American College of Radiology
ACR Appropriateness Criteria®
Headache
Variant 1: Chronic headache. No new features. Normal neurologic examination.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
MRI head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
MRI head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
Usually not appropriate
☢☢☢ 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
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Arteriography cervicocerebral
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Variant 2: Chronic headache with new feature or neurologic deficit.
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
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
Usually appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CTA head 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
MRA head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
Arteriography cervicocerebral
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Variant 3: Sudden onset of severe headache (“Worst headache of one’s life”, “thunderclap headache”).
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
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
Usually appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
Arteriography cervicocerebral
Usually appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRI head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
Variant 4: Sudden onset of unilateral headache, or suspected carotid or vertebral dissection or ipsilateral Horner syndrome.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
CTA head and neck with IV contrast
Usually appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI head without and with IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRA neck without and with IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
Usually appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRA neck without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
Arteriography cervicocerebral
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRI neck without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRI neck without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
MRI cervical spine without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
MRI cervical spine without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
CT neck without and 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 neck with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
US duplex Doppler carotid
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
CT neck without IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
Variant 5: Headache of trigeminal autonomic origin.
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
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
Arteriography cervicocerebral
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Variant 6: Headache of skull base, orbital, or periorbital origin.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
MRI head and orbits without and with IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI head and orbits without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
CT head and orbits without and with IV contrast
Usually appropriate
☢☢☢ 1-10 mSv
7
n/a
0
0
0
0
0
0
0
0
0
CT head and orbits with IV contrast
Usually appropriate
☢☢☢ 1-10 mSv
7
n/a
0
0
0
0
0
0
0
0
0
CT head and orbits without IV contrast
May be appropriate
☢☢☢ 1-10 mSv
6
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
Arteriography cervicocerebral
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Variant 7: Headache, suspected intracranial complication of sinusitis and/or mastoiditis. (See the ACR Appropriateness Criteria® on “Sinonasal Disease”)
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
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
Variant 8: Headache of oromaxillofacial origin.
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
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
Variant 9: New headache in elderly patients. Sedimentation rate higher than 55, temporal tenderness. Suspected temporal arteritis.
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
O 0 mSv
O 0 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CTA head and neck with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRA neck without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
MRA neck without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
Arteriography cervicocerebral
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
FDG-PET/CT whole body
Usually not appropriate
☢☢☢☢ 10-30 mSv
3
n/a
0
0
0
0
0
0
0
0
0
US head
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
Variant 10: New headache in cancer patient or immunocompromised individual.
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
O 0 mSv
O 0 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
FDG-PET/CT head
May be appropriate
☢☢☢☢ 10-30 mSv
☢☢☢☢ 3-10 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
Thallium-201 SPECT head
Usually not appropriate
☢☢☢☢ 10-30 mSv
3
n/a
0
0
0
0
0
0
0
0
0
Arteriography cervicocerebral
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Tc-99m HMPAO SPECT head
Usually not appropriate
☢☢☢☢ 10-30 mSv
☢☢☢☢ 3-10 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Variant 11: New headache. Suspected meningitis/encephalitis.
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
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
Variant 12: New headache in pregnant woman.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
Usually appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MR venography head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRI head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
CTA head with 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 head without and with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Variant 13: New headache. Focal neurologic deficit or papilledema.
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
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
Usually appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
Variant 14: Positional headache.
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
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
X-ray myelography and post myelography CT spine
Usually appropriate
☢☢☢☢ 10-30 mSv
7
n/a
0
0
0
0
0
0
0
0
0
MRI spine include MR myelography
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
Variant 15: Headache associated with cough, exertion or sexual activity.
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
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
CT head without IV contrast
Usually appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
X-ray myelography and post myelography CT spine
Usually not appropriate
☢☢☢☢ 10-30 mSv
2
n/a
0
0
0
0
0
0
0
0
0
MRI spine include MR myelography
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Variant 16: Post-traumatic headache.
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
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI head without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRI head without and with IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
MRA head without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
MRA head without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CTA head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head without and with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
CT head with IV contrast
May be appropriate
☢☢☢ 1-10 mSv
☢☢☢ 0.3-3 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
Arteriography cervicocerebral
Usually not appropriate
☢☢☢ 1-10 mSv
☢☢☢☢ 3-10 mSv [ped]
3
n/a
0
0
0
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.
