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Appropriateness Criteria

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
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
35 (24139671) 3
33 (23404352) 3
34 (22663912) 4
32 (21085024) 2
31 (19509621) 2
36 (25352931) 4
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 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
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
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
44 (25997715) 4
37 (25769487) 3
38 (24731570) 3
43 (24033302) 3
55 (27893647) 2
46 (21619408) M
41 (20336892) 4
47 (20065765) M
42 (18188119) M
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 2
56 (27438681) 2
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
44 (25997715) 4
37 (25769487) 3
38 (24731570) 3
43 (24033302) 3
55 (27893647) 2
46 (21619408) M
41 (20336892) 4
47 (20065765) M
42 (18188119) M
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 2
56 (27438681) 2
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
44 (25997715) 4
49 (26239776) 3
37 (25769487) 3
38 (24731570) 3
43 (24033302) 3
46 (21619408) M
41 (20336892) 4
47 (20065765) M
31 (19509621) 2
42 (18188119) M
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 2
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
44 (25997715) 4
49 (26239776) 3
37 (25769487) 3
38 (24731570) 3
43 (24033302) 3
46 (21619408) M
41 (20336892) 4
47 (20065765) M
31 (19509621) 2
42 (18188119) M
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 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
44 (25997715) 4
52 (24355656) 3
43 (24033302) 3
54 (22695428) 3
51 (12435934) 1
53 (14608149) 4
50 (24458034) 3
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
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
44 (25997715) 4
49 (26239776) 3
37 (25769487) 3
38 (24731570) 3
43 (24033302) 3
46 (21619408) M
41 (20336892) 4
47 (20065765) M
31 (19509621) 2
42 (18188119) M
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 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
35 (24139671) 3
33 (23404352) 3
34 (22663912) 4
32 (21085024) 2
31 (19509621) 2
36 (25352931) 4
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 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
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
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
44 (25997715) 4
37 (25769487) 3
38 (24731570) 3
43 (24033302) 3
55 (27893647) 2
46 (21619408) M
41 (20336892) 4
47 (20065765) M
42 (18188119) M
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 2
56 (27438681) 2
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
44 (25997715) 4
37 (25769487) 3
38 (24731570) 3
43 (24033302) 3
55 (27893647) 2
46 (21619408) M
41 (20336892) 4
47 (20065765) M
42 (18188119) M
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 2
56 (27438681) 2
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
44 (25997715) 4
49 (26239776) 3
37 (25769487) 3
38 (24731570) 3
43 (24033302) 3
46 (21619408) M
41 (20336892) 4
47 (20065765) M
31 (19509621) 2
42 (18188119) M
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 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
52 (24355656) 3
51 (12435934) 1
53 (14608149) 4
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
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
43 (24033302) 3
41 (20336892) 4
58 (20388006) 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
43 (24033302) 3
41 (20336892) 4
57 (15734929) 4
40 (16374279) 2
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
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 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
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
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
43 (24033302) 3
41 (20336892) 4
58 (20388006) 4
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
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
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
37 (25769487) 3
62 (23075855) 2
38 (24731570) 3
60 (24090539) 2
41 (20336892) 4
42 (18188119) M
39 (18073599) 4
40 (16374279) 2
61 (17906580) 4
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 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
37 (25769487) 3
62 (23075855) 2
38 (24731570) 3
60 (24090539) 2
41 (20336892) 4
42 (18188119) M
39 (18073599) 4
40 (16374279) 2
61 (17906580) 4
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
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
43 (24033302) 3
41 (20336892) 4
57 (15734929) 4
40 (16374279) 2
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
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
54 (22695428) 3
51 (12435934) 1
50 (24458034) 3
71 (18635617) 2
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
52 (24355656) 3
54 (22695428) 3
70 (16612293) 2
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
52 (24355656) 3
54 (22695428) 3
72 (16688051) 3
50 (24458034) 3
73 (25794340) 2
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
54 (22695428) 3
51 (12435934) 1
50 (24458034) 3
71 (18635617) 2
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
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
44 (25997715) 4
62 (23075855) 2
79 (25076462) 3
38 (24731570) 3
78 (22491556) 3
55 (27893647) 2
46 (21619408) M
41 (20336892) 4
47 (20065765) M
80 (18073612) 2
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 2
77 (28993912) 4
56 (27438681) 2
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
35 (24139671) 3
74 (21265348) 3
75 (20583514) 3
76 (16508493) 3
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 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
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
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
44 (25997715) 4
62 (23075855) 2
79 (25076462) 3
38 (24731570) 3
78 (22491556) 3
55 (27893647) 2
46 (21619408) M
41 (20336892) 4
47 (20065765) M
80 (18073612) 2
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 2
77 (28993912) 4
56 (27438681) 2
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
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
44 (25997715) 4
62 (23075855) 2
79 (25076462) 3
38 (24731570) 3
78 (22491556) 3
46 (21619408) M
41 (20336892) 4
47 (20065765) M
42 (18188119) M
80 (18073612) 2
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 2
83 (27448661) 4
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
62 (23075855) 2
35 (24139671) 3
81 (23809183) 2
33 (23404352) 3
34 (22663912) 4
32 (21085024) 2
74 (21265348) 3
75 (20583514) 3
42 (18188119) M
82 (11791052) 4
76 (16508493) 3
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 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
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
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
44 (25997715) 4
62 (23075855) 2
79 (25076462) 3
38 (24731570) 3
78 (22491556) 3
46 (21619408) M
41 (20336892) 4
47 (20065765) M
42 (18188119) M
80 (18073612) 2
39 (18073599) 4
48 (18469647) 3
45 (18404054) 4
40 (16374279) 2
83 (27448661) 4
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
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
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
35 (24139671) 3
74 (21265348) 3
75 (20583514) 3
100 (17108836) 4
101 (27984030) Good
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
85 (22187629) 1
96 (23273320) 3
95 (23143091) Good
88 (22310029) 3
42 (18188119) M
92 (19912072) 4
93 (19802673) 3
97 (18708935) 3
103 (21920865) 4
91 (19083212) 4
102 (21289550) 2
89 (20531071) 3
86 (19672633) 3
87 (15853463) 2
94 (18512085) 4
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
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 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
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
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
62 (23075855) 2
85 (22187629) 1
96 (23273320) 3
95 (23143091) Good
88 (22310029) 3
42 (18188119) M
92 (19912072) 4
93 (19802673) 3
97 (18708935) 3
103 (21920865) 4
91 (19083212) 4
102 (21289550) 2
89 (20531071) 3
86 (19672633) 3
87 (15853463) 2
94 (18512085) 4
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
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
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
104 (23422283) 2
110 (27663571) 2
109 (20699755) 3
108 (14566120) 2
107 (-3131250) 3
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
104 (23422283) 2
108 (14566120) 2
105 (12913630) 3
106 (16612322) 4
107 (-3131250) 3
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
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
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
104 (23422283) 2
110 (27663571) 2
109 (20699755) 3
108 (14566120) 2
107 (-3131250) 3
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 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
104 (23422283) 2
110 (27663571) 2
109 (20699755) 3
108 (14566120) 2
107 (-3131250) 3
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
43 (24033302) 3
41 (20336892) 4
111 (14769351) 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
43 (24033302) 3
41 (20336892) 4
57 (15734929) 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
43 (24033302) 3
41 (20336892) 4
111 (14769351) 4
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
43 (24033302) 3
41 (20336892) 4
57 (15734929) 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
43 (24033302) 3
41 (20336892) 4
57 (15734929) 4
40 (16374279) 2
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.