American College of Radiology
ACR Appropriateness Criteria®

Sinusitis–Child

Variant 1: Child. Uncomplicated acute sinusitis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT paranasal sinuses with IV contrast Usually not appropriate ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 3 0 0 0 0 0 0 0
CT paranasal sinuses without IV contrast Usually not appropriate ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 0 0 0 0 0 0 2
CT paranasal sinuses without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 1 0 0 0 0 0 0 0
MRI paranasal sinuses without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 16 1 0 0 0 0 1 0 0
MRI paranasal sinuses without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 17 1 0 0 0 0 0 0 0
Radiography paranasal sinuses Usually not appropriate ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 17 0 0 0 1 0 0 0 0
Variant 2: Child. Persistent sinusitis (worsening course or severe presentation, or not responding to treatment), or recurrent sinusitis, or chronic sinusitis, or define paranasal sinus anatomy before functional endoscopic sinus surgery. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT paranasal sinuses without IV contrast Usually appropriate ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 4 0 2 2 10
MRI paranasal sinuses without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 9 2 4 1 2 1 0 0 0
CT paranasal sinuses with IV contrast Usually not appropriate ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 4 4 0 0 0 0 0 0
CT paranasal sinuses without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 3 1 0 0 0 0 0
MRI paranasal sinuses without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 12 4 3 0 0 0 0 0 0
Radiography paranasal sinuses Usually not appropriate ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 11 3 2 1 1 0 0 0 0
Variant 3: Child. Sinusitis with clinical concern of orbital or intracranial complications. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT head and paranasal sinuses with IV contrast Usually appropriate ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 0 0 0 0 1 8 9
MRI head and paranasal sinuses without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 2 0 1 6 8
MRV head with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 8 5 2 2 0
CTA head with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 3 13 2 0 0 0
MRA head without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 1 0 1 3 13 1 0 0 0
MRV head without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 2 0 1 3 9 3 1 0 0
CTV head with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 8 3 5 0 0
MRV head without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 2 0 1 2 9 4 1 0 0
MRA head with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 2 2 0 7 7 1 0 0 0
MRI head and paranasal sinuses without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 3 2 7 4 3 0 0 0 0
CT head and paranasal sinuses without IV contrast Usually not appropriate ☢☢☢ 0.3-3 mSv [ped] 3 3 3 5 5 1 2 2 0 0 0
Radiography paranasal sinuses Usually not appropriate ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 2 0 0 0 0 0 0 0
CT head and paranasal sinuses without and with IV contrast Usually not appropriate ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 4 2 0 0 0 0 0
Variant 4: Child. Suspected invasive fungal sinusitis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT paranasal sinuses with IV contrast Usually appropriate ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 1 0 0 0 0 2 6 9
MRI paranasal sinuses without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 1 0 1 3 12
CTA head with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 1 5 0 9 2 0 0 0
MRA head without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 1 1 3 3 9 2 0 0 0
MRV head without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 1 1 4 0 12 1 0 0 0
CTV head with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 0 9 2 5 0 0
MRV head without and with IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 5 3 2 4 0 7 3 0 0 0
MRV head with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 1 0 1 0 8 5 1 2 0
MRA head with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 1 1 4 5 7 1 0 0 0
CT paranasal sinuses without IV contrast Usually not appropriate ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 3 0 8 0 7 0 0 0 1
MRI paranasal sinuses without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 4 1 5 3 5 1 0 0 0
CT paranasal sinuses without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 5 0 1 0 0 0 0
Radiography paranasal sinuses Usually not appropriate ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 17 1 0 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.