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Appropriateness Criteria

Variant 1: Child. Hematemesis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest May be appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 6 6 0 1 0 3 3 5 3 0 1
Radiography abdomen May be appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 6 6 0 1 0 3 3 5 3 0 1
CTA abdomen without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 1 1 2 7 4 0 1 0 0
US abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 1 1 6 5 1 0 0 1 0
MRA abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 3 3 2 0 0 0 0 0
References Study Quality
32 (28668417) 2
MRA chest abdomen pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 3 4 2 0 0 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 4 7 1 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 5 0 0 0 0 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 1 2 3 0 2 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 1 4 0 1 1 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 2 1 0 0 0 0 0
CTA abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 2 8 3 1 1 0 0 0
CTA chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 1 5 3 1 0 1 0 0
CTA chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 1 6 2 4 0 0 1 0
RBC scan abdomen and pelvis Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 4 1 5 3 0 2 0 0 0
RBC scan with SPECT or SPECT/CT abdomen and pelvis Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 2 1 6 3 1 2 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 1 4 0 1 1 1 0 0
CT chest abdomen pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 4 6 2 0 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 7 2 2 1 1 2 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 4 3 0 0 0 0 0 0
Variant 2: Child. Suspected GI bleed. Melena, or bright red blood per rectum, or positive fecal occult blood test. Stable patient. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography abdomen Usually appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 7 7 0 1 0 0 1 4 8 2 0
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 6 5 1 1 1
References Study Quality
23 (30549276) 4
Pertechnetate scan abdomen and pelvis May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 1 0 0 1 2 10 1 0
References Study Quality
26 (29103471) 4
21 (18353059) 4
Pertechnetate scan with SPECT or SPECT/CT abdomen and pelvis May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 1 1 0 2 4 6 1 0
References Study Quality
26 (29103471) 4
21 (18353059) 4
RBC scan abdomen and pelvis May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 1 1 3 4 4 2 0 0
RBC scan with SPECT or SPECT/CT abdomen and pelvis May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 1 1 4 4 5 0 0 0
CTA abdomen and pelvis with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 1 2 1 2 2 3 5 0 0
CTA abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 1 1 2 2 2 4 4 0 0
MRA abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 2 3 3 2 0 0 0 0
References Study Quality
32 (28668417) 2
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 6 4 1 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 4 5 0 0 0 0 1 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 2 10 2 0 0 0 0 0
Variant 3: Child. Suspected GI bleed. Melena, or bright red blood per rectum, or positive fecal occult blood test. Stable patient. Initial imaging negative. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Pertechnetate scan abdomen and pelvis Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 1 1 1 3 6 2 1
References Study Quality
26 (29103471) 4
21 (18353059) 4
Pertechnetate scan with SPECT or SPECT/CT abdomen and pelvis Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 0 1 1 1 3 5 3 1
References Study Quality
26 (29103471) 4
21 (18353059) 4
RBC scan abdomen and pelvis Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 1 0 0 0 6 9 0 0
RBC scan with SPECT or SPECT/CT abdomen and pelvis Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 7 7 0 1 0 1 0 5 9 0 0
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 1 1 4 8 0 1 0
References Study Quality
23 (30549276) 4
Arteriography visceral May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 3 4 1 3 1 1 2 1
MR enterography May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 1 5 4 4 1 0 0
References Study Quality
32 (28668417) 2
MRA abdomen and pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 3 3 5 3 0 0 0
References Study Quality
32 (28668417) 2
CT enterography May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 3 1 1 9 2 0 0 0
CTA abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 0 0 1 1 3 4 5 1 0
CTA abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 2 0 3 0 3 8 0 0
Arteriography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv Varies 3 3 5 1 7 0 0 2 0 0 0
Arteriography chest abdomen pelvis Usually not appropriate Expert Consensus Varies Varies 2 2 5 3 6 0 0 1 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 1 11 2 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 6 3 4 0 1 0 0 1 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 3 6 7 0 0 0 0 0 0
Variant 4: Child. Suspected GI bleed. Melena, or bright red blood per rectum, or positive fecal occult blood test. Unstable patient. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA abdomen and pelvis without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 0 0 1 0 2 3 4 5 0
Radiography abdomen May be appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 0 1 0 6 3 4 1 1 0
Arteriography visceral May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 2 0 1 3 6 2 1 1
CTA abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 0 1 0 1 4 4 4 1 1
Arteriography abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv Varies 3 3 2 5 5 2 1 1 0 0 0
Arteriography chest abdomen pelvis Usually not appropriate Expert Consensus Varies Varies 3 3 3 4 6 1 1 1 0 0 0
MRA abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 0 1 2 1 1 0 0 0
References Study Quality
32 (28668417) 2
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 7 2 1 0 1 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 3 3 2 0 0 0 0 0
Pertechnetate scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 4 3 1 1 0 0 0 0
References Study Quality
26 (29103471) 4
21 (18353059) 4
Pertechnetate scan with SPECT or SPECT/CT abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 4 3 1 1 0 0 0 0
References Study Quality
26 (29103471) 4
21 (18353059) 4
RBC scan abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 2 3 1 1 0 0 1 0
RBC scan with SPECT or SPECT/CT abdomen and pelvis Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 2 3 1 1 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] 3 3 5 2 4 3 1 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.