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Appropriateness Criteria

Variant 1: Indeterminate, greater than 1 cm liver lesion on initial imaging with US. Normal liver. No suspicion or evidence of extrahepatic malignancy or underlying liver disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 3 4 6 2 1
References Study Quality
9 (19542399) 2
35 (20652854) 3
13 (19688670) 3
34 (21655534) 4
31 (21390342) 3
32 (21188330) 4
29 (19666405) 3
37 (17206071) 2
14 (19673015) 3
36 (26649337) 4
18 (25971695) 4
33 (25666723) 4
30 (24689098) 4
MRI abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 3 7 7
References Study Quality
11 (24270109) 4
12 (18580333) 1
15 (21597893) 2
16 (22194486) 3
19 (20578020) 2
14 (19673015) 3
18 (25971695) 4
10 (23776623) 4
CT abdomen with IV contrast multiphase Usually appropriate Strong ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 0 0 8 8 1
References Study Quality
11 (24270109) 4
9 (19542399) 2
13 (19688670) 3
12 (18580333) 1
10 (23776623) 4
MRI abdomen without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 2 2 4 7 1 0 0
References Study Quality
11 (24270109) 4
12 (18580333) 1
15 (21597893) 2
16 (22194486) 3
14 (19673015) 3
18 (25971695) 4
10 (23776623) 4
Image-guided biopsy liver Usually not appropriate Limited Varies Varies 2 2 3 7 8 0 0 0 0 0 0
References Study Quality
21 (27623001) 4
20 (28119260) 4
28 (27080009) 4
23 (27017289) 3
22 (26649339) 3
26 (24531352) 3
25 (23980215) 3
4 (28927870) 4
24 (29299367) 3
27 (26847020) 4
CT abdomen without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 9 2 0 1 0 0 0
References Study Quality
11 (24270109) 4
9 (19542399) 2
13 (19688670) 3
12 (18580333) 1
10 (23776623) 4
DOTATATE PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 4 2 0 1 0 0 0 0
Liver spleen scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 8 5 3 0 1 0 0 0 0
RBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 8 4 3 1 1 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 7 6 2 2 0 0 0 0
References Study Quality
11 (24270109) 4
9 (19542399) 2
13 (19688670) 3
12 (18580333) 1
10 (23776623) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 3 1 0 0 0 0 0
Octreotide scan with SPECT or SPECT/CT chest and abdomen Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 12 2 2 0 1 0 0 0 0
Variant 2: Indeterminate, greater than 1 cm liver lesion on initial imaging with CT (noncontrast or single-phase) or noncontrast MRI. Normal liver. No suspicion or evidence of extrahepatic malignancy or underlying liver disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 0 0 2 7 7
References Study Quality
38 (19459531) 2
12 (18580333) 1
15 (21597893) 2
19 (20578020) 2
10 (23776623) 4
CT abdomen with IV contrast multiphase Usually appropriate Strong ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 1 0 6 9 1
References Study Quality
9 (19542399) 2
12 (18580333) 1
10 (23776623) 4
US abdomen May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 3 6 6 1 1 0 1
References Study Quality
9 (19542399) 2
29 (19666405) 3
US abdomen with IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 3 5 6 1 1
References Study Quality
9 (19542399) 2
37 (17206071) 2
39 (24387826) 3
Image-guided biopsy liver Usually not appropriate Limited Varies Varies 3 3 4 4 5 3 2 0 0 0 0
References Study Quality
21 (27623001) 4
20 (28119260) 4
28 (27080009) 4
23 (27017289) 3
22 (26649339) 3
26 (24531352) 3
25 (23980215) 3
24 (29299367) 3
27 (26847020) 4
DOTATATE PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 4 2 0 0 1 0 0 0
Liver spleen scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 2 2 1 1 0 1 0 0
RBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 2 2 1 1 0 1 0 0
CT abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 0 8 8 2 0 0 0 0 0
References Study Quality
9 (19542399) 2
12 (18580333) 1
10 (23776623) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 2 0 1 0 0 0 0
Octreotide scan with SPECT or SPECT/CT chest and abdomen Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 3 2 0 0 1 0 0 0
Variant 3: Indeterminate, greater than 1 cm liver lesion on initial imaging with US. Known history of an extrahepatic malignancy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 0 3 3 10
References Study Quality
49 (21702068) 2
41 (21293130) 3
48 (28449169) 3
50 (25025151) 4
47 (24289722) 4
CT abdomen with IV contrast multiphase Usually appropriate Limited ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 1 0 7 7 2
References Study Quality
45 (19077417) 4
42 (19057427) 2
41 (21293130) 3
43 (27397022) 4
44 (24331274) 4
40 (24089057) 4
US abdomen with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 10 6 1 0 1
References Study Quality
35 (20652854) 3
