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Appropriateness Criteria

Variant 1: Child or adult. Repaired tetralogy of Fallot or pulmonary valve stenosis with concern for pulmonary valve dysfunction or branch pulmonary artery stenosis. Incomplete or inadequate assessment of cardiovascular morphology and function after transthoracic echocardiography. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 7 7 0 0 0 2 3 3 9 4 0
References Study Quality
9 (18377431) 4
MRA chest without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 5 2 3 6 7
MRI heart function and morphology without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 1 0 3 8 10
References Study Quality
17 (33022183) 3
16 (32653300) 4
15 (7677083) 3
MRI heart function and morphology without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 2 4 10 5
References Study Quality
17 (33022183) 3
16 (32653300) 4
15 (7677083) 3
CTA chest with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 5 2 9 6 0
CT heart function and morphology with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 2 4 7 5 5
References Study Quality
14 (26679548) 4
13 (26272851) 4
US echocardiography transesophageal May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 1 6 8 5 0 0 0
References Study Quality
6 (22790360) 3
12 (24468055) 4
18 (15975339) 3
Arteriography coronary with ventriculography May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 17 2 0 0 0
References Study Quality
11 (20837914) 1
10 (16638542) 4
9 (18377431) 4
Arteriography pulmonary May be appropriate Limited ☢☢☢☢ 10-30 mSv 5 5 0 0 0 5 12 4 0 0 0
References Study Quality
12 (24468055) 4
MRA chest without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 1 0 0 2 6 5 5 3 1
CTA coronary arteries with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 5 4 8 2 0
Perfusion scan lung May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 1 0 2 7 6 4 0 2
References Study Quality
12 (24468055) 4
MRA abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 21 1 1 0 0 0 0 0 0
MRA abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 21 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 20 1 2 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 20 1 2 0 0 0 0 0 0
MRI heart function with stress without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 6 3 3 2 0 0 0 1
MRI heart function with stress without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 7 3 4 1 0 0 0 0
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 4 2 0 0 0 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 7 5 8 1 0 0 0 0 0
Variant 2: Child or adult. Transposition of the great arteries after atrial switch. Incomplete or inadequate assessment of cardiovascular morphology and function after transthoracic echocardiography. 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 chest without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 1 0 1 0 2 3 3 8 4
MRA chest without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 1 1 9 9 0
MRI heart function and morphology without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 1 0 2 5 13
References Study Quality
22 (15851616) 3
MRI heart function and morphology without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 1 0 5 9 6
References Study Quality
22 (15851616) 3
CTA chest with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 1 1 3 5 8 3 0
CT heart function and morphology with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 3 3 7 4 4
US echocardiography transesophageal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 1 0 3 8 7 2 0 0
Radiography chest May be appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 1 0 4 14 2 0 0 0
Arteriography pulmonary May be appropriate Limited ☢☢☢☢ 10-30 mSv 4 4 1 1 3 7 4 5 1 0 0
References Study Quality
21 (27372954) 4
CTA coronary arteries with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 2 0 7 8 3 1 0 0
Arteriography coronary with ventriculography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 6 6 0 0 0 0 0 0
References Study Quality
21 (27372954) 4
MRA abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 21 0 0 0 0 0 1 0 0
MRA abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 21 0 0 0 0 0 1 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 0 2 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 20 0 2 0 0 0 0 0 0
MRI heart function with stress without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 6 6 1 0 0 0 0 0
MRI heart function with stress without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 8 5 0 0 0 0 0 0
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 2 3 0 0 0 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 3 3 0 0 0 1 0 0
Variant 3: Child or adult. Transposition of the great arteries after arterial switch. Incomplete or inadequate assessment of cardiovascular morphology and function after transthoracic echocardiography. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest Usually appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 7 7 0 0 1 2 5 1 10 1 0
MRA chest without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 3 3 4 6 5
MRA chest without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 1 0 1 3 5 5 5 2
MRI heart function and morphology without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 1 2 0 1 5 13
References Study Quality
28 (29748700) 3
27 (20452235) 2
26 (15591430) 2
21 (27372954) 4
MRI heart function and morphology without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 3 0 4 9 6
References Study Quality
28 (29748700) 3
27 (20452235) 2
26 (15591430) 2
21 (27372954) 4
MRI heart function with stress without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 4 3 7 4 0
References Study Quality
29 (20416135) 4
28 (29748700) 3
26 (15591430) 2
CTA chest with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 0 0 5 4 9 3 0
CT heart function and morphology with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 3 3 7 5 3
