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Appropriateness Criteria

Variant 1: Acute ataxia following recent head trauma. 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 without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
5 (27262056) 4
17 (10891517) 3
18 (11356436) 3
16 (19027497) 4
MRA head and neck without and with IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
25 (20935079) M
23 (12082040) 1
24 (17035870) 1
26 (25632417) 4
27 (10598164) 4
MRA head and neck without IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
25 (20935079) M
23 (12082040) 1
24 (17035870) 1
26 (25632417) 4
27 (10598164) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
22 (26176603) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
22 (26176603) 4
MRV head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
4 (28473091) 4
CT temporal bone without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv 6 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
19 (26302389) 4
CTA head and neck with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
21 (20154559) 4
20 (20009659) 4
CTV head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Radiography skull Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRV head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
4 (28473091) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
CT temporal bone with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
19 (26302389) 4
CT temporal bone without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
19 (26302389) 4
Variant 2: Acute ataxia following recent spine trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI spine area of interest without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 2 5 5 4 1
References Study Quality
43 (22398829) 4
46 (20938788) 2
45 (21228747) 2
44 (26601812) 4
CTA neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 0 2 2 3 6 4 1
References Study Quality
21 (20154559) 4
20 (20009659) 4
42 (23338658) 4
CT spine area of interest without IV contrast Usually appropriate Strong Varies Varies 9 9 0 0 0 0 0 1 1 4 12
References Study Quality
35 (23422283) 2
32 (19509621) 2
38 (14566120) 2
33 (12913630) 3
34 (16612322) 4
36 (27250728) 3
37 (-3128680) 4
39 (7538874) 4
MRA neck with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 2 3 0 10 1 0 0 0
References Study Quality
26 (25632417) 4
27 (10598164) 4
MRA neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 2 2 1 11 1 0 0 0
References Study Quality
26 (25632417) 4
27 (10598164) 4
MRI spine area of interest without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 1 1 2 5 4 3 0 0
References Study Quality
40 (26612468) 4
43 (22398829) 4
46 (20938788) 2
45 (21228747) 2
47 (2520080) 3
44 (26601812) 4
48 (24346823) 2
Arteriography spine area of interest Usually not appropriate Limited Varies Varies 3 3 6 3 1 5 2 1 0 0 0
References Study Quality
49 (23361484) 4
Radiography spine area of interest Usually not appropriate Expert Consensus Varies Varies 2 2 6 3 8 0 0 0 0 0 0
CT myelography spine area of interest Usually not appropriate Expert Consensus Varies Varies 2 2 5 5 3 3 1 1 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Strong Varies Varies 2 2 5 5 7 0 0 0 0 0 0
References Study Quality
40 (26612468) 4
35 (23422283) 2
32 (19509621) 2
38 (14566120) 2
41 (12702827) 1
33 (12913630) 3
34 (16612322) 4
36 (27250728) 3
37 (-3128680) 4
39 (7538874) 4
CT spine area of interest without and with IV contrast Usually not appropriate Strong Varies Varies 2 2 9 3 3 0 2 0 1 0 0
References Study Quality
40 (26612468) 4
35 (23422283) 2
32 (19509621) 2
38 (14566120) 2
41 (12702827) 1
33 (12913630) 3
34 (16612322) 4
36 (27250728) 3
37 (-3128680) 4
39 (7538874) 4
Variant 3: Ataxia. No history of trauma. Suspected intracranial process. Stroke intervention not a consideration. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 2 1 14
References Study Quality
92 (16292245) 4
89 (15607611) 4
90 (12942319) 4
91 (16340337) 4
88 (16636229) 4
87 (19729538) 4
MRI head without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 1 6 9 1
References Study Quality
92 (16292245) 4
89 (15607611) 4
90 (12942319) 4
91 (16340337) 4
88 (16636229) 4
87 (19729538) 4
CT head with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 1 4 2 1 9 0 0 0
CT head without and with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 5 1 3 3 4 1 1 0 0
CT head without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 1 2 3 10 1 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 2 1 1 1 0 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 3 9 0 0 0 0 0 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 3 9 0 1 0 0 0 0
MRV head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 4 5 0 1 2 0 0 0
MRV head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 4 5 0 2 1 0 0 0
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 3 10 1 0 0 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 5 4 1 1 2 0 0 0
DTPA cisternography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 2 4 0 1 1 0 0 0
Ioflupane SPECT or SPECT/CT brain Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 4 3 0 2 1 0 0 0
Variant 4: Ataxia of any acuity. No history of trauma. Suspected spinal or spinal vascular process. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI spine area of interest without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 2 2 2 12
MRI spine area of interest without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 7 8 2
Arteriography spine area of interest May be appropriate Expert Consensus Varies Varies 4 4 4 1 1 6 6 0 0 0 0
MRA spine area of interest with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 6 8 1 0 0
References Study Quality
125 (17698524) 4
126 (14872165) 4
124 (10588098) 4
123 (18202236) 4
MRA spine area of interest without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 4 11 1 0 0 0
References Study Quality
125 (17698524) 4
126 (14872165) 4
124 (10588098) 4
123 (18202236) 4
CT myelography spine area of interest May be appropriate Limited Varies Varies 4 4 1 1 2 6 4 3 1 0 0
References Study Quality
127 (18710972) 4
9 (-3120926) 4
CT spine area of interest with IV contrast May be appropriate Expert Consensus Varies Varies 4 4 1 1 5 8 0 2 0 0 0
CT spine area of interest without IV contrast May be appropriate Expert Consensus Varies Varies 4 4 0 1 4 8 3 1 0 0 0
CTA spine area of interest with IV contrast May be appropriate Limited Varies Varies 5 5 0 1 2 1 12 1 0 0 0
References Study Quality
122 (16611770) 4
Radiography spine area of interest Usually not appropriate Expert Consensus Varies Varies 1 1 12 1 4 0 0 0 1 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 2 2 6 7 3 1 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.