Variant 1: Suspected osteomyelitis or septic arthritis or soft tissue infection (excluding spine and diabetic foot). Initial imaging.
Variant 2: Suspected septic arthritis or soft tissue infection. Initial radiographs normal or with findings suggestive of joint effusion or soft tissue swelling. Next imaging study.
Variant 3: Suspected osteomyelitis. Initial radiographs normal or with findings suggestive of osteomyelitis. Next imaging study.
Variant 4: Suspected osteomyelitis or soft tissue infection with implanted extra-articular surgical hardware. Initial radiographs normal or with findings suggestive of osteomyelitis or soft tissue infection with implanted extra-articular surgical hardware. Next imaging study.
Variant 5: Suspected septic arthritis with arthroplasty or other implanted intra-articular surgical hardware. Initial radiographs normal or with findings suggestive of septic arthritis with arthroplasty or other implanted intra-articular surgical hardware. Next imaging study.
Variant 6: Suspected soft tissue infection. History of puncture wound with possible retained foreign body. Radiographs normal. Next imaging study.
Variant 7: Suspected soft tissue infection. Initial radiographs show soft tissue gas (without puncture wound) or are normal with high clinical suspicion of necrotizing fasciitis. Next imaging study.
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.