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
MR venography 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
MR venography 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
CT venography 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
MR venography 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
MR venography 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
CT venography 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
MR venography 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
MR venography 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
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.