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Appropriateness Criteria

Variant 1: New or increasing nontraumatic cervical or neck pain. No “red flags.” Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography cervical spine Usually appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 8 8 0 0 0 2 0 0 4 10 3
References Study Quality
27 (17450072) 4
29 (24968795) 4
28 (9224245) 4
MRI cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 2 4 2 6 3 1 0 0
References Study Quality
22 (26571180) 3
23 (9460946) 2
CT cervical spine without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 2 3 8 4 2 0 0 0
References Study Quality
24 (17379279) Inadequate
25 (24314582) 4
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 14 1 3 0 0 0 0 0 0
Facet injection/medial branch block cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 14 2 2 0 0 0 0 0 0
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 3 1 1 0 0 0 0 0
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 1 4 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 1 2 2 0 0 0 0
MRI cervical spine with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 2 4 1 0 0 0 0 0
References Study Quality
22 (26571180) 3
23 (9460946) 2
MRI cervical spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 2 3 2 2 1 0 0 0
References Study Quality
22 (26571180) 3
23 (9460946) 2
Bone scan whole body with SPECT or SPECT/CT neck Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 4 0 0 0 0 0 0
References Study Quality
26 (23412368) 3
CT cervical spine with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 4 3 0 1 1 0 0 0
References Study Quality
24 (17379279) Inadequate
25 (24314582) 4
CT cervical spine without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 2 1 0 1 0 0 0
References Study Quality
24 (17379279) Inadequate
25 (24314582) 4
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 2 1 3 1 0 0 0 0
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 0 2 1 1 0 0 0 0
Variant 2: New or increasing nontraumatic cervical radiculopathy. No “red flags.” Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical spine without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 0 2 3 7 5
References Study Quality
40 (2398088) 3
33 (21047885) 2
39 (17204882) 4
41 (27318668) 3
21 (8107998) 3
23 (9460946) 2
35 (2847516) 4
Radiography cervical spine May be appropriate (Disagreement) Expert Opinion ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 0 0 1 4 3 6 1 1 2
References Study Quality
42 (14077981) 4
CT cervical spine without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 1 3 11 1 2 0
References Study Quality
35 (2847516) 4
36 (16632616) 2
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 12 3 3 0 0 0 0 0 0
Facet injection/medial branch block cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 2 1 0 0 0 0 0 0
Radiographic myelography cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 7 2 2 3 2 1 1 0 0
References Study Quality
17 (-3130497) 4
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 4 0 1 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 4 0 1 0 0 0 0
MRI cervical spine with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 1 0 4 1 0 1 0 0
References Study Quality
40 (2398088) 3
33 (21047885) 2
39 (17204882) 4
41 (27318668) 3
21 (8107998) 3
23 (9460946) 2
35 (2847516) 4
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 5 3 4 1 3 2 0 0 0
References Study Quality
40 (2398088) 3
33 (21047885) 2
39 (17204882) 4
41 (27318668) 3
21 (8107998) 3
23 (9460946) 2
35 (2847516) 4
Bone scan whole body with SPECT or SPECT/CT neck Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 2 0 1 0 0 0 0
CT cervical spine with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 5 1 1 0 0 0 0
References Study Quality
35 (2847516) 4
36 (16632616) 2
CT cervical spine without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 2 2 0 0 0 0 0
References Study Quality
35 (2847516) 4
36 (16632616) 2
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 4 2 1 1 0 0 0 0
CT myelography cervical spine Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 3 3 4 1 0 1 0 0
References Study Quality
37 (3823440) 2
38 (9534693) 2
Variant 3: Prior cervical spine surgery. New or increasing nontraumatic cervical or neck pain or radiculopathy. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography cervical spine Usually appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 8 8 1 0 1 0 0 2 2 4 8
References Study Quality
63 (21178831) 3
65 (19096562) 4
66 (23578991) 3
60 (23242622) 2
61 (19665192) 4
64 (18628706) 4
62 (24183750) 4
CT cervical spine without IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 0 1 0 1 1 6 5 3
References Study Quality
52 (23479714) 4
51 (23318108) Not Assessed
50 (23118135) 4
48 (18469691) 2
49 (16889148) 2
53 (26430596) 3
MRI cervical spine without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 2 4 9 1 2 0 1
References Study Quality
22 (26571180) 3
23 (9460946) 2
54 (-3127628) 4
57 (2119123) 4
56 (2966418) 2
55 (11371319) 4
MRI cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 0 1 1 1 1 6 4 3
