Variant 1: Adult. Epigastric pain as acute or new symptoms. Suspected upper gastrointestinal tract source. Initial imaging.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| CT abdomen and pelvis with IV contrast | Usually appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 8 | 8 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 6 | 5 |
| CT abdomen with IV contrast | Usually appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 8 | 8 | 0 | 0 | 0 | 0 | 0 | 0 | 6 | 4 | 3 |
| CT chest without and with IV contrast | Usually appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 7 | 7 | 0 | 0 | 1 | 0 | 0 | 0 | 11 | 2 | 0 |
| CT chest and abdomen with IV contrast | Usually appropriate | Limited | ☢☢☢☢ 10-30 mSv | 8 | 8 | 0 | 0 | 1 | 0 | 0 | 1 | 4 | 7 | 0 | |
| Fluoroscopy single-contrast esophagram | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢ 0.3-3 mSv [ped] | 4 | 4 | 1 | 3 | 2 | 2 | 5 | 1 | 0 | 0 | 0 |
| Fluoroscopy upper GI series | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢ 0.3-3 mSv [ped] | 5 | 5 | 1 | 0 | 0 | 1 | 10 | 2 | 0 | 0 | 0 |
| Radiography chest abdomen pelvis | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢ 0.3-3 mSv [ped] | 5 | 5 | 1 | 0 | 2 | 1 | 5 | 5 | 0 | 0 | 0 |
| Radiography chest abdomen pelvis | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢ 0.3-3 mSv [ped] | 5 | n/a | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| CT abdomen without IV contrast | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 5 | 5 | 0 | 2 | 1 | 4 | 6 | 1 | 0 | 0 | 0 |
| CT chest with IV contrast | May be appropriate (Disagreement) | Expert Opinion | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 5 | 5 | 0 | 0 | 2 | 0 | 1 | 1 | 5 | 5 | 0 |
| CT chest without IV contrast | May be appropriate (Disagreement) | Expert Opinion | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 5 | 5 | 0 | 1 | 1 | 1 | 0 | 4 | 6 | 1 | 0 |
| CT chest and abdomen without and with IV contrast | May be appropriate (Disagreement) | Expert Opinion | ☢☢☢☢ 10-30 mSv | 5 | 5 | 3 | 3 | 2 | 0 | 2 | 1 | 1 | 2 | 0 | |
| CT chest and abdomen without IV contrast | May be appropriate | Limited | ☢☢☢☢ 10-30 mSv | 5 | 5 | 0 | 0 | 1 | 1 | 11 | 1 | 0 | 0 | 0 | |
| Fluoroscopy biphasic esophagram | Usually not appropriate | Limited | ☢☢☢ 1-10 mSv | 2 | 2 | 7 | 4 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | |
| CT abdomen and pelvis without IV contrast | Usually not appropriate | Expert Consensus | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 2 | 2 | 5 | 3 | 3 | 0 | 2 | 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 | 7 | 2 | 4 | 1 | 0 | 0 | 0 | 0 | 0 |
| CT abdomen without and with IV contrast | Usually not appropriate | Expert Consensus | ☢☢☢☢ 10-30 mSv | ☢☢☢☢☢ 10-30 mSv [ped] | 2 | 2 | 6 | 1 | 2 | 2 | 0 | 1 | 1 | 0 | 0 |
Variant 2: Adult. Epigastric pain with known or suspected chronic symptoms of upper gastrointestinal tract inflammatory or infectious etiology. Initial imaging.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| Fluoroscopy biphasic esophagram | Usually appropriate | Limited | ☢☢☢ 1-10 mSv | 8 | 8 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 11 | 3 | |
| Fluoroscopy upper GI series | Usually appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢ 0.3-3 mSv [ped] | 8 | 8 | 0 | 0 | 0 | 0 | 0 | 0 | 4 | 8 | 2 |
| Fluoroscopy single-contrast esophagram | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢ 0.3-3 mSv [ped] | 6 | 6 | 0 | 1 | 0 | 0 | 1 | 5 | 4 | 2 | 0 |
| CT abdomen and pelvis with IV contrast | May be appropriate (Disagreement) | Expert Opinion | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 5 | 5 | 0 | 0 | 1 | 2 | 8 | 0 | 1 | 1 | 1 |
| CT abdomen with IV contrast | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 5 | 5 | 0 | 0 | 1 | 2 | 8 | 2 | 0 | 0 | 1 |
| CT abdomen without IV contrast | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 5 | 5 | 1 | 2 | 1 | 3 | 7 | 0 | 0 | 0 | 0 |
| CT chest and abdomen with IV contrast | May be appropriate | Limited | ☢☢☢☢ 10-30 mSv | 5 | 5 | 0 | 0 | 1 | 2 | 8 | 0 | 2 | 1 | 0 | |
| CT abdomen and pelvis without IV contrast | Usually not appropriate | Expert Consensus | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 2 | 2 | 6 | 6 | 1 | 0 | 1 | 0 | 0 | 0 | 0 |
| CT chest with IV contrast | Usually not appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 3 | 3 | 1 | 2 | 4 | 2 | 2 | 1 | 1 | 0 | 0 |
| CT chest without and with IV contrast | Usually not appropriate | Expert Consensus | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 2 | 2 | 6 | 3 | 3 | 0 | 0 | 1 | 0 | 0 | 0 |
| CT chest without IV contrast | Usually not appropriate | Expert Consensus | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 1 | 1 | 7 | 3 | 1 | 2 | 0 | 0 | 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 | 6 | 3 | 2 | 1 | 0 | 0 | 0 | 1 | 0 |
| CT abdomen without and with IV contrast | Usually not appropriate | Expert Consensus | ☢☢☢☢ 10-30 mSv | ☢☢☢☢☢ 10-30 mSv [ped] | 1 | 1 | 8 | 4 | 2 | 0 | 0 | 0 | 0 | 0 | 0 |
| CT chest and abdomen without and with IV contrast | Usually not appropriate | Expert Consensus | ☢☢☢☢ 10-30 mSv | 2 | 2 | 5 | 4 | 1 | 1 | 0 | 1 | 1 | 0 | 0 | |
| CT chest and abdomen without IV contrast | Usually not appropriate | Expert Consensus | ☢☢☢☢ 10-30 mSv | 2 | 2 | 6 | 2 | 1 | 2 | 1 | 0 | 1 | 0 | 0 | |
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.