American College of Radiology
ACR Appropriateness Criteria®

Jaundice

Variant 1: Jaundice. No known predisposing conditions. 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 appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 4 8
References Study Quality
15 (12601199) 2
16 (8425846) 3
17 (1646222) 4
18 (25561782) 4
19 (15671013) 4
20 (8095802) 2
21 (6385676) 4
22 (11420481) 3
23 (6608232) 3
24 (3310222) 4
25 (25719223) M
26 (18321943) 4
27 (10835126) 4
28 (1731843) 3
29 (19722262) 2
30 (12216762) 3
31 (18000708) 3
32 (27995906) 4
CT abdomen with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 0 4 7 1
References Study Quality
33 (16794173) 2
34 (19266258) 3
35 (11029095) 4
36 (10505997) 3
37 (20524442) 3
38 (18713297) 2
39 (27429673) 3
40 (25866583) 4
41 (9117928) 3
42 (-3144435) 4
43 (21862355) 3
44 (18544944) 3
45 (27089026) 3
MRI abdomen without and with IV contrast with MRCP Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 1 5 5 0
References Study Quality
26 (18321943) 4
34 (19266258) 3
36 (10505997) 3
44 (18544944) 3
47 (28448309) 3
48 (28154911) 3
49 (26607835) 3
50 (15615951) 2
51 (18050328) 2
52 (18212225) 2
53 (18956595) 1
54 (26901008) 3
55 (23925840) 4
56 (22560687) 4
57 (27101572) 4
58 (19910887) 3
59 (15837409) 2
60 (26688059) 3
61 (19029218) 4
62 (17531414) 4
63 (18463877) 2
MRI abdomen without IV contrast with MRCP May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 0 7 2 2 0
References Study Quality
26 (18321943) 4
34 (19266258) 3
44 (18544944) 3
46 (15129871) 3
47 (28448309) 3
48 (28154911) 3
49 (26607835) 3
50 (15615951) 2
51 (18050328) 2
52 (18212225) 2
53 (18956595) 1
54 (26901008) 3
55 (23925840) 4
56 (22560687) 4
57 (27101572) 4
58 (19910887) 3
59 (15837409) 2
60 (26688059) 3
61 (19029218) 4
62 (17531414) 4
63 (18463877) 2
CT abdomen without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 3 4 0 5 1 0 0 0
References Study Quality
27 (10835126) 4
33 (16794173) 2
34 (19266258) 3
35 (11029095) 4
36 (10505997) 3
37 (20524442) 3
38 (18713297) 2
39 (27429673) 3
40 (25866583) 4
41 (9117928) 3
42 (-3144435) 4
43 (21862355) 3
44 (18544944) 3
45 (27089026) 3
CT abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 3 10 0 0 0 0 0 0
References Study Quality
27 (10835126) 4
33 (16794173) 2
34 (19266258) 3
35 (11029095) 4
36 (10505997) 3
37 (20524442) 3
38 (18713297) 2
39 (27429673) 3
40 (25866583) 4
41 (9117928) 3
42 (-3144435) 4
43 (21862355) 3
44 (18544944) 3
45 (27089026) 3
ERCP Usually not appropriate Moderate ☢☢☢ 1-10 mSv 3 3 2 3 3 4 1 0 0 0 0
References Study Quality
26 (18321943) 4
53 (18956595) 1
65 (12447259) 4
66 (12933488) 4
67 (9240949) 3
68 (16635233) 4
69 (17509029) Good
70 (9684657) 3
71 (11875959) 4
72 (18790436) 4
73 (17127190) 4
74 (3355239) 4
75 (8282260) 4
US abdomen endoscopic Usually not appropriate Moderate O 0 mSv O 0 mSv [ped] 3 3 2 3 5 3 0 0 0 0 0
References Study Quality
76 (19073413) 3
77 (19506529) 3
78 (19249774) 3
79 (18384788) 3
80 (27129552) 2
81 (27214660) 4
82 (22180307) 4
83 (14687813) 3
84 (27580856) Good
85 (9165320) 3
86 (20105473) 4
Variant 2: Jaundice. Suspected mechanical obstruction based on initial imaging, clinical condition, or laboratory values.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 0 4 7 1
References Study Quality
33 (16794173) 2
34 (19266258) 3
35 (11029095) 4
36 (10505997) 3
37 (20524442) 3
38 (18713297) 2
39 (27429673) 3
52 (18212225) 2
54 (26901008) 3
106 (20489090) 2
107 (18520538) 2
108 (18509655) 3
109 (19478630) 2
110 (27770159) 3
111 (26261722) 4
112 (14736675) 4
113 (18941084) 4
114 (29101993) 4
MRI abdomen without and with IV contrast with MRCP Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 1 7 3
References Study Quality
26 (18321943) 4
34 (19266258) 3
46 (15129871) 3
48 (28154911) 3
49 (26607835) 3
50 (15615951) 2
51 (18050328) 2
52 (18212225) 2
53 (18956595) 1
54 (26901008) 3
57 (27101572) 4
58 (19910887) 3
61 (19029218) 4
63 (18463877) 2
69 (17509029) Good
70 (9684657) 3
91 (17955311) 3
93 (25132706) 3
94 (28298257) 3
95 (27986172) 4
96 (20829538) M
97 (12024143) 2
98 (19025934) 3
99 (20195160) 2
100 (20382592) 4
101 (12949455) 3
102 (26409603) 4
103 (17385107) 4
104 (26745601) 3
105 (1892027) 2
92 (22560689) 4
