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Appropriateness Criteria

Variant 1: Adult or child 5 years of age or older. Fall or acute twisting trauma to the knee. No focal tenderness, no effusion, able to walk. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography knee May be appropriate Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 0 1 1 10 3 1 1 0
References Study Quality
9 (15769564) 2
10 (8594242) 3
8 (15995467) 4
2 (8536122) 3
3 (7574123) 3
6 (23399332) 1
11 (22636383) 4
1 (29243880) 4
5 (23827289) 2
US knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MR arthrography knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRI knee without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRI knee without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 1 0 0 0
CT knee with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
CT knee without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
CT knee without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
Bone scan with SPECT or SPECT/CT knee Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
Variant 2: Adult or child 5 years of age or older. Fall or acute twisting trauma to the knee. One or more of the following: focal tenderness, effusion, inability to bear weight. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography knee Usually appropriate Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 0 0 0 1 16
References Study Quality
8 (15995467) 4
6 (23399332) 1
5 (23827289) 2
US knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 4 0 0 1 1 0 0 0
MR arthrography knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 1 0 0 0 0 0 0 0
MRI knee without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRI knee without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 0 1 1 1 0 0 1 0
CT knee with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
CT knee without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
CT knee without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 10 4 1 1 1 0 0 0 0
Bone scan with SPECT or SPECT/CT knee Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 1 0 0 0 0 0 0 0
Variant 3: Adult or skeletally mature child. Fall or acute twisting trauma to the knee. No fracture seen on radiographs. Suspect occult fracture or internal derangement. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI knee without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 3 14
References Study Quality
23 (16118171) 1
26 (16861540) 3
21 (23677359) 2
22 (17394470) 4
24 (18795300) 4
20 (23773879) 4
30 (21380741) 2
35 (17483932) 2
36 (12324825) 3
19 (-3093387) 4
25 (29752650) 4
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
27 (27097792) 4
28 (27177438) 3
CT knee without IV contrast May be appropriate Strong ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 6 6 0 0 0 0 3 6 2 1 5
References Study Quality
14 (26025120) 3
17 (20551186) 1
12 (16392612) 3
13 (17136560) 3
16 (23020888) 2
15 (28214478) 4
18 (25816992) 2
US knee Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 13 2 1 0 0 1 0 0 0
References Study Quality
40 (16786321) 2
43 (17678659) 3
44 (21982460) 3
41 (28374066) 4
47 (29466145) Good
49 (27145775) 4
48 (28343806) 4
46 (25916746) Good
42 (25911713) 3
45 (23412237) 2
MR arthrography knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRI knee without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
23 (16118171) 1
26 (16861540) 3
21 (23677359) 2
22 (17394470) 4
24 (18795300) 4
20 (23773879) 4
30 (21380741) 2
35 (17483932) 2
36 (12324825) 3
19 (-3093387) 4
25 (29752650) 4
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
27 (27097792) 4
28 (27177438) 3
CT knee with IV contrast Usually not appropriate Strong ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
14 (26025120) 3
17 (20551186) 1
12 (16392612) 3
13 (17136560) 3
16 (23020888) 2
15 (28214478) 4
18 (25816992) 2
CT knee without and with IV contrast Usually not appropriate Strong ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
14 (26025120) 3
17 (20551186) 1
12 (16392612) 3
13 (17136560) 3
16 (23020888) 2
15 (28214478) 4
18 (25816992) 2
Bone scan with SPECT or SPECT/CT knee Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 0 0 0 0 0 0 1
References Study Quality
38 (16894322) 2
37 (12218448) 3
39 (25558700) 3
Variant 4: Skeletally immature child. Fall or acute twisting trauma to the knee. No fracture seen on radiographs. Suspect occult fracture or internal derangement. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI knee without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 0 0 1 15
References Study Quality
26 (16861540) 3
21 (23677359) 2
