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Appropriateness Criteria

Variant 1: Adult. Suspected acute superior vena cava or brachiocephalic vein occlusion. Initial Imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA and MRV chest without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 6 1 5 3 2
References Study Quality
8 (26452112) 4
MRV chest without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 3 3 4 4 3
References Study Quality
8 (26452112) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 1 0 0 4 6 8
References Study Quality
8 (26452112) 4
7 (35297100) 4
6 (25082145) 4
CT chest without and with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 2 9 6 0
CT neck and chest with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 3 2 6 5 2
CT neck and chest without and with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 1 3 7 4 1
CTA and CTV chest with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 0 0 1 0 6 1 2 4 4
References Study Quality
9 (25724223) 4
CTV chest with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv 9 9 0 0 0 0 1 0 2 5 10
References Study Quality
9 (25724223) 4
Radiography chest May be appropriate (Disagreement) Expert Opinion ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 1 5 4 0 1 2 3 2 0
References Study Quality
10 (33357528) 4
11 (22560123) 4
MRA chest with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 3 5 2 1 5 2 0
References Study Quality
8 (26452112) 4
MRA chest without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 3 5 1 4 3 2 0
References Study Quality
8 (26452112) 4
MRA chest without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 1 1 5 6 4 0 1 0 0
MRI chest with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 5 6 4 3 0
References Study Quality
8 (26452112) 4
MRI chest without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 5 4 4 3 0
References Study Quality
8 (26452112) 4
MRI chest without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 1 5 5 6 1 0 0 0
References Study Quality
8 (26452112) 4
MRV chest without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 6 3 4 1 1
References Study Quality
8 (26452112) 4
CTA chest with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 3 3 4 1 4 3 0
References Study Quality
9 (25724223) 4
CTA chest without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 0 0 6 3 1 1 4 3 0
References Study Quality
9 (25724223) 4
US duplex Doppler upper extremity and chest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 0 2 8 1 4 2 0 1 0
References Study Quality
7 (35297100) 4
10 (33357528) 4
Catheter venography upper extremity and SVC Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 4 3 6 3 0 1 0 1 0
References Study Quality
5 (32928071) 3
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 2 5 9 0 1 0 0 0
CT neck and chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 5 5 3 1 0 0 0
Variant 2: Adult. Suspected chronic superior vena cava or brachiocephalic vein occlusion. Initial Imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA and MRV chest without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 0 1 4 3 3 3 3
References Study Quality
8 (26452112) 4
MRV chest without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 5 2 4 4 3
References Study Quality
8 (26452112) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 1 1 3 7 6
References Study Quality
5 (32928071) 3
6 (25082145) 4
8 (26452112) 4
CT chest without and with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 1 8 7 1
CT neck and chest with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 0 10 8 0
CT neck and chest without and with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 5 8 4 0
CTA and CTV chest with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 1 0 0 0 1 2 5 6 3
References Study Quality
9 (25724223) 4
CTV chest with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 0 4 3 4 8
References Study Quality
9 (25724223) 4
US duplex Doppler upper extremity and chest May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 4 4 1 1 1 3 1 2
References Study Quality
7 (35297100) 4
10 (33357528) 4
Radiography chest May be appropriate (Disagreement) Expert Opinion ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 1 5 4 0 1 2 2 2 1
References Study Quality
10 (33357528) 4
11 (22560123) 4
Catheter venography upper extremity and SVC May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 2 3 5 0 1 5 2 0 0
References Study Quality
5 (32928071) 3
MRA chest with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 0 2 6 3 5 1 0
References Study Quality
8 (26452112) 4
MRA chest without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 0 5 3 3 5 1 0
References Study Quality
8 (26452112) 4
MRI chest with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 1 0 4 4 6 2 1 0
References Study Quality
8 (26452112) 4
MRI chest without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 3 6 5 3 0
References Study Quality
8 (26452112) 4
MRI chest without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 1 2 6 6 2 2 0 0 0
References Study Quality
8 (26452112) 4
MRV chest without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 1 6 2 4 3 1 1
References Study Quality
8 (26452112) 4
CTA chest with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 3 2 2 3 4 3 0
References Study Quality
9 (25724223) 4
CTA chest without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 0 0 3 3 3 2 4 3 0
References Study Quality
9 (25724223) 4
MRA chest without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 4 5 5 1 3 0 0 0
References Study Quality
8 (26452112) 4
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 2 5 5 2 0 1 0 0
CT neck and chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 9 0 3 0 1 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.