MRI abdomen without IV contrast with MRCP Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 0 4 4 3 1
References Study Quality
26 (18321943) 4
34 (19266258) 3
46 (15129871) 3
48 (28154911) 3
49 (26607835) 3
50 (15615951) 2
51 (18050328) 2
52 (18212225) 2
53 (18956595) 1
54 (26901008) 3
57 (27101572) 4
58 (19910887) 3
61 (19029218) 4
63 (18463877) 2
69 (17509029) Good
70 (9684657) 3
91 (17955311) 3
92 (22560689) 4
93 (25132706) 3
94 (28298257) 3
95 (27986172) 4
96 (20829538) M
97 (12024143) 2
98 (19025934) 3
99 (20195160) 2
100 (20382592) 4
101 (12949455) 3
102 (26409603) 4
103 (17385107) 4
104 (26745601) 3
105 (1892027) 2
US abdomen Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 1 0 4 2 4
References Study Quality
20 (8095802) 2
21 (6385676) 4
22 (11420481) 3
23 (6608232) 3
24 (3310222) 4
25 (25719223) M
32 (27995906) 4
34 (19266258) 3
35 (11029095) 4
36 (10505997) 3
76 (19073413) 3
ERCP May be appropriate Strong ☢☢☢ 1-10 mSv 6 6 1 0 0 1 0 5 6 0 0
References Study Quality
26 (18321943) 4
34 (19266258) 3
51 (18050328) 2
52 (18212225) 2
53 (18956595) 1
58 (19910887) 3
62 (17531414) 4
63 (18463877) 2
65 (12447259) 4
66 (12933488) 4
67 (9240949) 3
68 (16635233) 4
69 (17509029) Good
70 (9684657) 3
71 (11875959) 4
72 (18790436) 4
73 (17127190) 4
76 (19073413) 3
78 (19249774) 3
115 (14986787) 4
116 (26365063) 3
117 (19533558) 3
118 (19286177) 3
119 (15542504) 4
120 (20066744) 3
US abdomen endoscopic May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 5 1 0 0 4 7 2 1 0 0
References Study Quality
76 (19073413) 3
77 (19506529) 3
78 (19249774) 3
79 (18384788) 3
80 (27129552) 2
81 (27214660) 4
82 (22180307) 4
83 (14687813) 3
84 (27580856) Good
85 (9165320) 3
CT abdomen without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 3 4 2 2 1 0 0 0
References Study Quality
33 (16794173) 2
34 (19266258) 3
35 (11029095) 4
36 (10505997) 3
37 (20524442) 3
38 (18713297) 2
39 (27429673) 3
52 (18212225) 2
54 (26901008) 3
106 (20489090) 2
107 (18520538) 2
108 (18509655) 3
109 (19478630) 2
110 (27770159) 3
111 (26261722) 4
112 (14736675) 4
113 (18941084) 4
114 (29101993) 4
CT abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 4 8 1 0 0 0 0 0
References Study Quality
33 (16794173) 2
34 (19266258) 3
35 (11029095) 4
36 (10505997) 3
37 (20524442) 3
38 (18713297) 2
39 (27429673) 3
52 (18212225) 2
54 (26901008) 3
106 (20489090) 2
107 (18520538) 2
108 (18509655) 3
109 (19478630) 2
110 (27770159) 3
111 (26261722) 4
112 (14736675) 4
113 (18941084) 4
114 (29101993) 4
Variant 3: Jaundice. Suspected medical, metabolic, or functional etiologies based on initial imaging, clinical condition, or laboratory values. No suspected mechanical obstruction.
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 with MRCP Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 2 3 6 1
References Study Quality
12 () 4
32 (27995906) 4
44 (18544944) 3
105 (1892027) 2
121 (12809842) 3
122 (8537493) 4
123 (17955076) 4
124 (26455963) 3
125 (16778613) 4
126 (20656832) Good
127 (28668418) 4
128 (18666139) 4
129 (17663420) 3
CT abdomen with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 3 1 4 3 1
References Study Quality
12 () 4
32 (27995906) 4
124 (26455963) 3
US abdomen Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 2 9 1 3
References Study Quality
15 (12601199) 2
16 (8425846) 3
17 (1646222) 4
18 (25561782) 4
19 (15671013) 4
20 (8095802) 2
21 (6385676) 4
22 (11420481) 3
23 (6608232) 3
24 (3310222) 4
25 (25719223) M
32 (27995906) 4
MRI abdomen without IV contrast with MRCP May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 2 1 7 3 1 0 1
References Study Quality
12 () 4
32 (27995906) 4
44 (18544944) 3
105 (1892027) 2
121 (12809842) 3
122 (8537493) 4
123 (17955076) 4
124 (26455963) 3
125 (16778613) 4
126 (20656832) Good
127 (28668418) 4
128 (18666139) 4
129 (17663420) 3
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 3 1 4 0 0 0 0
References Study Quality
12 () 4
32 (27995906) 4
124 (26455963) 3
CT abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 3 6 3 0 0 0 0 0
References Study Quality
12 () 4
32 (27995906) 4
124 (26455963) 3
ERCP Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 4 4 3 1 1 0 0 0 0
US abdomen endoscopic Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 3 4 1 1 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.