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
27 (27097792) 4
28 (27177438) 3
CT knee without IV contrast May be appropriate Strong ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 1 0 0 2 12 1 1 0 0
References Study Quality
14 (26025120) 3
17 (20551186) 1
26 (16861540) 3
21 (23677359) 2
12 (16392612) 3
50 (22965381) 4
16 (23020888) 2
51 (28190582) 3
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
15 (28214478) 4
27 (27097792) 4
28 (27177438) 3
18 (25816992) 2
US knee Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 12 1 1 1 0 1 1 0 0
References Study Quality
40 (16786321) 2
44 (21982460) 3
47 (29466145) Good
49 (27145775) 4
48 (28343806) 4
46 (25916746) Good
42 (25911713) 3
45 (23412237) 2
MR arthrography knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 1
MRI knee without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
26 (16861540) 3
21 (23677359) 2
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
27 (27097792) 4
28 (27177438) 3
CT knee with IV contrast Usually not appropriate Strong ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
14 (26025120) 3
17 (20551186) 1
26 (16861540) 3
21 (23677359) 2
12 (16392612) 3
50 (22965381) 4
16 (23020888) 2
51 (28190582) 3
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
15 (28214478) 4
27 (27097792) 4
28 (27177438) 3
18 (25816992) 2
CT knee without and with IV contrast Usually not appropriate Strong ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
14 (26025120) 3
17 (20551186) 1
26 (16861540) 3
21 (23677359) 2
12 (16392612) 3
50 (22965381) 4
16 (23020888) 2
51 (28190582) 3
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
15 (28214478) 4
27 (27097792) 4
28 (27177438) 3
18 (25816992) 2
Bone scan with SPECT or SPECT/CT lower extremity Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
38 (16894322) 2
37 (12218448) 3
39 (25558700) 3
Variant 5: Skeletally immature child. Fall or acute twisting trauma to the knee. No fracture seen on radiographs. Suspect occult fracture or internal derangement. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI knee without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 2 1 13
References Study Quality
26 (16861540) 3
21 (23677359) 2
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
27 (27097792) 4
28 (27177438) 3
CT knee without IV contrast May be appropriate Strong ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 5 8 0 0 0 1 0 2 5 1 8
References Study Quality
14 (26025120) 3
17 (20551186) 1
26 (16861540) 3
21 (23677359) 2
12 (16392612) 3
50 (22965381) 4
16 (23020888) 2
51 (28190582) 3
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
15 (28214478) 4
27 (27097792) 4
28 (27177438) 3
18 (25816992) 2
US knee Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 1 1 0 0 0
References Study Quality
40 (16786321) 2
44 (21982460) 3
47 (29466145) Good
49 (27145775) 4
48 (28343806) 4
46 (25916746) Good
42 (25911713) 3
45 (23412237) 2
MR arthrography knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRI knee without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 1 0 0 0
References Study Quality
26 (16861540) 3
21 (23677359) 2
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
27 (27097792) 4
28 (27177438) 3
CT knee with IV contrast Usually not appropriate Strong ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
14 (26025120) 3
17 (20551186) 1
26 (16861540) 3
21 (23677359) 2
12 (16392612) 3
50 (22965381) 4
16 (23020888) 2
51 (28190582) 3
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
15 (28214478) 4
27 (27097792) 4
28 (27177438) 3
18 (25816992) 2
CT knee without and with IV contrast Usually not appropriate Strong ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
14 (26025120) 3
17 (20551186) 1
26 (16861540) 3
21 (23677359) 2
12 (16392612) 3
50 (22965381) 4
16 (23020888) 2
51 (28190582) 3
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
15 (28214478) 4
27 (27097792) 4
28 (27177438) 3
18 (25816992) 2
Bone scan with SPECT or SPECT/CT lower extremity Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
38 (16894322) 2
37 (12218448) 3
39 (25558700) 3
Variant 6: Adult or child 5 years of age or older. Fall or acute twisting trauma to the knee. Tibial plateau fracture on radiographs. Suspect additional bone or soft-tissue injury. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI knee without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
26 (16861540) 3
21 (23677359) 2
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
27 (27097792) 4
28 (27177438) 3
CT knee without IV contrast Usually appropriate Limited ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
14 (26025120) 3
12 (16392612) 3
