American College of Radiology
ACR Appropriateness Criteria®

Urinary Tract Infection–Child

Variant 1: Age <2 months, first febrile urinary tract infection.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys and bladder Usually appropriate O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy voiding cystourethrography May be appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
Tc-99m pertechnetate radionuclide cystography May be appropriate TBD TBD ☢☢ 0.03-0.3 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Tc-99m DMSA renal cortical scintigraphy Usually not appropriate TBD TBD ☢☢☢ 0.3-3 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Variant 2: Age >2 months and ≤6 years, first febrile urinary tract infection with good response to treatment.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys and bladder Usually appropriate O 0 mSv O 0 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
Tc-99m pertechnetate radionuclide cystography May be appropriate TBD TBD ☢☢ 0.03-0.3 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy voiding cystourethrography May be appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
Tc-99m DMSA renal cortical scintigraphy Usually not appropriate TBD TBD ☢☢☢ 0.3-3 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Variant 3: Age >6 years, first febrile urinary tract infection with good response to treatment.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys and bladder May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Tc-99m pertechnetate radionuclide cystography Usually not appropriate TBD TBD ☢☢ 0.03-0.3 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m DMSA renal cortical scintigraphy Usually not appropriate TBD TBD ☢☢☢ 0.3-3 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Variant 4: Child. Atypical (poor response to antibiotics within 48 hours, sepsis, poor urine stream, raised creatinine, or non–E coli UTI) or recurrent febrile urinary tract infection.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys and bladder Usually appropriate O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
Tc-99m pertechnetate radionuclide cystography Usually appropriate TBD TBD ☢☢ 0.03-0.3 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
Tc-99m DMSA renal cortical scintigraphy May be appropriate TBD TBD ☢☢☢ 0.3-3 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 n/a 0 0 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.