American College of Radiology
ACR Appropriateness Criteria®

Postmenopausal Subacute or Chronic Pelvic Pain

Variant 1: Postmenopausal subacute or chronic pelvic pain, localized to the deep pelvis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 1 0 1 0 0 0 0 4 8
References Study Quality
9 (21419329) 4
10 (17805925) 4
11 (15653583) 4
12 (20722981) 3
13 (17805166) 4
14 (21638034) 2
15 (26441020) 4
16 (28203370) 4
17 (27057579) 4
US duplex Doppler pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 1 7 4
References Study Quality
9 (21419329) 4
10 (17805925) 4
11 (15653583) 4
12 (20722981) 3
15 (26441020) 4
18 (21326577) 4
US pelvis transabdominal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 1 1 0 1 2 3 6
MRI pelvis without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 2 5 4 0 2
References Study Quality
10 (17805925) 4
11 (15653583) 4
15 (26441020) 4
23 (22647749) 4
24 (22231573) 4
25 (-3132600) 4
26 (18718774) 2
27 (21385913) 3
28 (24630150) 4
29 (26562496) 3
30 (20846985) 3
CT abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 8 3 1 1 0
References Study Quality
10 (17805925) 4
18 (21326577) 4
19 (19098213) 4
20 (16644167) 3
21 (17039365) 3
22 (25101988) 3
CT pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 2 4 2 4 1 0 0
References Study Quality
10 (17805925) 4
19 (19098213) 4
20 (16644167) 3
21 (17039365) 3
22 (25101988) 3
23 (22647749) 4
MRI pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 2 3 5 0 1 2 0
References Study Quality
11 (15653583) 4
15 (26441020) 4
23 (22647749) 4
25 (-3132600) 4
26 (18718774) 2
27 (21385913) 3
28 (24630150) 4
29 (26562496) 3
10 (17805925) 4
24 (22231573) 4
30 (20846985) 3
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 2 3 5 0 1 0 0 0
References Study Quality
10 (17805925) 4
18 (21326577) 4
19 (19098213) 4
20 (16644167) 3
21 (17039365) 3
22 (25101988) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 1 4 1 3 2 0 0 0
References Study Quality
10 (17805925) 4
18 (21326577) 4
19 (19098213) 4
20 (16644167) 3
21 (17039365) 3
22 (25101988) 3
CT pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 2 5 2 1 0 0 1 0
References Study Quality
10 (17805925) 4
19 (19098213) 4
20 (16644167) 3
21 (17039365) 3
22 (25101988) 3
23 (22647749) 4
CT pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 1 4 2 2 2 0 0 0
References Study Quality
10 (17805925) 4
19 (19098213) 4
20 (16644167) 3
21 (17039365) 3
22 (25101988) 3
23 (22647749) 4
Radiography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 4 1 0 0 1 0 1 0
Variant 2: Postmenopausal subacute or chronic pelvic pain, clinically suspected pathologies in perineum, vulva, or vagina. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 0 0 7 6
References Study Quality
12 (20722981) 3
US pelvis transabdominal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 0 2 7 4
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 0 1 7 5
References Study Quality
8 (23887963) 4
31 (28164373) 4
MRI pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 2 7 1 1 1
References Study Quality
11 (15653583) 4
24 (22231573) 4
25 (-3132600) 4
32 (19057921) 4
33 (24210437) 4
34 (26485454) 4
35 (18097905) 3
36 (18793996) 4
37 (26231233) 2
MRI pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 1 6 3 2 0 2 0
References Study Quality
11 (15653583) 4
24 (22231573) 4
25 (-3132600) 4
32 (19057921) 4
33 (24210437) 4
34 (26485454) 4
35 (18097905) 3
36 (18793996) 4
37 (26231233) 2
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 6 2 0 1 1 0 1 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 2 2 2 0 1 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 4 5 2 0 2 1 0 0 0
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 6 4 1 0 0 0 0 0
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 3 2 1 1 0 1 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 5 2 0 2 1 0 0 0
Radiography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 8 3 1 1 0 0 0 1 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.