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Appropriateness Criteria

Variant 1: Adult. Acute posttraumatic visual defect. Suspect orbital injury. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT maxillofacial without IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 1 0 0 1 0 2 2 3 9
References Study Quality
30 (26208419) 4
29 (25397707) 4
24 (22964404) 4
20 (25086804) 4
CT orbits without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 0 0 1 0 1 1 2 3 10
References Study Quality
30 (26208419) 4
29 (25397707) 4
24 (22964404) 4
20 (25086804) 4
CT head without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 0 1 2 10 3 1 0 0
References Study Quality
34 (28455003) 4
35 (29503015) 2
Radiography face Usually not appropriate Limited ☢ <0.1 mSv 1 1 13 1 2 0 1 1 0 0 0
References Study Quality
24 (22964404) 4
30 (26208419) 4
Radiography orbit Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 14 0 2 0 1 1 0 0 0
References Study Quality
24 (22964404) 4
30 (26208419) 4
Arteriography cerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 1 0 0 1 0 0 0 0
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 1 0 1 0 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 0 2 0 0 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 1 1 0 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 1 1 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 2 0 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 1 1 0 0 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 2 1 0 1 1 0 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 2 0 0 1 1 0 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 2 1 1 1 0 0 0
MRI orbits with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 0 4 0 0 1 1 0 0
MRI orbits without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 0 1 1 1 1 0 0 1
MRI orbits without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 6 2 7 3 0 0 0 0 0
References Study Quality
13 (25086805) 4
27 (25882280) 2
29 (25397707) 4
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 11 0 4 1 1 1 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 0 3 0 1 1 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 2 1 1 1 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 0 4 0 1 1 0 0 0
CT orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 1 3 2 0 1 0 1 0
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 1 1 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 12 2 1 0 1 1 1 0 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 4 0 0 1 1 0 0 0
Variant 2: Adult. Acute vision loss. Infection or inflammatory disorder suspected. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 2 3 12
References Study Quality
12 (30310941) 4
35 (29503015) 2
38 (18842758) 4
CT maxillofacial with IV contrast Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 1 0 0 0 1 1 15
References Study Quality
12 (30310941) 4
37 (18936033) 4
39 (23053380) 4
CT orbits with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 1 0 2 3 2 9
References Study Quality
12 (30310941) 4
37 (18936033) 4
39 (23053380) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 8 7 2 0 0
References Study Quality
44 (27010526) 2
41 (30978149) 4
CT orbits without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 3 2 3 4 4 1 1 0 0
References Study Quality
40 (36830848) 4
Arteriography cerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 1 0 0 0 0
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 1 0 1 1 0 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 1 0 0 1 1 0 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 2 0 0 1 0 0 0
MRA head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 3 2 2 0 1 0 0 0
References Study Quality
42 (30115678) 2
41 (30978149) 4
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 2 0 0 0
MRA head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 1 2 0 1 0 0 0
References Study Quality
41 (30978149) 4
42 (30115678) 2
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 2 0 0 0 2 0 0
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 1 3 1 0 2 0 0 0
MRI orbits with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 1 2 0 0 1 1 0
MRI orbits without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 8 0 6 2 1 1 0 0 0
References Study Quality
12 (30310941) 4
MRV head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 2 4 0 0 0 0 0 0
References Study Quality
44 (27010526) 2
MRV head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 2 1 0 1 1 0 0 0
References Study Quality
45 (32154332) 4
MRV head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 13 3 1 0 0 0 1 0 0
References Study Quality
45 (32154332) 4
CT maxillofacial without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 2 2 9 3 6 0 0 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 1 1 1 2 1 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 2 0 1 1 0 1 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 0 1 2 1 0 1 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 1 1 1 1 0 0 1 0
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 2 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 0 1 1 0 0 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 1 1 1 1 0 0 0
CTV head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 1 0 0 2 0 0 0
Variant 3: Adult. Chronic or progressive unilateral vision loss. Intraorbital mass-like lesion suspected or vascular lesion suspected. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 2 15
References Study Quality
46 (25195185) 4
50 (26518678) 4
MRI head without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 0 1 5 10 1 0 0 0
CT orbits with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 1 1 1 13 2 0 0 0
References Study Quality
48 (24614543) 4
50 (26518678) 4
52 (24108560) 4
Arteriography cerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 1 0 0 1 0 0 0
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 1 1 0 1 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 1 0 0 1
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 1 0 1 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 0 0 1 1 1 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 1 0 1 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 2 0 0 0 0 1 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 1 1 0 0 0 2 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 1 2 0 1 0 0 0
MRI orbits with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 0 3 1 0 0 1 1 0
MRI orbits without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 2 4 0 0 0 0 0 0
References Study Quality
46 (25195185) 4
50 (26518678) 4
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 11 4 1 1 0 1 0 0 0
CT maxillofacial without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 13 1 2 0 0 2 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 0 1 0 0 2 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 3 0 0 0 2 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 0 1 1 1 1 0 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 1 1 0 1 1 0 0 1
CT orbits without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 1 3 0 1 0 0 0 0
References Study Quality
50 (26518678) 4
52 (24108560) 4
