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Appropriateness Criteria

Variant 1: Adult. Suspected splanchnic or renal artery aneurysm. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA abdomen and pelvis with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 3 9 4
References Study Quality
7 (14627251) 0
53 (27692855) 4
19 (25814198) 4
MRA abdomen and pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 1 3 8 4
References Study Quality
7 (14627251) 0
53 (27692855) 4
19 (25814198) 4
MRA abdomen with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 3 2 11 2
References Study Quality
7 (14627251) 0
53 (27692855) 4
19 (25814198) 4
MRA abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 2 2 8 4
References Study Quality
7 (14627251) 0
19 (25814198) 4
CTA abdomen with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 1 2 5 10
References Study Quality
2 (31971937) 0
38 (21498313) 4
7 (14627251) 0
73 (8862370) 4
13 (38037721) 0
57 (38768832) 4
19 (25814198) 4
55 (29164308) 3
12 (38030849) 0
36 (15026595) 4
11 (32201007) 0
28 (17715112) 4
53 (27692855) 4
CTA abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 0 1 1 4 12
References Study Quality
2 (31971937) 0
38 (21498313) 4
7 (14627251) 0
73 (8862370) 4
13 (38037721) 0
57 (38768832) 4
19 (25814198) 4
55 (29164308) 3
12 (38030849) 0
30 (8733861) 1
36 (15026595) 4
11 (32201007) 0
28 (17715112) 4
53 (27692855) 4
CTA abdomen and pelvis without and with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 1 1 2 0 1 1 12
References Study Quality
2 (31971937) 0
38 (21498313) 4
7 (14627251) 0
73 (8862370) 4
13 (38037721) 0
57 (38768832) 4
19 (25814198) 4
55 (29164308) 3
12 (38030849) 0
36 (15026595) 4
11 (32201007) 0
28 (17715112) 4
53 (27692855) 4
US aorta abdomen with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 1 0 12 2 0 0 0
References Study Quality
53 (27692855) 4
39 (18392255) 4
US duplex Doppler aorta abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 2 6 3 5 0 1
References Study Quality
40 (9922199) 4
73 (8862370) 4
39 (18392255) 4
53 (27692855) 4
MRA abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 1 4 6 5 1 0 0 0
MRA abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 1 4 5 7 0 0 0 0
CT abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 0 0 2 4 5 5 0 1
CT abdomen with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 0 1 0 5 4 4 2 1
CT abdomen and pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 1 0 0 2 6 5 3 0 1
CT abdomen without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 1 0 1 10 4 1 0 0
Arteriography abdomen Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 6 7 3 1 0 0 0 0
References Study Quality
51 (11593635) 3
30 (8733861) 1
Arteriography abdomen and pelvis Usually not appropriate Strong ☢☢☢☢ 10-30 mSv Varies 3 3 1 7 6 2 2 0 0 0 0
References Study Quality
51 (11593635) 3
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 4 9 1 1 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 4 9 0 0 0 0 0 0
MRI abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 3 8 0 3 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 6 7 0 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 6 6 1 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 6 4 2 1 1 1 0 0
Variant 2: Adult. Known splanchnic or renal artery aneurysm. Active surveillance.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA abdomen and pelvis with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 5 7 5
References Study Quality
53 (27692855) 4
MRA abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 2 0 0 1 3 7 5
References Study Quality
53 (27692855) 4
MRA abdomen with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 4 8 5
References Study Quality
53 (27692855) 4
MRA abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 1 0 1 3 8 4
References Study Quality
53 (27692855) 4
CTA abdomen with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 1 0 1 4 12
References Study Quality
2 (31971937) 0
38 (21498313) 4
55 (29164308) 3
57 (38768832) 4
11 (32201007) 0
53 (27692855) 4
29 (20609877) 4
CTA abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 1 0 2 4 11
References Study Quality
2 (31971937) 0
38 (21498313) 4
55 (29164308) 3
57 (38768832) 4
11 (32201007) 0
53 (27692855) 4
29 (20609877) 4
US aorta abdomen with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 1 0 4 4 6 1 1
References Study Quality
53 (27692855) 4
39 (18392255) 4
US duplex Doppler aorta abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 4 6 6 0 1
References Study Quality
57 (38768832) 4
53 (27692855) 4
39 (18392255) 4
MRA abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 2 2 5 6 2 0 0 0
MRA abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 1 1 7 5 3 0 0 0
CT abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 1 6 7 2 1 0
CT abdomen with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 1 0 1 7 6 1 1 1
CT abdomen and pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 1 0 0 9 5 2 1 0
CT abdomen without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 0 1 2 9 3 2 1 0
Arteriography abdomen Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 6 1 6 2 1 0 1 0 1
Arteriography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv Varies 3 3 5 2 6 2 1 0 1 0 1
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 5 6 0 2 1 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 3 9 5 0 1 0 0 0 0
MRI abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 5 7 0 3 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 8 5 0 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 1 8 3 3 1 0 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 5 2 3 0 0 1 0
Variant 3: Pregnant. Suspected splanchnic or renal artery aneurysm. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US aorta abdomen with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 2 1 1 6 5 3
US duplex Doppler aorta abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 2 0 1 1 4 3 7
MRA abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 0 2 9 4 0 0 0
MRA abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 0 2 10 3 0 0 0
CTA abdomen with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 2 3 2 9 0 0 0 0
CTA abdomen and pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 1 1 1 4 6 5 0 0 0
Arteriography abdomen Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 2 3 2 1 0 0 0 0
Arteriography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv Varies 1 1 10 2 3 2 1 0 0 0 0
MRA abdomen and pelvis with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 3 5 5 1 0 1 0 0
MRA abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 4 6 3 2 0 0 0 0
MRA abdomen with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 2 8 4 0 1 0 0 0
MRA abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 4 7 3 0 1 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 7 4 2 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 8 3 0 1 2 0 0 0
MRI abdomen without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 4 8 4 2 0 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 7 4 1 0 1 1 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 6 3 1 0 1 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 5 6 0 1 1 0 0 0
CT abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 5 2 2 0 2 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 5 5 1 2 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 4 7 3 1 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 4 5 5 3 0 1 0 0 0
Variant 4: Pregnant. Known splanchnic or renal artery aneurysm. Active surveillance.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US aorta abdomen with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 1 7 6 2
US duplex Doppler aorta abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 2 3 3 3 6
MRA abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 1 1 10 3 0 0 0
MRA abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 2 0 11 3 0 0 0
CT abdomen with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 4 3 2 5 3 0 1 0 0
CTA abdomen with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 2 5 2 4 3 2 0 0 0
CTA abdomen and pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 1 2 4 4 6 0 0 0 0
Arteriography abdomen Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 1 2 2 3 0 0 0 0
Arteriography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv Varies 2 2 9 2 2 2 2 1 0 0 0
MRA abdomen and pelvis with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 4 6 4 0 1 0 0 0
MRA abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 4 8 1 1 1 0 0 0
MRA abdomen with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 3 7 4 1 0 0 0 0
MRA abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 3 9 2 1 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 4 9 4 1 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 6 5 0 1 0 2 0 0
MRI abdomen without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 4 7 6 1 0 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 7 4 1 1 1 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 3 4 4 1 0 2 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 5 3 2 1 1 0 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 3 2 2 1 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 5 3 5 4 1 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 4 4 5 4 1 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.