ACR logo

Appropriateness Criteria

Variant 1: Suspected acute pyelonephritis. First-time presentation. Uncomplicated patient (eg, no history of pyelonephritis, diabetes, immune compromise, history of stones or renal obstruction, prior renal surgery, advanced age, vesicoureteral reflux, lack of response to therapy, or pregnancy). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
15 (18203942) 4
17 (30708379) 3
10 (28271650) 4
US color Doppler kidneys and bladder retroperitoneal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 1 0 0
References Study Quality
15 (18203942) 4
Fluoroscopy voiding cystourethrography Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 16 0 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
Fluoroscopy antegrade pyelography Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 16 0 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 0 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 3 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
MRI abdomen and pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 2 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
MRI abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 3 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
MRI abdomen without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 2 1 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
MRU without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 2 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
MRU without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
CT abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 0 4 0 1 1 0 0 1
References Study Quality
15 (18203942) 4
14 (2655002) 4
8 (30392592) 4
1 (29298155) 4
10 (28271650) 4
16 (22859793) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 3 1 0 0 1 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
8 (30392592) 4
1 (29298155) 4
10 (28271650) 4
16 (22859793) 4
CT abdomen with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
1 (29298155) 4
10 (28271650) 4
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 3 0 0 2 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
1 (29298155) 4
10 (28271650) 4
DMSA renal scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 0 0 0 1 0 0 1 0
References Study Quality
15 (18203942) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 2 2 0 0 1 0 1 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
8 (30392592) 4
1 (29298155) 4
10 (28271650) 4
16 (22859793) 4
CT abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 12 0 2 1 0 1 1 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
1 (29298155) 4
10 (28271650) 4
CTU without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
1 (29298155) 4
10 (28271650) 4
Variant 2: Suspected acute pyelonephritis. Complicated patient (eg, recurrent pyelonephritis, diabetes, immune compromise, advanced age, vesicoureteral reflux, or lack of response to initial therapy). 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 Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 1 1 1 5 8
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
2 (17599303) 4
10 (28271650) 4
16 (22859793) 4
US abdomen May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 12 3 0 0 0
References Study Quality
37 (21792579) 4
39 (17941932) 2
38 (11149528) 3
10 (28271650) 4
36 (20428429) 2
US color Doppler kidneys and bladder retroperitoneal May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 5 0 5 5 1 0
References Study Quality
41 (12592126) 1
37 (21792579) 4
42 (15241674) 1
40 (10961277) 4
38 (11149528) 3
10 (28271650) 4
36 (20428429) 2
MRI abdomen and pelvis without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 1 0 2 9 3 1 0 0
References Study Quality
29 (23887662) 3
27 (23884301) 2
30 (23749224) 3
28 (24443116) 3
14 (2655002) 4
20 (3883000) 4
8 (30392592) 4
31 (27229497) 4
32 (19711638) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 1 2 5 7 2 0 0 0 0
References Study Quality
29 (23887662) 3
27 (23884301) 2
30 (23749224) 3
28 (24443116) 3
14 (2655002) 4
20 (3883000) 4
8 (30392592) 4
31 (27229497) 4
32 (19711638) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 3 3 2 1 6 2 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
2 (17599303) 4
10 (28271650) 4
16 (22859793) 4
CT abdomen with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 4 1 3 3 2 4 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
CT abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 2 2 4 0 3 1 3 2 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
2 (17599303) 4
10 (28271650) 4
16 (22859793) 4
Fluoroscopy voiding cystourethrography Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 10 4 2 0 0 0 0 1 0
References Study Quality
25 (22040289) 2
26 (15993478) 4
Fluoroscopy antegrade pyelography Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 13 2 1 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 2 1 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
MRI abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 1 4 0 8 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 2 4 4 2 0 0 0 0
