American College of Radiology
ACR Appropriateness Criteria®
Chronic Hip Pain
Variant 1: Chronic hip pain. First test.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
Radiography hip
Usually appropriate
☢☢☢ 1-10 mSv
9
n/a
0
0
0
0
0
0
0
0
0
Radiography pelvis
Usually appropriate
☢☢ 0.1-1mSv
☢☢ 0.03-0.3 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
CT arthrography hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip without IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
MR arthrography hip
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
MRI hip without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
MRI hip without IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
Tc-99m bone scan hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
US hip
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
CT hip without and with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Image-guided anesthetic +/- corticosteroid injection hip joint or surrounding structures
Usually not appropriate
Varies Varies
1
n/a
0
0
0
0
0
0
0
0
0
F18-fluoride PET hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Variant 2: Chronic hip pain. Radiographs negative, equivocal, or nondiagnostic. Suspect extra-articular noninfectious soft-tissue abnormality, such as tendonitis.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
MRI hip without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
US hip
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
Image-guided anesthetic +/- corticosteroid injection hip joint or surrounding structures
May be appropriate
Varies Varies
5
n/a
0
0
0
0
0
0
0
0
0
MRI hip without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
MR arthrography hip
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
CT hip without IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT arthrography hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Tc-99m bone scan hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip without and with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
F18-fluoride PET hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Variant 3: Chronic hip pain. Radiographs negative, equivocal, or nondiagnostic. Suspect impingement.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
MR arthrography hip
Usually appropriate
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
MRI hip without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
8
n/a
0
0
0
0
0
0
0
0
0
CT arthrography hip
Usually appropriate
☢☢☢ 1-10 mSv
7
n/a
0
0
0
0
0
0
0
0
0
CT hip without IV contrast
May be appropriate
☢☢☢ 1-10 mSv
5
n/a
0
0
0
0
0
0
0
0
0
Image-guided anesthetic +/- corticosteroid injection hip joint or surrounding structures
May be appropriate
Varies Varies
5
n/a
0
0
0
0
0
0
0
0
0
US hip
May be appropriate
O 0 mSv
O 0 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
MRI hip without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
3
n/a
0
0
0
0
0
0
0
0
0
Tc-99m bone scan hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip without and with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
F18-fluoride PET hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Variant 4: Chronic hip pain. Radiographs negative, equivocal, or nondiagnostic. Suspect labral tear with or without clinical findings consistent with or suggestive of impingement.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
MR arthrography hip
Usually appropriate
O 0 mSv
O 0 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
CT arthrography hip
Usually appropriate
☢☢☢ 1-10 mSv
7
n/a
0
0
0
0
0
0
0
0
0
MRI hip without IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
6
n/a
0
0
0
0
0
0
0
0
0
MRI hip without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
Image-guided anesthetic +/- corticosteroid injection hip joint or surrounding structures
May be appropriate
Varies Varies
5
n/a
0
0
0
0
0
0
0
0
0
CT hip without IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Tc-99m bone scan hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
US hip
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
F18-fluoride PET hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip without and with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Variant 5: Chronic hip pain. Evaluate articular cartilage. Next test after radiographs.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
MR arthrography hip
Usually appropriate
O 0 mSv
O 0 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
MRI hip without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
CT arthrography hip
Usually appropriate
☢☢☢ 1-10 mSv
8
n/a
0
0
0
0
0
0
0
0
0
MRI hip without and with IV contrast
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
Image-guided anesthetic +/- corticosteroid injection hip joint or surrounding structures
May be appropriate
Varies Varies
4
n/a
0
0
0
0
0
0
0
0
0
CT hip without IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Tc-99m bone scan hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
US hip