References Study Quality
22 (26571180) 3
23 (9460946) 2
54 (-3127628) 4
55 (11371319) 4
CT myelography cervical spine May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 6 1 2 8 1 1 0 0 0
References Study Quality
37 (3823440) 2
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 12 4 1 1 0 0 0 0 0
Facet injection/medial branch block cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 14 3 1 0 0 0 0 0 0
Radiographic myelography cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 6 1 5 4 2 0 0 0 0
References Study Quality
17 (-3130497) 4
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 4 1 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 1 5 0 1 0 0 0 0
MRI cervical spine with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 7 4 3 1 1 1 1 0 0
References Study Quality
22 (26571180) 3
23 (9460946) 2
54 (-3127628) 4
57 (2119123) 4
56 (2966418) 2
55 (11371319) 4
Bone scan whole body with SPECT or SPECT/CT neck 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
58 (11037993) 1
59 (9171175) 3
Bone scan whole body with SPECT or SPECT/CT neck Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 4 1 2 0 0 0 0
References Study Quality
58 (11037993) 1
59 (9171175) 3
CT cervical spine with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 1 3 2 1 1 1 0 0
References Study Quality
52 (23479714) 4
51 (23318108) Not Assessed
50 (23118135) 4
48 (18469691) 2
49 (16889148) 2
53 (26430596) 3
CT cervical spine without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 1 1 1 0 1 1 0
References Study Quality
52 (23479714) 4
51 (23318108) Not Assessed
50 (23118135) 4
48 (18469691) 2
49 (16889148) 2
53 (26430596) 3
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 3 2 1 1 0 0 0 0
Variant 4: Suspicion for infection with new or increasing nontraumatic cervical or neck pain or radiculopathy. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical spine without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 0 1 2 14
References Study Quality
69 (25952173) 4
68 (25296275) 4
76 (3875878) 2
77 (12802004) 2
78 (11199429) 2
79 (15776239) 3
80 (12594568) 4
Radiography cervical spine May be appropriate (Disagreement) Expert Opinion ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 0 1 1 2 8 3 2 1 1
References Study Quality
81 (11316362) 4
82 (11316355) 4
MRI cervical spine with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 2 3 2 2 4 2 0 1
References Study Quality
69 (25952173) 4
68 (25296275) 4
76 (3875878) 2
77 (12802004) 2
78 (11199429) 2
79 (15776239) 3
80 (12594568) 4
MRI cervical spine without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 2 1 7 6 2 0
References Study Quality
69 (25952173) 4
68 (25296275) 4
76 (3875878) 2
77 (12802004) 2
78 (11199429) 2
79 (15776239) 3
80 (12594568) 4
CT cervical spine with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 1 1 8 5 3 0
References Study Quality
69 (25952173) 4
70 (22677300) 4
CT cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 2 5 3 3 4 1 0
References Study Quality
69 (25952173) 4
70 (22677300) 4
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 14 2 1 0 1 0 0 0 0
Facet injection/medial branch block cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 1 1 0 0 0 0 0 0
Radiographic myelography cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 2 1 2 1 0 0 0 0
References Study Quality
17 (-3130497) 4
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 3 1 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 2 2 1 0 0 0 0
Bone scan whole body with SPECT or SPECT/CT neck Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
76 (3875878) 2
Bone scan whole body with SPECT or SPECT/CT neck Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 1 4 0 4 1 1 0 0
References Study Quality
76 (3875878) 2
CT cervical spine without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 1 7 2 0 0 2 0 0
References Study Quality
69 (25952173) 4
70 (22677300) 4
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 11 2 2 2 1 0 0 0 0
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 9 3 3 1 2 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 8 1 7 1 1 1 0 0 0
References Study Quality
72 (25475377) 4
71 (29256136) 2
73 (9364643) 4
Gallium scan whole body Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 7 3 9 0 0 0 0 0 0
References Study Quality
74 (11129162) 3
75 (26848173) 2
WBC scan whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 1 3 2 1 2 0 0 0
Variant 5: Known malignancy. New or increasing nontraumatic cervical or neck pain or radiculopathy. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical spine without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 2 4 11
References Study Quality
88 (25412631) 4
94 (-3127654) 4
MRI cervical spine without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 2 0 4 8 4 1
References Study Quality
88 (25412631) 4
94 (-3127654) 4
Radiography cervical spine May be appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 6 6 0 0 1 1 7 3 3 1 2
References Study Quality
87 (18191356) 3
97 (-3127649) 4
