Variant 1: Adult. Penetrating trauma, abdomen and pelvis. Suspected upper urinary tract trauma. 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] | 7 | 7 | 0 | 0 | 0 | 0 | 0 | 1 | 7 | 1 | 4 | ||||||||||||||||||||
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| CTU without and with IV contrast | Usually appropriate | Limited | ☢☢☢☢ 10-30 mSv | ☢☢☢☢☢ 10-30 mSv [ped] | 9 | 9 | 0 | 0 | 0 | 0 | 1 | 1 | 2 | 2 | 7 | ||||||||||||||||||||
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| CT abdomen and pelvis without IV contrast | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 4 | 4 | 0 | 1 | 4 | 2 | 5 | 0 | 1 | 0 | 0 | ||||||||||||||||||||
| CT abdomen and pelvis without and with IV contrast | May be appropriate | Limited | ☢☢☢☢ 10-30 mSv | ☢☢☢☢☢ 10-30 mSv [ped] | 5 | 5 | 1 | 0 | 3 | 2 | 4 | 3 | 1 | 0 | 0 | ||||||||||||||||||||
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| US kidneys and bladder retroperitoneal | Usually not appropriate | Expert Consensus | O 0 mSv | O 0 mSv [ped] | 3 | 3 | 2 | 1 | 7 | 1 | 0 | 1 | 0 | 1 | 0 | ||||||||||||||||||||
| Radiography intravenous urography | Usually not appropriate | Expert Consensus | ☢☢☢ 1-10 mSv | ☢☢☢ 0.3-3 mSv [ped] | 3 | 3 | 2 | 3 | 2 | 4 | 0 | 2 | 0 | 0 | 0 | ||||||||||||||||||||
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| MRI abdomen and pelvis without and with IV contrast | Usually not appropriate | Limited | O 0 mSv | O 0 mSv [ped] | 3 | 3 | 3 | 2 | 5 | 2 | 0 | 0 | 0 | 1 | 0 | ||||||||||||||||||||
| MRI abdomen and pelvis without IV contrast | Usually not appropriate | Limited | O 0 mSv | O 0 mSv [ped] | 3 | 3 | 3 | 3 | 4 | 2 | 0 | 0 | 0 | 1 | 0 | ||||||||||||||||||||
| MRI abdomen without and with IV contrast | Usually not appropriate | Limited | O 0 mSv | O 0 mSv [ped] | 3 | 3 | 4 | 2 | 4 | 2 | 0 | 0 | 0 | 1 | 0 | ||||||||||||||||||||
| MRI abdomen without IV contrast | Usually not appropriate | Limited | O 0 mSv | O 0 mSv [ped] | 2 | 2 | 4 | 3 | 4 | 1 | 0 | 1 | 0 | 0 | 0 | ||||||||||||||||||||
| MRU without and with IV contrast | Usually not appropriate | Limited | O 0 mSv | O 0 mSv [ped] | 2 | 2 | 2 | 7 | 4 | 1 | 0 | 0 | 0 | 0 | 0 | ||||||||||||||||||||
| MRU without IV contrast | Usually not appropriate | Limited | O 0 mSv | O 0 mSv [ped] | 2 | 2 | 5 | 6 | 2 | 1 | 0 | 0 | 0 | 0 | 0 | ||||||||||||||||||||
Variant 2: Adult. Penetrating trauma, lower abdomen and pelvis. Suspected lower urinary tract trauma. Initial imaging.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||||||||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||||||||||||||||||||||
| Fluoroscopy retrograde urethrography | Usually appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢ 0.3-3 mSv [ped] | 8 | 8 | 1 | 0 | 0 | 0 | 2 | 1 | 2 | 1 | 6 | ||||||||||||||||||||
| CT abdomen and pelvis with IV contrast | Usually appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 7 | 7 | 0 | 0 | 0 | 1 | 3 | 1 | 6 | 0 | 2 | ||||||||||||||||||||