MRI heart function with stress without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 2 1 6 3 6 2 0
References Study Quality
29 (20416135) 4
28 (29748700) 3
26 (15591430) 2
CTA coronary arteries with IV contrast May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 6 8 4 2 0
References Study Quality
19 (28632651) 4
25 (19356445) 2
24 (29090351) 3
23 (33028389) Good
SPECT or SPECT/CT MPI rest and stress May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 0 2 2 12 3 1 0 0
References Study Quality
30 (31119712) 4
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 2 5 3 4 2 0 0 0
Arteriography coronary with ventriculography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 2 6 4 2 2 0 0 0
References Study Quality
21 (27372954) 4
Arteriography pulmonary Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 3 3 7 2 4 1 0 0 0
MRA abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 0 1 0 0 0 1 0 0
MRA abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 0 1 0 0 0 1 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 1 2 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 19 1 2 0 0 0 0 0 0
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 8 2 2 1 7 1 1 0 0
Variant 4: Child. Suspected or confirmed congenital or acquired coronary artery abnormality. Incomplete or inadequate assessment of coronary morphology after transthoracic echocardiography. 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 chest without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 5 9 4 0
References Study Quality
38 (21921132) 2
37 (34540764) 3
36 (31371063) 3
MRA chest without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 1 5 9 4 0
References Study Quality
38 (21921132) 2
37 (34540764) 3
36 (31371063) 3
MRI heart function and morphology without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 4 5 8 3 0
MRI heart function and morphology without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 5 4 7 3 0
CTA coronary arteries with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 1 0 0 4 17
References Study Quality
35 (33755749) 2
Arteriography coronary with ventriculography May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 3 7 4 1 5
References Study Quality
33 (33614558) 2
MRA abdomen without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 2 0 1 5 9 3 0 0 0
MRI heart function with stress without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 9 7 2 2 0
References Study Quality
36 (31371063) 3
39 (32069111) 2
MRI heart function with stress without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 0 13 5 0 1 0
References Study Quality
36 (31371063) 3
39 (32069111) 2
CTA chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 1 7 1 4 7 0 0 1
References Study Quality
34 (28356445) 4
CT heart function and morphology with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 10 6 1 1 1
SPECT or SPECT/CT MPI rest and stress May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 0 2 1 4 3 8 2 0
References Study Quality
40 (28385257) 4
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 0 10 1 4 1 1 0 0
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 11 6 2 0 1 0 0 0 0
Arteriography pulmonary Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 12 5 2 1 0 0 2 0 0
MRA abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 9 2 2 3 4 1 1 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 2 1 0 2 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 1 2 1 0 1 0 0 0
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 5 1 0 1 1 0 1 0
Variant 5: Child. Known single ventricle physiology. Preoperative evaluation for stage 2 single ventricle palliation. Incomplete or inadequate assessment of cardiovascular morphology and function after transthoracic echocardiography. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Arteriography coronary with ventriculography Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 0 11 8 1
References Study Quality
41 (26356648) 4
42 (19616678) 2
Arteriography pulmonary Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 0 0 2 0 6 1 6 6 1
References Study Quality
41 (26356648) 4
MRA chest without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 6 10 4
MRA chest without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 1 11 5 2
MRI heart function and morphology without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 1 1 0 2 9 8
References Study Quality
42 (19616678) 2
MRI heart function and morphology without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 2 1 4 8 6
References Study Quality
42 (19616678) 2
CTA chest with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 5 5 7 4 1
References Study Quality
44 (33078501) 2
CT heart function and morphology with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 5 2 4 5 4
References Study Quality
43 (24930614) 4
US echocardiography transesophageal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 0 0 2 8 9 0 0 0
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 3 3 3 4 5 1 7 0 0 1 1
MRA abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 0 1 0 0 0 0 1 0
MRA abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 0 1 0 0 0 0 1 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 0 1 0 0 1 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 0 1 0 0 1 0 0 0
MRI heart function with stress without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 10 7 3 0 0 0 0 0 0
MRI heart function with stress without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 10 9 1 0 0 0 0 0 0
CTA coronary arteries with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 8 4 1 1 0 0 0 0
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 18 2 1 0 0 1 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 16 3 1 0 0 1 1 0 0
Variant 6: Child. Known single ventricle physiology. Preoperative evaluation for stage 3 single ventricle palliation (total cavopulmonary connection). Incomplete or inadequate assessment of cardiovascular morphology and function after transthoracic echocardiography. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Arteriography coronary with ventriculography Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 1 11 7 1