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
CT hip without and with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
F18-fluoride PET hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Variant 6: Chronic hip pain. Radiographs positive. Arthritis of uncertain type. Infection is a consideration.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
MRI hip without and with IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
Aspiration hip
Usually appropriate
Varies Varies
9
n/a
0
0
0
0
0
0
0
0
0
MRI hip without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
7
n/a
0
0
0
0
0
0
0
0
0
US hip
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
Tc-99m 3-phase bone scan hip
May be appropriate
☢☢☢ 1-10 mSv
4
n/a
0
0
0
0
0
0
0
0
0
CT hip without IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
2
n/a
0
0
0
0
0
0
0
0
0
CT hip without and with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
2
n/a
0
0
0
0
0
0
0
0
0
CT hip with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
2
n/a
0
0
0
0
0
0
0
0
0
F18-fluoride PET hip
Usually not appropriate
☢☢☢ 1-10 mSv
2
n/a
0
0
0
0
0
0
0
0
0
MR arthrography hip
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
Image-guided anesthetic +/- corticosteroid injection hip joint or surrounding structures
Usually not appropriate
Varies Varies
1
n/a
0
0
0
0
0
0
0
0
0
CT arthrography hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Variant 7: Chronic hip pain. Radiographs suggestive of pigmented villonodular synovitis or osteochondromatosis.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
MRI hip without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
CT arthrography hip
May be appropriate
☢☢☢ 1-10 mSv
5
n/a
0
0
0
0
0
0
0
0
0
Aspiration hip
May be appropriate
Varies Varies
4
n/a
0
0
0
0
0
0
0
0
0
CT hip without IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
2
n/a
0
0
0
0
0
0
0
0
0
MR arthrography hip
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
MRI hip without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Tc-99m bone scan hip
Usually not appropriate
☢☢☢ 1-10 mSv
2
n/a
0
0
0
0
0
0
0
0
0
US hip
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
Image-guided anesthetic +/- corticosteroid injection hip joint or surrounding structures
Usually not appropriate
Varies Varies
2
n/a
0
0
0
0
0
0
0
0
0
CT hip without and with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
2
n/a
0
0
0
0
0
0
0
0
0
CT hip with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
2
n/a
0
0
0
0
0
0
0
0
0
F18-fluoride PET hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Variant 8: Chronic hip pain and low back, pelvic, or knee pathology. Want to exclude hip as the source. Radiographs negative, equivocal, or showing mild osteoarthritis.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
MRI hip without IV contrast
Usually appropriate
O 0 mSv
O 0 mSv [ped]
9
n/a
0
0
0
0
0
0
0
0
0
Image-guided anesthetic +/- corticosteroid injection hip joint or surrounding structures
Usually appropriate
Varies Varies
8
n/a
0
0
0
0
0
0
0
0
0
CT hip without IV contrast
May be appropriate
☢☢☢ 1-10 mSv
5
n/a
0
0
0
0
0
0
0
0
0
MR arthrography hip
May be appropriate
O 0 mSv
O 0 mSv [ped]
5
n/a
0
0
0
0
0
0
0
0
0
US hip
May be appropriate
O 0 mSv
O 0 mSv [ped]
4
n/a
0
0
0
0
0
0
0
0
0
MRI hip without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
2
n/a
0
0
0
0
0
0
0
0
0
CT arthrography hip
Usually not appropriate
☢☢☢ 1-10 mSv
2
n/a
0
0
0
0
0
0
0
0
0
Tc-99m bone scan hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip without and with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
F18-fluoride PET hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Variant 9: Computer navigation of hip arthroplasty or modeling.
Procedure
Appropriateness Category
SOE
Adult RRL
Peds RRL
Rating
Median
Final Tabulations
1
2
3
4
5
6
7
8
9
CT hip without IV contrast
Usually appropriate
☢☢☢ 1-10 mSv
9
n/a
0
0
0
0
0
0
0
0
0
Radiography hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Radiography pelvis
Usually not appropriate
☢☢ 0.1-1mSv
☢☢ 0.03-0.3 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
CT arthrography hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
MR arthrography hip
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
MRI hip without and with IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
MRI hip without IV contrast
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
Tc-99m bone scan hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
US hip
Usually not appropriate
O 0 mSv
O 0 mSv [ped]
1
n/a
0
0
0
0
0
0
0
0
0
CT hip without and with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
CT hip with IV contrast
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
0
0
0
0
0
0
0
Image-guided anesthetic +/- corticosteroid injection hip joint or surrounding structures
Usually not appropriate
Varies Varies
1
n/a
0
0
0
0
0
0
0
0
0
F18-fluoride PET hip
Usually not appropriate
☢☢☢ 1-10 mSv
1
n/a
0
0
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.
