Variant 1: Asymptomatic BMD screening or individuals with established or clinically suspected low BMD.
Variant 2: In patients with T-scores less than −1.0 and one or more of the following: a. Women age ≥70 years or men age ≥80 years b. Historical height loss >4 cm (>1.5 inches) c. Self-reported but undocumented prior vertebral fracture d. Glucocorticoid therapy equivalent to ≥5 mg of prednisone or equivalent per day for ≥3 months
Variant 3: Follow-up. Patients demonstrated to have risk for fracture or low density.
Variant 4: Identify low BMD. Premenopausal females with risk factors. Males 20-50 years old with risk factors.
Variant 5: Follow-up to low BMD. Premenopausal females with risk factors. Males 20–50 years of age with risk factors.
Variant 6: Diagnosis. Males and females >50 years of age with advanced degenerative changes of the spine with or without scoliosis.
Variant 7: Suspected fracture (nonscreening) of a vertebral body based on acute or subacute symptomatology in a patient with suspected osteoporosis or a patient treated with corticosteroids (>3 months). First examination.
Variant 8: Suspected fracture (nonscreening) of a vertebral body based on acute or subacute symptomatology in a patient with suspected osteoporosis or a patient treated with corticosteroids (>3 months). Initial radiograph is negative.
Variant 9: Patients on long-term treatment (3–5 years) of bisphosphonates with thigh or groin pain. First examination.
Variant 10: Patients on long-term treatment (3–5 years) of bisphosphonates with thigh or groin pain and negative radiographs.
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.