References Study Quality
46 (22077996) 2
45 (19660367) 2
Arteriography pulmonary Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 2 3 10 4 1
MRA chest without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 1 0 1 0 3 5 4 6 2
MRI heart function and morphology without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 2 0 1 0 2 7 10
References Study Quality
50 (24254479) 4
49 (-3194075) 4
MRI heart function and morphology without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 1 2 1 3 8 6
References Study Quality
50 (24254479) 4
49 (-3194075) 4
CTA chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 5 6 8 2 1
References Study Quality
48 (27618316) 4
CT heart function and morphology with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 2 3 9 4 3
References Study Quality
47 (28889811) 3
US echocardiography transesophageal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 9 7 2 0 0
Radiography chest May be appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 1 3 4 10 2 0 0 0
MRA chest without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 8 8 3 0 0
MRA abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 1 1 1 0 0 0 0 1
MRA abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 0 1 1 0 0 0 1 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 1 1 0 0 0 1 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 19 1 1 0 0 0 1 0 0
MRI heart function with stress without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 10 2 5 0 3 0 1 1 0
MRI heart function with stress without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 11 2 4 1 3 0 0 1 0
CTA coronary arteries with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 3 8 2 0 2 0 0 0
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 18 1 3 0 0 0 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 2 2 0 1 1 1 0 0
Variant 7: Child or adult. Known single ventricle physiology. Postoperative evaluation after stage 3 single ventricle palliation (total cavopulmonary connection). Incomplete or inadequate assessment of cardiovascular morphology and function after transthoracic echocardiography. 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 chest without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 1 8 5 4
References Study Quality
52 (-3194076) 4
53 (12234957) 3
MRA chest without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 1 0 5 1 10 3 1
References Study Quality
52 (-3194076) 4
53 (12234957) 3
MRI heart function and morphology without and with IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 2 0 3 4 13
References Study Quality
56 (34934948) 2
55 (-3194077) 4
54 (28548989) 4
53 (12234957) 3
MRI heart function and morphology without IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 2 1 4 8 6
References Study Quality
56 (34934948) 2
55 (-3194077) 4
54 (28548989) 4
53 (12234957) 3
CTA chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 2 8 6 4 2
References Study Quality
48 (27618316) 4
52 (-3194076) 4
53 (12234957) 3
CT heart function and morphology with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 2 7 8 2 2
US echocardiography transesophageal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 6 11 1 0 0
Radiography chest May be appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 4 4 3 2 5 6 4 0 0 1 1
Arteriography coronary with ventriculography May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 10 8 2 0 0
References Study Quality
52 (-3194076) 4
Arteriography pulmonary May be appropriate Limited ☢☢☢☢ 10-30 mSv 5 5 0 0 0 0 13 5 2 0 0
References Study Quality
52 (-3194076) 4
CTA coronary arteries with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 9 8 3 0 0
References Study Quality
52 (-3194076) 4
MRA abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 1 2 0 0 0 0 0 1
MRA abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 2 1 0 0 0 0 1 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 20 0 2 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 20 0 2 0 0 0 0 0 0
MRI heart function with stress without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 0 6 5 3 0 0 1 0
References Study Quality
57 (26917538) 2
58 (20631032) 3
MRI heart function with stress without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 2 7 3 2 0 1 0 0
References Study Quality
57 (26917538) 2
58 (20631032) 3
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 4 1 3 0 0 1 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 10 3 5 4 0 0 0 0 0
Variant 8: Child or adult. Known or suspected anomalous pulmonary venous return with inadequate evaluation after transthoracic echocardiography. 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 chest without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 0 3 7 11
References Study Quality
70 (8126275) 4
69 (19184180) 4
68 (22236895) 4
MRA chest without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 3 4 6 5 3
References Study Quality
70 (8126275) 4
69 (19184180) 4
68 (22236895) 4
MRI heart function and morphology without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 8 6 4
References Study Quality
68 (22236895) 4
71 (12804753) 2
MRI heart function and morphology without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 1 12 5 2
References Study Quality
68 (22236895) 4
71 (12804753) 2
CTA chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 2 6 3 11
References Study Quality
68 (22236895) 4
67 (29550261) 4
66 (19506848) 3
65 (23341089) 2
64 (11044048) 3
MRA abdomen without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 13 3 2 0 0
MRA abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 1 4 10 4 1 0 0
CT heart function and morphology with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 10 6 4 0 0