37 (17206071) 2
48 (28449169) 3
Image-guided biopsy liver May be appropriate Limited Varies Varies 6 6 0 0 1 1 6 4 3 2 0
References Study Quality
21 (27623001) 4
20 (28119260) 4
28 (27080009) 4
23 (27017289) 3
22 (26649339) 3
26 (24531352) 3
25 (23980215) 3
24 (29299367) 3
27 (26847020) 4
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 1 3 7 5 0 0 0
References Study Quality
49 (21702068) 2
41 (21293130) 3
48 (28449169) 3
50 (25025151) 4
47 (24289722) 4
DOTATATE PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢ 1-10 mSv 5 5 0 1 0 5 7 2 2 0 0
References Study Quality
8 (25143861) 4
CT abdomen without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 2 2 1 11 2 0 0 0
References Study Quality
45 (19077417) 4
42 (19057427) 2
41 (21293130) 3
43 (27397022) 4
44 (24331274) 4
40 (24089057) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 5 4 5 2 1
References Study Quality
42 (19057427) 2
40 (24089057) 4
Octreotide scan with SPECT or SPECT/CT chest and abdomen May be appropriate Limited ☢☢☢☢ 10-30 mSv 4 4 2 1 1 6 5 1 1 0 0
References Study Quality
46 (19713709) 4
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 6 5 0 0 1 0 0
References Study Quality
45 (19077417) 4
42 (19057427) 2
41 (21293130) 3
43 (27397022) 4
44 (24331274) 4
40 (24089057) 4
Liver spleen scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 3 2 2 0 0 1 0 0
RBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 3 2 2 0 0 0 0 0
Variant 4: Indeterminate, greater than 1 cm liver lesion on initial imaging with CT (noncontrast or single-phase) or noncontrast MRI. Known history of an extrahepatic malignancy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 1 0 0 0 0 2 7 7
References Study Quality
49 (21702068) 2
41 (21293130) 3
48 (28449169) 3
50 (25025151) 4
47 (24289722) 4
CT abdomen with IV contrast multiphase Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 1 0 8 7 1
References Study Quality
45 (19077417) 4
41 (21293130) 3
43 (27397022) 4
44 (24331274) 4
40 (24089057) 4
FDG-PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 6 6 3 1
References Study Quality
42 (19057427) 2
40 (24089057) 4
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 2 5 0 3 5 0 1 1 0
References Study Quality
9 (19542399) 2
US abdomen with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 5 10 1 1 0
References Study Quality
35 (20652854) 3
37 (17206071) 2
2 (26427339) 4
Image-guided biopsy liver May be appropriate Strong Varies Varies 5 5 0 0 0 1 9 7 0 1 0
References Study Quality
21 (27623001) 4
20 (28119260) 4
28 (27080009) 4
23 (27017289) 3
22 (26649339) 3
54 (25170868) 4
26 (24531352) 3
25 (23980215) 3
53 (21757981) 2
51 (21387263) 3
24 (29299367) 3
27 (26847020) 4
52 (29404497) 3
DOTATATE PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢ 1-10 mSv 5 5 0 0 0 2 13 1 2 0 0
References Study Quality
8 (25143861) 4
CT abdomen without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 1 0 6 10 0 1 0 0
References Study Quality
45 (19077417) 4
41 (21293130) 3
43 (27397022) 4
44 (24331274) 4
40 (24089057) 4
Octreotide scan with SPECT or SPECT/CT chest and abdomen May be appropriate Limited ☢☢☢☢ 10-30 mSv 5 5 1 1 2 3 9 0 1 0 0
References Study Quality
46 (19713709) 4
Liver spleen scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 8 4 1 2 0 2 0 0 0
RBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 3 1 3 0 1 0 0 0
Variant 5: Incidental liver lesion, greater than 1 cm on US, noncontrast or single-phase CT, or noncontrast MRI. Known chronic liver disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 0 1 4 2 7 1 1
References Study Quality
35 (20652854) 3
31 (21390342) 3
32 (21188330) 4
77 (18834687) 3
78 (25812115) 4
79 (25202903) 4
72 (23116806) 4
56 (20806437) 3
76 (25717230) 4
MRI abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 2 4 10
References Study Quality
35 (20652854) 3
65 (20882620) 2
64 (21563246) 2
73 (20657216) 3
61 (21969663) 3
57 (20098330) 2
71 (28723741) 4
70 (28078512) 3
62 (27835984) 2
63 (25192607) 3
72 (23116806) 4
67 (23011874) 4
56 (20806437) 3
CT abdomen with IV contrast multiphase Usually appropriate Moderate ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 0 1 5 10 1
References Study Quality
57 (20098330) 2
59 (23883211) 3
56 (20806437) 3
Image-guided biopsy liver May be appropriate Limited Varies Varies 4 4 1 2 5 2 5 1 0 0 1
References Study Quality
54 (25170868) 4
6 (-3148733) 4
27 (26847020) 4
74 (29038857) 4
75 (18669577) 4
52 (29404497) 3
DOTATATE PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 5 2 0 0 0 1 0 0
Liver spleen scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 4 2 0 2 0 0 0 0
RBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 4 3 1 0 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 0 3 7 0 5 1 1 0 0