| CT pelvis with bladder contrast (CT cystography) | Usually appropriate | Limited | ☢☢☢☢ 10-30 mSv | ☢☢☢☢ 3-10 mSv [ped] | 8 | 8 | 0 | 0 | 0 | 0 | 2 | 1 | 2 | 2 | 6 | ||||||||||||||||||||
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| Fluoroscopy voiding cystourethrography | May be appropriate (Disagreement) | Expert Opinion | ☢☢ 0.1-1mSv | ☢☢ 0.03-0.3 mSv [ped] | 5 | 5 | 1 | 1 | 1 | 2 | 5 | 2 | 2 | 0 | 0 | ||||||||||||||||||||
| Fluoroscopy retrograde cystography | May be appropriate (Disagreement) | Expert Opinion | ☢☢☢ 1-10 mSv | 5 | 5 | 1 | 0 | 1 | 3 | 2 | 3 | 2 | 1 | 1 | |||||||||||||||||||||
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| CT abdomen and pelvis without IV contrast | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 4 | 4 | 0 | 1 | 5 | 3 | 2 | 1 | 0 | 1 | 0 | ||||||||||||||||||||
| CT pelvis with IV contrast | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 5 | 5 | 1 | 0 | 1 | 3 | 6 | 2 | 1 | 0 | 0 | ||||||||||||||||||||
| CT pelvis without IV contrast | May be appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢☢ 3-10 mSv [ped] | 4 | 4 | 0 | 1 | 4 | 5 | 1 | 1 | 1 | 0 | 0 | ||||||||||||||||||||
| CT 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 | 3 | 2 | 4 | 3 | 0 | 0 | 0 | ||||||||||||||||||||
| CT pelvis without and with IV contrast | May be appropriate | Expert Consensus | ☢☢☢☢ 10-30 mSv | ☢☢☢☢ 3-10 mSv [ped] | 4 | 4 | 0 | 1 | 6 | 2 | 4 | 1 | 0 | 0 | 0 | ||||||||||||||||||||
| CTU without and with IV contrast | May be appropriate (Disagreement) | Expert Opinion | ☢☢☢☢ 10-30 mSv | ☢☢☢☢☢ 10-30 mSv [ped] | 5 | 5 | 0 | 1 | 2 | 0 | 2 | 7 | 2 | 0 | 0 | ||||||||||||||||||||
| US pelvis (bladder and urethra) | Usually not appropriate | Expert Consensus | O 0 mSv | O 0 mSv [ped] | 3 | 3 | 1 | 2 | 4 | 2 | 2 | 1 | 1 | 0 | 0 | ||||||||||||||||||||
| Radiography intravenous urography | Usually not appropriate | Limited | ☢☢☢ 1-10 mSv | ☢☢☢ 0.3-3 mSv [ped] | 1 | 1 | 8 | 5 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | ||||||||||||||||||||
| MRI abdomen and pelvis without and with IV contrast | Usually not appropriate | Expert Consensus | O 0 mSv | O 0 mSv [ped] | 2 | 2 | 2 | 5 | 3 | 2 | 0 | 0 | 1 | 0 | 0 | ||||||||||||||||||||
| MRI abdomen and pelvis without IV contrast | Usually not appropriate | Expert Consensus | O 0 mSv | O 0 mSv [ped] | 2 | 2 | 3 | 5 | 2 | 2 | 0 | 0 | 0 | 1 | 0 | ||||||||||||||||||||
| MRI pelvis without and with IV contrast | Usually not appropriate | Limited | O 0 mSv | O 0 mSv [ped] | 3 | 3 | 2 | 3 | 4 | 2 | 1 | 0 | 1 | 0 | 0 | ||||||||||||||||||||
| MRI pelvis without IV contrast | Usually not appropriate | Limited | O 0 mSv | O 0 mSv [ped] | 3 | 3 | 3 | 3 | 4 | 2 | 0 | 0 | 1 | 0 | 0 | ||||||||||||||||||||
| MRU without and with IV contrast | Usually not appropriate | Limited | O 0 mSv | O 0 mSv [ped] | 2 | 2 | 4 | 4 | 3 | 3 | 0 | 0 | 0 | 0 | 0 | ||||||||||||||||||||
| MRU without IV contrast | Usually not appropriate | Limited | O 0 mSv | O 0 mSv [ped] | 2 | 2 | 5 | 5 | 1 | 3 | 0 | 0 | 0 | 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.