American College of Radiology
ACR Appropriateness Criteria®

Acute Nonlocalized Abdominal Pain

Variant 1: Acute nonlocalized abdominal pain and fever. No recent 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 abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 0 2 14
MRI abdomen and pelvis without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 2 7 4 2 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 0 3 1 7 3 1 1
CT abdomen and pelvis without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 3 5 5 4 0 0 0
MRI abdomen and pelvis without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 9 1 2 1 0
CT abdomen and pelvis without and with IV contrast May be appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 2 3 6 5 0 0 0 0
Radiography abdomen May be appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 4 4 0 0 3 11 2 0 0 0 0
Tc-99m WBC scan abdomen and pelvis Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 4 4 4 0 0 0 0 0
Tc-99m cholescintigraphy Usually not appropriate ☢☢ 0.1-1mSv 3 3 3 4 2 5 2 0 0 0 0
In-111 WBC scan abdomen and pelvis Usually not appropriate ☢☢☢☢ 10-30 mSv 3 3 6 2 4 4 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 4 3 3 1 2 0 0 0
Fluoroscopy contrast enema Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 2 1 0 0 0 0 0
Fluoroscopy upper GI series with small bowel follow-through Usually not appropriate ☢☢☢ 1-10 mSv 2 2 8 4 3 1 0 0 0 0 0
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 0 2 14
MRI abdomen and pelvis without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 1 0 0 0 4 6 5 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 1 2 2 3 7 1 0 0
CT abdomen and pelvis without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 2 5 5 5 0 0 0
MRI abdomen and pelvis without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 1 1 0 3 5 5 1 0 0
CT abdomen and pelvis without and with IV contrast May be appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 2 4 3 6 1 0 0 0
Fluoroscopy contrast enema May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 1 11 2 2 0 0 0
Fluoroscopy upper GI series with small bowel follow-through May be appropriate ☢☢☢ 1-10 mSv 4 4 0 0 2 10 2 2 0 0 0
Radiography abdomen May be appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 4 4 0 1 1 8 2 4 0 0 0
Tc-99m WBC scan abdomen and pelvis Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 6 3 4 0 1 0 0 0
Tc-99m cholescintigraphy Usually not appropriate ☢☢ 0.1-1mSv 3 3 0 6 3 3 3 1 0 0 0
In-111 WBC scan abdomen and pelvis Usually not appropriate ☢☢☢☢ 10-30 mSv 3 3 4 3 4 4 0 1 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 4 3 2 3 1 0 0 0
Variant 3: Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 0 2 14
CT abdomen and pelvis without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 0 9 5 1 1
MRI abdomen and pelvis without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 3 7 4 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 4 4 4 1 0
MRI abdomen and pelvis without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 0 2 3 8 2 1 0 0
CT abdomen and pelvis without and with IV contrast May be appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 2 3 7 4 0 0 0 0
Tc-99m WBC scan abdomen and pelvis Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 4 2 2 1 0 0 0
In-111 WBC scan abdomen and pelvis Usually not appropriate ☢☢☢☢ 10-30 mSv 3 3 4 4 3 2 2 1 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 5 2 3 2 1 1 0 0
Radiography abdomen Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 0 2 10 3 1 0 0 0 0
Fluoroscopy contrast enema Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 7 0 2 0 0 0 0 0
Fluoroscopy upper GI series with small bowel follow-through Usually not appropriate ☢☢☢ 1-10 mSv 2 2 7 6 0 3 0 0 0 0 0
Tc-99m cholescintigraphy Usually not appropriate ☢☢ 0.1-1mSv 2 2 2 8 2 1 2 1 0 0 0
Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 0 4 12
CT abdomen and pelvis without IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 8 7 0 1
MRI abdomen and pelvis without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 4 7 2 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 2 7 2 3 1
MRI abdomen and pelvis without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 6 2 3 2 0
CT abdomen and pelvis without and with IV contrast May be appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 2 3 8 3 0 0 0 0
Radiography abdomen May be appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 4 4 0 3 0 9 2 2 0 0 0
Fluoroscopy upper GI series with small bowel follow-through Usually not appropriate ☢☢☢ 1-10 mSv 2 2 8 4 1 3 0 0 0 0 0
Tc-99m WBC scan abdomen and pelvis Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 4 1 0 1 0 0 0
Tc-99m cholescintigraphy Usually not appropriate ☢☢ 0.1-1mSv 2 2 5 6 2 1 1 1 0 0 0
In-111 WBC scan abdomen and pelvis Usually not appropriate ☢☢☢☢ 10-30 mSv 2 2 6 4 4 1 0 1 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 6 4 3 2 1 0 0 0 0
Fluoroscopy contrast enema Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 5 1 1 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.