CT orbits without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 1 1 0 0 0 0 0 0
References Study Quality
46 (25195185) 4
50 (26518678) 4
52 (24108560) 4
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 1 1 2 1 0 1 0
References Study Quality
48 (24614543) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 0 1 0 0 0
References Study Quality
50 (26518678) 4
53 (31939615) 4
Variant 4: Adult. Acute vision loss, retinal structural abnormality suspected. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 1 0 0 0 0 1
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 1 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 1 0 0 0 0 0 1
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 1 1 0 0 1 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 0 1 2 0 0 1 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 1 1 0 0 1 0
MRI orbits with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 1 0 0 0 0 0 0
MRI orbits without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 2 1 2 1 0 0 0 0
References Study Quality
56 (28506603) 4
MRI orbits without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 0 1 1 1 2 0 0 0
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 1 0 0 2 0 0 0 0
CT maxillofacial without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 1 0 1 1 0 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 1 0 0 1 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 1 0 0 0 0 0 1 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 0 1 0 1 1 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 1 0 1 0 0 1 0 0
CT orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 0 0 1 2 0 0 0
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 0 1 1 0 0 1 0 0
CT orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 0 1 1 1 1 0 0 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 1 0 0 0 1 0
Variant 5: Adult. Acute or chronic vision loss, optic nerve abnormality suspected. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI orbits without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 2 15
References Study Quality
72 (11545635) 4
71 (35439224) 4
70 (29683029) 4
69 (31756609) 2
64 (33584521) 4
63 (33766824) 4
62 (35091465) 4
60 (36062458) 4
52 (24108560) 4
75 (34851430) 4
74 (28495949) 3
73 (29563953) 4
68 (34281903) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 14 3 0 0 0
References Study Quality
68 (34281903) 4
67 (33737263) 3
66 (36017841) 2
65 (31435862) 4
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 0 0 1 0 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 2 0 0 0 1 0 0 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 2 0 0 1 0 0 0 0
MRA head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 0 1 0 0 0 0
MRA head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 1 1 0 0 0
MRA head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 1 1 0 0 0
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 2 0 0 0 2 0 0
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 9 0 3 2 3 1 0 0 0
References Study Quality
69 (31756609) 2
MRI orbits with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 1 0 0 0 0
MRI orbits without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 1 2 1 2 1 0 0 0
References Study Quality
74 (28495949) 3
73 (29563953) 4
72 (11545635) 4
64 (33584521) 4
62 (35091465) 4
60 (36062458) 4
52 (24108560) 4
CT maxillofacial with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 0 1 0 0 1 1 0 0
CT maxillofacial without IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 1 1 0 0 1 0 0 0
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 1 1 0 1 0 1 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 1 0 0 1 1 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 0 1 1 0 0 1 0 0
CT maxillofacial without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 1 1 0 0 1 0 1 0
CT orbits with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 2 1 0 0 0 0 0 0
References Study Quality
52 (24108560) 4
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 1 1 0 0 0 0 0 0
CT orbits without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 2 3 3 1 1 0 0 0
References Study Quality
52 (24108560) 4
CTA head and neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 1 0 0 1 0 0 0
CTA head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 1 0 0 0 1 0 0 0
Variant 6: Adult. Bitemporal hemianopia or junctional scotoma. Sellar or parasellar mass suspected. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI sella without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 1 17
References Study Quality
78 (25248586) 4
79 (36799985) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 9 6 0 1 1
References Study Quality
79 (36799985) 4
Arteriography cerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 2 0 1 0 0 0 0
MRA head and neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 3 0 0 0 0 0 0
MRA head and neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 3 0 0 0 0 0 0
MRA head and neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 3 0 0 0 0 0 0
MRA head with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 0 4 1 3 0 0 0 0
References Study Quality
76 (23891029) 4
80 (24103356) 4
MRA head without and with IV contrast Usually not appropriate Moderate O 0 mSv O 0 mSv [ped] 1 1 12 0 4 1 1 0 0 0 0
References Study Quality
76 (23891029) 4
80 (24103356) 4
81 (28887618) Good
MRA head without IV contrast Usually not appropriate Moderate O 0 mSv O 0 mSv [ped] 1 1 10 0 4 1 3 0 0 0 0
References Study Quality
76 (23891029) 4
80 (24103356) 4
81 (28887618) Good
MRI head with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 2 0 0 0 0 0 0 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 1 0 1 0 0 0 0
MRI orbits with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 1 1 0 1 0 1 0
MRI orbits without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 1 1 0 1 0 1 0
MRI orbits without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 2 0 0 1 1 0 0
MRI sella with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 2 0 1 0 0 0 0
MRI sella without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 2 4 0 1 0 1 0 0
References Study Quality
62 (35091465) 4
79 (36799985) 4
CT head with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 16 0 0 2 0 0 0 0 0
CT head without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 1 0 1 1 0 0 0
CT head without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 0 1 0 0 0 1 1 0
CT orbits with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 0 1 0 1 1 0 0 0
CT orbits without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 0 1 1 0 1 1 0 0
CT orbits without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 0 1 1 1 0 0 0 0
CT sella with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 2 4 0 0 0 0 0 0
CT sella without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 2 0 0 0 0 0 0
CT sella without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 9 2 2 2 1 1 1 0 0
References Study Quality
2 (22284056) 4
79 (36799985) 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 1 0 0 0
CTA head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 1 3 1 3 1 0 0 0
References Study Quality
76 (23891029) 4
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.