MRU without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 1 2 1 7 0 0 0 0
References Study Quality
33 (24128878) 3
34 (20531092) 4
35 (14975495) 1
MRU without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 9 1 7 0 0 0 0 0 0
References Study Quality
33 (24128878) 3
34 (20531092) 4
35 (14975495) 1
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 3 6 1 0 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
DMSA renal scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 2 6 0 0 0 0 0 0
References Study Quality
23 (23414827) 4
24 (10966194) 4
CT abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 4 3 2 1 5 2 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
CTU without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 4 1 10 1 1 0 0 0 0
Variant 3: Suspected acute pyelonephritis. History of renal stones or renal obstruction. 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 Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 1 0 0 0 2 2 5 6
References Study Quality
15 (18203942) 4
22 (27563103) 2
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
10 (28271650) 4
11 (-3194118) 4
16 (22859793) 4
CT abdomen and pelvis without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 0 0 0 0 5 10 2
References Study Quality
15 (18203942) 4
22 (27563103) 2
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
10 (28271650) 4
11 (-3194118) 4
16 (22859793) 4
US abdomen May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 8 7 0 1 0
References Study Quality
37 (21792579) 4
39 (17941932) 2
38 (11149528) 3
10 (28271650) 4
36 (20428429) 2
44 (12819343) 4
45 (23091240) 4
US color Doppler kidneys and bladder retroperitoneal May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 1 3 8 3 1 0
References Study Quality
41 (12592126) 1
37 (21792579) 4
42 (15241674) 1
40 (10961277) 4
38 (11149528) 3
10 (28271650) 4
36 (20428429) 2
44 (12819343) 4
45 (23091240) 4
MRI abdomen and pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 2 4 6 3 0 0 0
References Study Quality
29 (23887662) 3
30 (23749224) 3
28 (24443116) 3
14 (2655002) 4
8 (30392592) 4
31 (27229497) 4
32 (19711638) 4
MRI abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 1 4 0 9 2 1 0 0 0
References Study Quality
29 (23887662) 3
30 (23749224) 3
28 (24443116) 3
14 (2655002) 4
8 (30392592) 4
31 (27229497) 4
32 (19711638) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 2 0 4 6 2 2 1
References Study Quality
15 (18203942) 4
22 (27563103) 2
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
10 (28271650) 4
11 (-3194118) 4
16 (22859793) 4
CT abdomen without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 4 0 4 3 0 6 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
Fluoroscopy voiding cystourethrography Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 12 3 1 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
Fluoroscopy antegrade pyelography Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 3 0 1 0 0 0 1 0
References Study Quality
15 (18203942) 4
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 3 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
MRI abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 1 4 5 2 0 0 0 0
References Study Quality
31 (27229497) 4
32 (19711638) 4
MRI abdomen without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 1 7 2 0 0 0 0 0
References Study Quality
31 (27229497) 4
32 (19711638) 4
MRU without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 3 3 5 0 0 0 0 0
References Study Quality
31 (27229497) 4
32 (19711638) 4
43 (29399012) 3
MRU without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 2 2 4 1 0 0 0 0
References Study Quality
31 (27229497) 4
32 (19711638) 4
43 (29399012) 3
CT abdomen with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 0 6 1 5 1 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 3 3 6 1 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
DMSA renal scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 2 3 3 1 0 0 1 0
References Study Quality
24 (10966194) 4
CTU without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 5 1 4 0 5 1 1 0 0
Variant 4: Suspected acute pyelonephritis. Pregnant female with no other complications (eg, no history of diabetes, immune compromise, history of stones or renal obstruction, prior renal surgery, vesicoureteral reflux, or lack of response to therapy). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 1 5 5 3 0
References Study Quality
37 (21792579) 4
51 (3280355) 4
49 (15075842) 4
50 (20833847) 4
38 (11149528) 3
8 (30392592) 4
10 (28271650) 4
36 (20428429) 2
48 (15625136) 4
US color Doppler kidneys and bladder retroperitoneal May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 0 1 8 4 1 2
References Study Quality
41 (12592126) 1
37 (21792579) 4
51 (3280355) 4
49 (15075842) 4
50 (20833847) 4
42 (15241674) 1
40 (10961277) 4
38 (11149528) 3
8 (30392592) 4
10 (28271650) 4
36 (20428429) 2
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 2 3 11 1 0 0 0
