American College of Radiology
ACR Appropriateness Criteria®

Suspected Spine Trauma

Variant 1: Age greater than or equal to 16 years and less than 65 years. Suspected acute blunt cervical spine trauma; imaging not indicated by NEXUS or CCR clinical criteria. Patient meets low-risk criteria. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT cervical spine without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 4 1 0 3 0 0 0 0
References Study Quality
49 (26239776) 3
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
43 (24033302) 3
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
37 (25769487) 3
31 (19509621) 2
CTA head and neck with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 0 0 1 1 0 0 0
References Study Quality
54 (22695428) 3
53 (14608149) 4
52 (24355656) 3
51 (12435934) 1
50 (24458034) 3
43 (24033302) 3
44 (25997715) 4
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 2 0 0 0 0 0 0 0
CT cervical spine with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
CT cervical spine without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
References Study Quality
49 (26239776) 3
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
43 (24033302) 3
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
37 (25769487) 3
31 (19509621) 2
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 1 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
MRI cervical spine without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 0 0 0 0
References Study Quality
56 (27438681) 2
55 (27893647) 2
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
43 (24033302) 3
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
37 (25769487) 3
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
References Study Quality
55 (27893647) 2
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
43 (24033302) 3
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
37 (25769487) 3
56 (27438681) 2
Radiography cervical spine Usually not appropriate Strong ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 9 3 1 0 2 1 0 0 1
References Study Quality
36 (25352931) 4
35 (24139671) 3
34 (22663912) 4
33 (23404352) 3
32 (21085024) 2
31 (19509621) 2
Variant 2: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Imaging indicated by NEXUS or CCR clinical criteria. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT cervical spine without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 1 1 15
References Study Quality
49 (26239776) 3
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
43 (24033302) 3
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
37 (25769487) 3
31 (19509621) 2
Radiography cervical spine May be appropriate Strong ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 0 0 2 4 10 0 0 0 0
References Study Quality
36 (25352931) 4
35 (24139671) 3
34 (22663912) 4
33 (23404352) 3
32 (21085024) 2
31 (19509621) 2
CTA head and neck with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 0 0 1 0 0 1 0
References Study Quality
53 (14608149) 4
52 (24355656) 3
51 (12435934) 1
50 (24458034) 3
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 0 0 0 1 0 0 0 0
CT cervical spine with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 2 0 0 0 0 0 0
CT cervical spine without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 2 0 0 0 0 0 0
References Study Quality
49 (26239776) 3
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
43 (24033302) 3
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
37 (25769487) 3
31 (19509621) 2
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 0 0 1 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 0 0 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
MRI cervical spine without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 9 6 1 0 0 0 0 0 0
References Study Quality
56 (27438681) 2
55 (27893647) 2
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
43 (24033302) 3
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
37 (25769487) 3
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
References Study Quality
56 (27438681) 2
55 (27893647) 2
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
43 (24033302) 3
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
37 (25769487) 3
Variant 3: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Confirmed or suspected cervical spinal cord or nerve root injury, with or without traumatic injury identified on cervical CT. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical spine without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 17
References Study Quality
58 (20388006) 4
43 (24033302) 3
41 (20336892) 4
CT myelography cervical spine May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 1 3 10 1 1 0 0
References Study Quality
57 (15734929) 4
43 (24033302) 3
41 (20336892) 4
40 (16374279) 2
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 0 1 1 0 0 1 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 15 0 1 1 0 0 0 0 0
References Study Quality
59 (25632417) 4
MRA neck without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 14 0 3 0 0 0 0 0 0
References Study Quality
59 (25632417) 4
MRI cervical spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 0 2 0 1 1 1 0 0
References Study Quality
58 (20388006) 4
43 (24033302) 3
41 (20336892) 4
Radiography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 15 0 1 0 1 0 0 0 0
Variant 4: Age greater than or equal to 16 years. Acute cervical spine injury detected on radiographs. Treatment planning for mechanically unstable spine.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT cervical spine without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 1 0 0 0 15
References Study Quality
31 (19509621) 2
MRI cervical spine without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 0 3 12
References Study Quality
62 (23075855) 2
61 (17906580) 4
60 (24090539) 2
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
37 (25769487) 3
CT myelography cervical spine Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 1 2 1 2 1 0 0 0
References Study Quality
57 (15734929) 4
43 (24033302) 3
41 (20336892) 4
40 (16374279) 2
CT cervical spine with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
CT cervical spine without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
References Study Quality
31 (19509621) 2
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 14 0 1 0 1 0 0 0 0
References Study Quality
62 (23075855) 2
61 (17906580) 4
60 (24090539) 2
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
37 (25769487) 3
Variant 5: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Clinical or imaging findings suggest arterial injury with or without positive cervical spine CT. Next imaging study.
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 Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 1 1 0 2 13
References Study Quality
70 (16612293) 2
54 (22695428) 3
52 (24355656) 3
50 (24458034) 3
Arteriography cervicocerebral May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 5 6 1 2 2
References Study Quality
73 (25794340) 2
72 (16688051) 3
54 (22695428) 3
52 (24355656) 3
50 (24458034) 3
MRA neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 13 3 0 0 0
References Study Quality
71 (18635617) 2
54 (22695428) 3
51 (12435934) 1
50 (24458034) 3
MRA neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 2 1 6 5 2
References Study Quality
71 (18635617) 2
54 (22695428) 3
51 (12435934) 1
50 (24458034) 3
Variant 6: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Obtunded patient with no traumatic injury identified on cervical spine CT. Next imaging study after CT cervical spine without IV contrast.
