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Appropriateness Criteria

Variant 1: Pulsatile abdominal mass, suspected abdominal aortic 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 Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 4 6 7
References Study Quality
57 (25662155) 1
42 (24473919) 4
55 (19631858) 3
47 (29277483) 3
43 (31821437) 4
58 (27436173) 4
56 (12947257) 3
54 (21852165) 2
53 (21193715) 4
52 (20519070) 3
51 (21861264) 4
50 (21439859) 3
49 (24723017) 2
48 (24491283) 1
46 (33646456) 3
45 (14709438) 4
44 (-3195123) 4
41 (23406071) 4
16 (34224827) 4
15 (7776474) 2
14 (22336051) 4
13 (29724423) 4
12 (31054747) 4
10 (30528142) 4
9 (30337540) 4
7 (29268916) 4
3 (16549646) 4
MRA abdomen and pelvis with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 1 6 6 3
References Study Quality
39 (32160925) 4
38 (32646571) 4
37 (32374422) 4
36 (31638489) 4
35 (26102308) 4
34 (21388544) 4
28 (24842834) 4
27 (24220116) 4
25 (25623219) 4
13 (29724423) 4
10 (30528142) 4
8 (25173340) 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 0 3 2 4 6 3
References Study Quality
39 (32160925) 4
38 (32646571) 4
37 (32374422) 4
36 (31638489) 4
35 (26102308) 4
34 (21388544) 4
28 (24842834) 4
27 (24220116) 4
25 (25623219) 4
13 (29724423) 4
10 (30528142) 4
8 (25173340) 4
MRA abdomen and pelvis without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 5 1 8 1 2
References Study Quality
39 (32160925) 4
38 (32646571) 4
37 (32374422) 4
36 (31638489) 4
35 (26102308) 4
34 (21388544) 4
28 (24842834) 4
27 (24220116) 4
25 (25623219) 4
13 (29724423) 4
10 (30528142) 4
8 (25173340) 4
CTA abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 0 0 4 7 7
References Study Quality
29 (27610820) 2
30 (30476460) 1
28 (24842834) 4
27 (24220116) 4
26 (29460048) 4
25 (25623219) 4
13 (29724423) 4
10 (30528142) 4
7 (29268916) 4
CTA abdomen and pelvis without and with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 9 9 0 0 1 0 0 0 4 4 9
References Study Quality
29 (27610820) 2
30 (30476460) 1
28 (24842834) 4
27 (24220116) 4
26 (29460048) 4
25 (25623219) 4
13 (29724423) 4
10 (30528142) 4
7 (29268916) 4
MRI abdomen and pelvis with IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 13 7 0 0 0
References Study Quality
25 (25623219) 4
10 (30528142) 4
8 (25173340) 4
5 (20541348) 3
40 (27553926) 1
MRI abdomen and pelvis without and with IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 12 7 0 0 0
References Study Quality
40 (27553926) 1
25 (25623219) 4
10 (30528142) 4
8 (25173340) 4
5 (20541348) 3
MRI abdomen and pelvis without IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 16 3 0 0 0
References Study Quality
40 (27553926) 1
25 (25623219) 4
10 (30528142) 4
8 (25173340) 4
5 (20541348) 3
CT abdomen and pelvis with IV contrast May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 6 11 1 0 0
References Study Quality
4 (28216357) 4
5 (20541348) 3
24 (28193267) 2
23 (26072194) 4
22 (23508616) 4
21 (27235992) 3
7 (29268916) 4
CT abdomen and pelvis without IV contrast May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 5 11 4 0 0 0
References Study Quality
4 (28216357) 4
24 (28193267) 2
23 (26072194) 4
22 (23508616) 4
21 (27235992) 3
7 (29268916) 4
5 (20541348) 3
CT abdomen and pelvis without and with IV contrast May be appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 0 0 0 2 7 10 1 0 0
References Study Quality
4 (28216357) 4
24 (28193267) 2
23 (26072194) 4
22 (23508616) 4
21 (27235992) 3
7 (29268916) 4
5 (20541348) 3
US intravascular aorta abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 3 8 6 0 1 0 0 0 0
References Study Quality
60 (12618701) 4
59 (10194490) 3
Aortography abdomen Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 3 7 5 1 2 0 0 0 0
References Study Quality
3 (16549646) 4
7 (29268916) 4
Radiography abdomen and pelvis Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 5 4 0 0 1 0 0 0
References Study Quality
3 (16549646) 4
7 (29268916) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 6 4 0 1 0 0 0 0
References Study Quality
33 (27283346) 4
32 (24200128) 4
31 (18729562) 4
10 (30528142) 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.