References Study Quality
29 (23887662) 3
27 (23884301) 2
30 (23749224) 3
28 (24443116) 3
20 (3883000) 4
8 (30392592) 4
47 (-3188535) 4
31 (27229497) 4
32 (19711638) 4
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 4 2 2 8 1 0 0 0 0
References Study Quality
29 (23887662) 3
30 (23749224) 3
28 (24443116) 3
47 (-3188535) 4
31 (27229497) 4
32 (19711638) 4
MRU without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 1 3 3 5 5 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 16 0 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
Fluoroscopy antegrade pyelography Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 15 1 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 9 1 7 0 0 0 0 0 0
References Study Quality
29 (23887662) 3
27 (23884301) 2
30 (23749224) 3
28 (24443116) 3
20 (3883000) 4
8 (30392592) 4
47 (-3188535) 4
31 (27229497) 4
32 (19711638) 4
MRI abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
References Study Quality
29 (23887662) 3
30 (23749224) 3
28 (24443116) 3
47 (-3188535) 4
31 (27229497) 4
32 (19711638) 4
MRU without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 2 1 0 0 0 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 5 1 0 0 0 0 0
References Study Quality
46 (-3120926) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 6 1 5 3 0 1 1 0 0
References Study Quality
46 (-3120926) 4
CT abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 0 7 1 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 2 2 2 1 0 0 0
DMSA renal scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 9 2 4 0 0 1 0 1 0
References Study Quality
46 (-3120926) 4
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 14 2 1 0 0 0 0 0 0
CTU without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 1 2 1 0 1 0 1 0
Variant 5: Suspected acute pyelonephritis. History of pelvic renal transplant with native kidneys in situ and no other complications (eg, no history of pyelonephritis, diabetes, history of stones or renal obstruction, prior renal surgery, advanced age, vesicoureteral reflux, lack of response to therapy, or pregnancy). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler kidney transplant Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 2 7 3 4
References Study Quality
53 (20659906) 2
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 0 0 0 1 2 10 2 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
MRI abdomen and pelvis without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 0 4 4 7 0 0 0
References Study Quality
53 (20659906) 2
29 (23887662) 3
30 (23749224) 3
28 (24443116) 3
54 (27039324) 3
31 (27229497) 4
32 (19711638) 4
52 (30689126) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 1 2 8 4 1 0 0 0
References Study Quality
53 (20659906) 2
29 (23887662) 3
30 (23749224) 3
28 (24443116) 3
54 (27039324) 3
31 (27229497) 4
32 (19711638) 4
52 (30689126) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 3 1 4 7 1 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
CT abdomen and pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 3 1 2 1 9 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
US abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 1 6 1 0 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
US color Doppler kidneys and bladder retroperitoneal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 2 7 2 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 13 2 0 0 0 1 0 1 0
References Study Quality
15 (18203942) 4
Fluoroscopy antegrade pyelography Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 13 2 1 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 0 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
MRI abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 5 3 0 0 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
MRI abdomen without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 2 1 0 0 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
MRI pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 1 3 6 1 0 0 0 0
MRI pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 2 5 4 0 0 0 0 0
MRU without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 0 4 5 1 0 0 0 0
MRU without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 2 5 1 2 0 0 0 0
CT abdomen with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 2 0 0 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
52 (30689126) 4
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 1 0 0 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
52 (30689126) 4
DMSA renal scan Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 1 0 0 0 0 1 0
References Study Quality
15 (18203942) 4
CT abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 13 2 1 0 0 0 0 0 0
References Study Quality
15 (18203942) 4
14 (2655002) 4
21 (7789019) 4
20 (3883000) 4
8 (30392592) 4
18 (28525662) 4
17 (30708379) 3
19 (30224907) 3
1 (29298155) 4
16 (22859793) 4
52 (30689126) 4
CTU without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 6 3 6 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.