American College of Radiology
ACR Appropriateness Criteria®

Back Pain — Child

Variant 1: Child. Back pain with none of the following clinical red flags: constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neurologic examination. Initial imaging evaluation.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography spine area of interest Usually not appropriate Varies Varies Varies Varies 2 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without IV contrast Usually not appropriate Varies Varies Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Varies Varies Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Varies Varies Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
CT myelography complete spine Usually not appropriate ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Tc-99m bone scan whole body with SPECT complete spine Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 2: Child. Back pain with 1 or more of the following clinical red flags: constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neurologic examination. Initial imaging evaluation.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography spine area of interest Usually appropriate Varies Varies Varies Varies 8 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without IV contrast Usually not appropriate Varies Varies Varies Varies 3 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Varies Varies Varies Varies 2 n/a 0 0 0 0 0 0 0 0 0
Tc-99m bone scan whole body with SPECT complete spine Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Varies Varies Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
CT myelography complete spine Usually not appropriate ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 3: Child. Back pain with 1 or more of the following clinical red flags: constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neurologic examination. Negative radiographs.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI complete spine without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without IV contrast May be appropriate Varies Varies Varies Varies 5 n/a 0 0 0 0 0 0 0 0 0
Tc-99m bone scan whole body with SPECT complete spine May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Varies Varies Varies Varies 2 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Varies Varies Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
CT myelography complete spine Usually not appropriate ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 4: Child. Back pain with 1 or more of the following clinical red flags: constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neurologic examination. Positive radiographs.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI complete spine without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without IV contrast May be appropriate Varies Varies Varies Varies 5 n/a 0 0 0 0 0 0 0 0 0
Tc-99m bone scan whole body with SPECT complete spine May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Varies Varies Varies Varies 3 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Varies Varies Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
CT myelography complete spine Usually not appropriate ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 5: Child. Chronic back pain associated with overuse. Mechanical back pain.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography spine area of interest Usually appropriate Varies Varies Varies Varies 9 n/a 0 0 0 0 0 0 0 0 0
MRI spine area of interest without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without IV contrast May be appropriate Varies Varies Varies Varies 6 n/a 0 0 0 0 0 0 0 0 0
Tc-99m bone scan whole body with SPECT complete spine May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
MRI spine area of interest without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Varies Varies Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Varies Varies Varies Varies 1 n/a 0 0 0 0 0 0 0 0 0
CT myelography complete spine Usually not appropriate ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI spine area of interest with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 6: Child. Back pain associated with suspected inflammation, infection, or malignancy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI complete spine without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
Radiography complete spine Usually appropriate ☢☢☢ 0.3-3 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without IV contrast May be appropriate Varies Varies Varies Varies 5 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Tc-99m bone scan whole body with SPECT complete spine May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest with IV contrast Usually not appropriate Varies Varies Varies Varies 3 n/a 0 0 0 0 0 0 0 0 0
MRI complete spine with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
CT spine area of interest without and with IV contrast Usually not appropriate Varies Varies Varies Varies 2 n/a 0 0 0 0 0 0 0 0 0
CT myelography complete spine Usually not appropriate ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.