References Study Quality
57 (20098330) 2
59 (23883211) 3
56 (20806437) 3
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 1 9 3 2 1 0 1 0 0
References Study Quality
6 (-3148733) 4
60 (19191771) 4
Octreotide scan with SPECT or SPECT/CT chest and abdomen Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 4 1 0 1 0 0 0 0
Variant 6: Indeterminate, less than 1 cm liver lesion on initial imaging with US. Known history of an extrahepatic malignancy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 1 0 4 7 4
References Study Quality
84 (19501995) 2
15 (21597893) 2
US abdomen with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 8 8 1 1 0
References Study Quality
9 (19542399) 2
30 (24689098) 4
MRI abdomen without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 8 8 1 1 0 0
References Study Quality
84 (19501995) 2
15 (21597893) 2
CT abdomen with IV contrast multiphase May be appropriate Limited ☢☢☢☢ 10-30 mSv 6 6 0 0 0 1 7 5 4 1 0
References Study Quality
82 (9885589) 4
83 (24674191) 4
81 (12439304) 4
80 (19842564) 4
Image-guided biopsy liver Usually not appropriate Expert Consensus Varies Varies 3 3 4 2 3 5 3 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 6 4 1 1 0 0 0 0
References Study Quality
82 (9885589) 4
83 (24674191) 4
81 (12439304) 4
80 (19842564) 4
DOTATATE PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 3 3 3 4 4 1 4 1 0 0 0
Liver spleen scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 4 2 0 0 0 1 0 0
RBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 4 2 1 0 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 2 8 8 0 0 0 0 0 0
References Study Quality
82 (9885589) 4
83 (24674191) 4
81 (12439304) 4
80 (19842564) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 6 6 1 1 0 0 0 0
Octreotide scan with SPECT or SPECT/CT chest and abdomen Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 5 4 3 2 2 1 0 0 0
Variant 7: Indeterminate, less than 1 cm liver lesion on initial imaging with CT (noncontrast or single-phase) or noncontrast MRI. Known history of an extrahepatic malignancy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 3 4 6 3
References Study Quality
86 (16845289) 3
87 (20829538) M
CT abdomen with IV contrast multiphase Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 0 0 1 0 5 2 9 1 0
References Study Quality
82 (9885589) 4
85 (15833992) 4
US abdomen with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 4 4 5 1 0
References Study Quality
88 (20517816) 4
9 (19542399) 2
Image-guided biopsy liver May be appropriate Expert Consensus Varies Varies 4 4 3 0 4 6 3 1 0 0 0
US abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 3 3 3 4 1 0 0 0
References Study Quality
88 (20517816) 4
DOTATATE PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 5 4 2 2 2 1 1 0 0
Liver spleen scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 4 2 0 0 0 1 0 0
RBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 4 2 0 0 1 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 2 8 8 0 0 0 0 0 0
References Study Quality
82 (9885589) 4
85 (15833992) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 6 6 1 0 0 0 0 0
Octreotide scan with SPECT or SPECT/CT chest and abdomen Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 6 4 2 3 1 0 1 0 0
Variant 8: Incidental liver lesion, less than 1 cm on US, noncontrast or single-phase CT, or noncontrast MRI. Known chronic liver disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 1 1 1 3 7 3
References Study Quality
57 (20098330) 2
92 (18069697) 2
67 (23011874) 4
91 (23932636) 2
CT abdomen with IV contrast multiphase Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 0 0 1 3 0 13 1 0
References Study Quality
57 (20098330) 2
91 (23932636) 2
US abdomen with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 6 1 7 1 0
References Study Quality
30 (24689098) 4
95 (-3128692) 4
Image-guided biopsy liver Usually not appropriate Limited Varies Varies 3 3 3 5 4 2 3 0 0 0 0
References Study Quality
94 (23271200) 4
54 (25170868) 4
93 (20616581) 4
27 (26847020) 4
75 (18669577) 4
52 (29404497) 3
DOTATATE PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 5 2 0 0 0 0 0 0
Liver spleen scan Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 4 2 0 0 1 0 0 0
RBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 4 3 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 2 8 8 0 0 0 0 0 0
References Study Quality
57 (20098330) 2
91 (23932636) 2
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 6 2 0 0 0 0 0 0
Octreotide scan with SPECT or SPECT/CT chest and abdomen Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 4 2 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.