American College of Radiology
ACR Appropriateness Criteria®

Growth Disturbances–Risk of Fetal Growth Restriction

Variant 1: Growth disturbance. Low risk for fetal growth restriction. Initial evaluation.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pregnant uterus transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 0 0 2 9
References Study Quality
26 (26031399) 3
US pregnant uterus biophysical profile Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 0 4 4 2 3 0 0 0 0
References Study Quality
27 (2404302) 4
US duplex Doppler velocimetry fetal umbilical artery Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 3 5 0 0 1 0 0 0
References Study Quality
31 (2178428) 3
US duplex Doppler velocimetry maternal uterine artery Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 4 4 0 1 1 0 0 0
References Study Quality
28 (26112630) 3
29 (28712949) 3
30 (24277892) 3
US duplex Doppler velocimetry ductus venosus Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 5 2 0 0 0 0 0 0
US duplex Doppler velocimetry fetal middle cerebral artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 6 2 0 0 0 0 0 0
Variant 2: Growth disturbance. High risk for fetal growth restriction. Initial evaluation.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pregnant uterus transabdominal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 2 10
US pregnant uterus biophysical profile Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 3 2 3 4 1
References Study Quality
18 (16319247) 3
27 (2404302) 4
32 (-3130664) 4
US duplex Doppler velocimetry fetal umbilical artery Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 3 6 2 0
References Study Quality
35 (7755042) M
US duplex Doppler velocimetry ductus venosus May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 9 3 0 0 0
References Study Quality
19 (17267821) 3
US duplex Doppler velocimetry maternal uterine artery May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 1 0 5 4 0 1 0
References Study Quality
33 (25810352) 3
34 (25346413) 2
US duplex Doppler velocimetry fetal middle cerebral artery Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 2 6 2 0 1 0 1 0 0
Variant 3: Established fetal growth restriction. Follow-up evaluation.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pregnant uterus biophysical profile Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 0 2 9
References Study Quality
25 (24931475) 3
32 (-3130664) 4
US pregnant uterus transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 1 11
References Study Quality
1 (24785859) 4
8 (24839087) 4
11 (23635765) 4
US duplex Doppler velocimetry fetal umbilical artery Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 1 2 4 5
References Study Quality
9 (15302194) 1
18 (16319247) 3
37 (24635223) 3
38 (25603682) 3
39 (25068564) 3
40 (23999424) 3
41 (25754212) 4
42 (25545442) 3
43 (25751217) 4
44 (28032647) 2
45 (23585420) 2
US duplex Doppler velocimetry ductus venosus Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 3 4 3 2
References Study Quality
18 (16319247) 3
44 (28032647) 2
47 (25747582) 2
48 (28938063) 4
49 (27854382) 4
US duplex Doppler velocimetry fetal middle cerebral artery Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 3 2 4 0 2
References Study Quality
25 (24931475) 3
40 (23999424) 3
US duplex Doppler velocimetry maternal uterine artery May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 1 5 4 1 1 0
References Study Quality
23 (25098960) 4
36 (25358519) 2
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.