US echocardiography transesophageal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 3 8 2 1 0 0 0 0
References Study Quality
74 (16238553) 4
73 (9137235) 4
72 (1772706) 4
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 3 3 7 3 4 2 4 0 0 0 0
References Study Quality
65 (23341089) 2
Arteriography coronary with ventriculography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 6 7 2 0 0 0 0 0
References Study Quality
63 (16580428) 4
62 (6235060) 4
61 (16784931) 3
60 (27831520) 4
Arteriography pulmonary Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 6 5 8 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 19 1 2 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 20 0 2 0 0 0 0 0 0
MRI heart function with stress without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 11 3 4 3 1 0 0 0 0
MRI heart function with stress without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 3 5 2 0 0 0 0 0
CTA coronary arteries with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 10 3 4 1 3 1 0 0 0
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 20 0 1 1 0 0 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 18 2 2 0 0 0 0 0 0
Variant 9: Child or adult. Suspected aortic coarctation with inadequate evaluation after transthoracic echocardiography. 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 chest without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 0 1 6 4 10
References Study Quality
82 (21861960) 3
81 (15699283) 3
80 (8489869) 3
79 (25714305) 4
MRA chest without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 0 1 1 3 8 4 4
References Study Quality
82 (21861960) 3
81 (15699283) 3
80 (8489869) 3
79 (25714305) 4
MRI heart function and morphology without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 2 10 6 2
References Study Quality
75 (21947983) 4
MRI heart function and morphology without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 5 9 4 1
References Study Quality
75 (21947983) 4
CTA chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 1 0 4 7 9
References Study Quality
79 (25714305) 4
78 (28377475) 4
77 (14975985) 3
Arteriography coronary with ventriculography May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 2 4 9 4 0 0 0
References Study Quality
76 (7585760) 2
CT heart function and morphology with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 4 3 2 7 3 0 0 0
US echocardiography transesophageal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 7 1 9 2 1 0 0 0 0
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 3 3 7 1 7 2 3 0 0 0 0
Arteriography pulmonary Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 13 5 2 0 0 2 0 0 0
MRA abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 2 1 0 0 0 1 0
MRA abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 1 1 1 0 0 1 0 0
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 3 0 0 0 0 1 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 18 0 3 0 0 0 1 0 0
MRI heart function with stress without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 3 6 0 0 0 0 1 0
MRI heart function with stress without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 2 6 0 0 0 1 0 0
CTA coronary arteries with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 10 3 3 3 2 0 1 0 0
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 18 2 1 1 0 0 0 0 0
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 17 1 4 0 0 0 0 0 0
Variant 10: Child. Known aortopathy or connective tissue disease. Surveillance of the aorta after inadequate or incomplete evaluation by transthoracic echocardiography. 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 abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 0 13 4 1
References Study Quality
86 (20687249) 4
MRA abdomen without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 0 2 12 5 0
References Study Quality
86 (20687249) 4
MRA chest without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 0 0 7 14
References Study Quality
91 (32453278) 2
92 (32531300) 4
93 (32167203) 2
MRA chest without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 2 1 5 7 6
References Study Quality
91 (32453278) 2
92 (32531300) 4
93 (32167203) 2
MRA neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 0 1 11 6 1
References Study Quality
94 (21730308) 2
MRA neck without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 1 12 5 0
References Study Quality
94 (21730308) 2
CTA chest with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 4 3 3 4 8
US echocardiography transesophageal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 4 1 3 8 4 1 0 0 1
MRI heart function and morphology without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 7 8 3 1 0
References Study Quality
97 (20861133) 3
96 (31342116) 3
95 (2913733) 4
MRI heart function and morphology without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 8 6 2 1 0
References Study Quality
97 (20861133) 3
96 (31342116) 3
95 (2913733) 4
CTA coronary arteries with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 8 5 4 0 0
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 3 3 5 3 6 4 2 0 0 0 0
References Study Quality
98 (20591885) 4
Arteriography coronary with ventriculography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 3 5 2 1 1 0 0 0
References Study Quality
89 (27733430) 2
Arteriography pulmonary Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 8 5 4 3 0 1 0 0 1
MRI heart function with stress without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 11 6 5 0 0 0 0 0 0
MRI heart function with stress without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 4 5 0 0 0 0 0 0
CT heart function and morphology with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 4 6 4 4 1 0 0 0
References Study Quality
90 (19375878) 2
FDG-PET/CT heart Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 18 0 2 1 0 0 0 0 1
SPECT or SPECT/CT MPI rest and stress Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 17 2 3 0 0 0 0 0 0
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.