13 (17136560) 3
50 (22965381) 4
51 (28190582) 3
52 (25102505) 4
15 (28214478) 4
US knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MR arthrography knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRA knee without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRA knee without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI knee without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
26 (16861540) 3
21 (23677359) 2
34 (28680889) 3
32 (28432395) 4
33 (28424850) 4
29 (27775896) 3
31 (28293698) 4
27 (27097792) 4
28 (27177438) 3
CT knee with IV contrast Usually not appropriate Limited ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
14 (26025120) 3
12 (16392612) 3
13 (17136560) 3
50 (22965381) 4
51 (28190582) 3
52 (25102505) 4
15 (28214478) 4
CT knee without and with IV contrast Usually not appropriate Limited ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
14 (26025120) 3
12 (16392612) 3
13 (17136560) 3
50 (22965381) 4
51 (28190582) 3
52 (25102505) 4
15 (28214478) 4
Bone scan with SPECT or SPECT/CT knee Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 7: Adult or child 5 years of age or older. Acute trauma to the knee. Mechanism unknown. Focal patellar tenderness, effusion, able to walk. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography knee Usually appropriate Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
8 (15995467) 4
6 (23399332) 1
11 (22636383) 4
1 (29243880) 4
5 (23827289) 2
US knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MR arthrography knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRA knee without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRA knee without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI knee without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
55 (17056925) 4
54 (20063162) 2
53 (8517287) 4
MRI knee without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
55 (17056925) 4
54 (20063162) 2
53 (8517287) 4
CT knee with IV contrast Usually not appropriate Limited ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (16392612) 3
CT knee without and with IV contrast Usually not appropriate Limited ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (16392612) 3
CT knee without IV contrast Usually not appropriate Limited ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (16392612) 3
Bone scan with SPECT or SPECT/CT knee Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 8: Adult or child 5 years of age or older. Significant trauma to the knee (eg, motor vehicle accident, knee dislocation). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography knee Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 1 0 0 0 16
References Study Quality
10 (8594242) 3
3 (7574123) 3
CTA lower extremity with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 2 1 3 4 6
References Study Quality
58 (21156317) 4
59 (17869471) 4
60 (16498092) 2
Arteriography lower extremity May be appropriate Limited ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 1 2 1 11 1 1 0 0
References Study Quality
58 (21156317) 4
56 (19932064) 4
57 (19074408) 4
MRA knee without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 1 1 2 10 2 0 0 0
References Study Quality
61 (11972076) 4
62 (21446625) 3
MRI knee without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 2 0 1 1 12 1 0 0 0
References Study Quality
26 (16861540) 3
21 (23677359) 2
62 (21446625) 3
32 (28432395) 4
29 (27775896) 3
31 (28293698) 4
27 (27097792) 4
28 (27177438) 3
CT knee with IV contrast May be appropriate (Disagreement) Expert Opinion ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 9 0 2 1 3 0 1 1 0
References Study Quality
12 (16392612) 3
CT knee without IV contrast May be appropriate Limited ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 3 3 1 1 7 2 0 0 0
References Study Quality
12 (16392612) 3
US knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 0 0 0 2 0 0 0
MR arthrography knee Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
MRA knee without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 7 0 3 1 4 1 0 0 1
References Study Quality
61 (11972076) 4
62 (21446625) 3
MRI knee without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 1 0 0 0 0
References Study Quality
26 (16861540) 3
21 (23677359) 2
62 (21446625) 3
32 (28432395) 4
29 (27775896) 3
31 (28293698) 4
27 (27097792) 4
28 (27177438) 3
CT knee without and with IV contrast Usually not appropriate Limited ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
12 (16392612) 3
Bone scan with SPECT or SPECT/CT knee Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 1 0 0 0 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.