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 not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 1 0 2 0 0 1 0
References Study Quality
65 (22327974) 3
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 1 1 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 0 1 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 1 0 1 0 0 0 0
MRI cervical spine without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 4 2 4 2 5
References Study Quality
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
80 (18073612) 2
79 (25076462) 3
78 (22491556) 3
77 (28993912) 4
62 (23075855) 2
56 (27438681) 2
55 (27893647) 2
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 14 0 1 0 1 0 1 0 0
References Study Quality
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
62 (23075855) 2
56 (27438681) 2
55 (27893647) 2
80 (18073612) 2
79 (25076462) 3
78 (22491556) 3
77 (28993912) 4
Radiography cervical spine Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 14 0 1 1 0 1 0 0 0
References Study Quality
76 (16508493) 3
75 (20583514) 3
74 (21265348) 3
35 (24139671) 3
Variant 7: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Clinical or imaging findings suggest ligamentous injury. Next imaging study after CT cervical spine without IV contrast.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical spine without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 2 1 1 13
References Study Quality
42 (18188119) M
41 (20336892) 4
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
48 (18469647) 3
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
83 (27448661) 4
80 (18073612) 2
79 (25076462) 3
78 (22491556) 3
62 (23075855) 2
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 1 0 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 14 0 1 0 1 0 1 0 0
References Study Quality
47 (20065765) M
46 (21619408) M
45 (18404054) 4
44 (25997715) 4
42 (18188119) M
41 (20336892) 4
48 (18469647) 3
40 (16374279) 2
39 (18073599) 4
38 (24731570) 3
83 (27448661) 4
80 (18073612) 2
79 (25076462) 3
78 (22491556) 3
62 (23075855) 2
Radiography cervical spine Usually not appropriate Strong ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 10 0 1 3 3 0 0 0 0
References Study Quality
35 (24139671) 3
34 (22663912) 4
33 (23404352) 3
32 (21085024) 2
82 (11791052) 4
81 (23809183) 2
76 (16508493) 3
75 (20583514) 3
74 (21265348) 3
62 (23075855) 2
42 (18188119) M
Variant 8: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Follow-up imaging on patient with no unstable injury demonstrated initially, but kept in collar for neck pain. No new neurologic symptoms. Includes whiplash associated disorders.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT cervical spine without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 5 0 1 0 9 0 1 0 0
MRI cervical spine without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 8 5 0 1 0
References Study Quality
62 (23075855) 2
42 (18188119) M
89 (20531071) 3
88 (22310029) 3
87 (15853463) 2
86 (19672633) 3
85 (22187629) 1
97 (18708935) 3
96 (23273320) 3
95 (23143091) Good
94 (18512085) 4
93 (19802673) 3
92 (19912072) 4
91 (19083212) 4
103 (21920865) 4
102 (21289550) 2
Radiography cervical spine May be appropriate Strong ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 0 0 0 2 7 3 1 0 3
References Study Quality
74 (21265348) 3
35 (24139671) 3
75 (20583514) 3
101 (27984030) Good
100 (17108836) 4
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 1 1 0 0 0 0 0
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
CT cervical spine with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
CT cervical spine without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 1 0 0 0 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 1 0 0 0 0 0
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 0
References Study Quality
89 (20531071) 3
88 (22310029) 3
87 (15853463) 2
86 (19672633) 3
85 (22187629) 1
103 (21920865) 4
102 (21289550) 2
97 (18708935) 3
96 (23273320) 3
95 (23143091) Good
94 (18512085) 4
93 (19802673) 3
92 (19912072) 4
91 (19083212) 4
62 (23075855) 2
42 (18188119) M
Variant 9: Age greater than or equal to 16 years. Blunt trauma meeting criteria for thoracic and lumbar imaging. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT thoracic and lumbar spine without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 1 0 1 0 15
References Study Quality
110 (27663571) 2
109 (20699755) 3
108 (14566120) 2
107 (-3131250) 3
104 (23422283) 2
Radiography thoracic and lumbar spine May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 0 1 12 3 0 0 0
References Study Quality
108 (14566120) 2
107 (-3131250) 3
106 (16612322) 4
105 (12913630) 3
104 (23422283) 2
CT myelography thoracic and lumbar spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 1 0 0 1 0 0 0
CT thoracic and lumbar spine with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 0 2 0 0 0 1 0 0
References Study Quality
110 (27663571) 2
109 (20699755) 3
108 (14566120) 2
107 (-3131250) 3
104 (23422283) 2
CT thoracic and lumbar spine without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 2 0 0 0 0 0 0
References Study Quality
110 (27663571) 2
109 (20699755) 3
108 (14566120) 2
107 (-3131250) 3
104 (23422283) 2
MRI thoracic and lumbar spine without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 0 2 3 2 0 0 0 0
MRI thoracic and lumbar spine without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 2 0 0 0 0 0 0
Variant 10: Age greater than or equal to 16 years. Acute thoracic or lumbar spine injury detected on radiographs or noncontrast CT. Neurologic abnormalities. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI thoracic and lumbar spine without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 16
References Study Quality
111 (14769351) 4
43 (24033302) 3
41 (20336892) 4
CT myelography thoracic and lumbar spine May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 5 8 1 1 0 0
References Study Quality
57 (15734929) 4
43 (24033302) 3
41 (20336892) 4
40 (16374279) 2
CT thoracic and lumbar spine with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 0 0 0 0 0 0 0
References Study Quality
57 (15734929) 4
43 (24033302) 3
41 (20336892) 4
40 (16374279) 2
CT thoracic and lumbar spine without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
References Study Quality
57 (15734929) 4
43 (24033302) 3
41 (20336892) 4
40 (16374279) 2
MRI thoracic and lumbar spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 0 2 0 1 0 0 0 0
References Study Quality
111 (14769351) 4
43 (24033302) 3
41 (20336892) 4
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.