) 1
84 (28662928) 4
82 (27542700) 4
76 (29460048) 4
US echocardiography transthoracic resting Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 4 8 0 5 0 0 0 0
References Study Quality
33 (25623219) 4
58 (25529153) 4
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢☢ 30-100 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 2 0 0 0 1 1 4 14
References Study Quality
35 (24625611) 4
34 (19884165) 3
31 (24503676) 4
33 (25623219) 4
MRA chest abdomen pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 1 4 9 6
References Study Quality
23 (32772927) 3
24 (21103933) 4
33 (25623219) 4
CTA chest and abdomen with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 6 6 0 0 0 0 9 6 6 1 0
MRA chest abdomen pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 4 9 6 1 1
References Study Quality
51 (24399340) 2
45 (27553926) 1
39 (20013276) 3
38 (22386146) 2
34 (19884165) 3
33 (25623219) 4
37 (17968882) 3
44 (28388971) 2
50 (20200628) 2
MRA chest and abdomen without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 9 9 4 0 0
CT chest abdomen pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 0 3 14 3 1 0 0
CT chest abdomen pelvis without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 0 0 1 15 5 0 0 1
CT chest abdomen pelvis without IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 2 7 12 1 0 0 0
References Study Quality
31 (24503676) 4
30 (30835189) 1
29 (22451563) 2
CT chest and abdomen with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 5 5 0 0 1 8 11 2 0 0 0
CT chest and abdomen without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 5 5 0 0 1 5 14 2 0 0 0
MRA chest and abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 1 0 2 12 5 2 0 0
CT chest and abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 3 3 9 0 6 1 0 0 0
Aortography chest abdomen pelvis Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 7 7 8 0 0 0 0 0 0
References Study Quality
27 (29613964) 4
US duplex Doppler aorta abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 7 9 0 0 0 0 0 0
References Study Quality
43 (31054559) 4
56 (15838577) 3
US echocardiography transthoracic resting Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 6 6 1 3 0 0 0 0
References Study Quality
58 (25529153) 4
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 12 2 7 1 0 0 0 0 0
Radiography chest abdomen pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 2 7 0 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.