MRI cervical spine with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 3 5 4 0 3 2 1 0
References Study Quality
88 (25412631) 4
94 (-3127654) 4
Bone scan whole body with SPECT or SPECT/CT neck May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
36 (16632616) 2
95 (26339464) 4
96 (11142324) 4
Bone scan whole body with SPECT or SPECT/CT neck May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 4 2 3 3 6 1 0 0 0
References Study Quality
36 (16632616) 2
95 (26339464) 4
96 (11142324) 4
CT cervical spine with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 2 2 5 3 4 2 1 0
References Study Quality
88 (25412631) 4
87 (18191356) 3
86 (17890090) 2
89 (6831145) 3
CT cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 2 5 0 7 3 2 0
References Study Quality
88 (25412631) 4
87 (18191356) 3
86 (17890090) 2
89 (6831145) 3
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 14 3 1 0 0 0 0 0 0
Facet injection/medial branch block cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 1 1 0 0 0 0 0 0
Radiographic myelography cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 11 2 2 3 0 0 0 0 0
References Study Quality
17 (-3130497) 4
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 3 4 0 0 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 2 4 0 1 0 0 0 0
CT cervical spine without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 5 0 1 0 1 0 0
References Study Quality
88 (25412631) 4
87 (18191356) 3
86 (17890090) 2
89 (6831145) 3
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 2 4 1 1 0 0 0 0
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 1 1 1 3 0 0 0 0
FDG-PET/CT whole body Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 1 6 1 1 2 0 0 0
References Study Quality
92 (20015657) 4
93 (25533313) 2
Fluoride PET/CT whole body Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 1 1 13 3 2 0 0 1 0 0 0
References Study Quality
90 (27634981) 4
91 (28872551) 2
Variant 6: Cervicogenic headache and new or increasing nontraumatic cervical or neck pain. No neurologic deficit. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Facet injection/medial branch block cervical spine May be appropriate Expert Consensus ☢☢ 0.1-1mSv 4 4 4 2 3 6 2 2 0 0 0
Radiography cervical spine May be appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 5 0 0 2 6 4 5 1 1 0
References Study Quality
103 (2743413) 4
104 (14510932) 2
MRI cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 0 1 3 6 3 1 2 0
References Study Quality
103 (2743413) 4
104 (14510932) 2
CT cervical spine without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 0 2 9 4 2 1 0 0
References Study Quality
103 (2743413) 4
104 (14510932) 2
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 10 2 1 1 2 1 1 0 0
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 2 3 0 0 0 0 0 0
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 1 2 2 0 1 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 1 4 1 1 0 0 0
MRI cervical spine with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 1 3 1 2 0 0 0 0
References Study Quality
103 (2743413) 4
104 (14510932) 2
MRI cervical spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 9 0 1 3 4 1 0 0 0
References Study Quality
103 (2743413) 4
104 (14510932) 2
Bone scan whole body with SPECT or SPECT/CT neck Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 1 3 3 2 1 1 0 0
References Study Quality
106 (19643679) 4
36 (16632616) 2
105 (27262701) 4
CT cervical spine with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 2 0 1 0 0 0 0
References Study Quality
103 (2743413) 4
104 (14510932) 2
CT cervical spine without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 3 1 0 0 0 0 0
References Study Quality
103 (2743413) 4
104 (14510932) 2
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 1 1 3 2 0 1 0 0
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 14 2 2 0 0 0 0 0 0
Variant 7: Chronic cervical or neck pain. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography cervical spine Usually appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
107 (17347239) 4
108 (3787320) 2
MRI cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
22 (26571180) 3
23 (9460946) 2
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 n/a 0 0 0 0 0 0 0 0 0
Facet injection/medial branch block cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 n/a 0 0 0 0 0 0 0 0 0
Radiographic myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
MRA neck 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 neck 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 cervical spine 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
22 (26571180) 3
23 (9460946) 2
MRI cervical spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
22 (26571180) 3
23 (9460946) 2
Bone scan whole body with SPECT or SPECT/CT neck Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
106 (19643679) 4
CT cervical spine with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
CT cervical spine without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
CT cervical spine without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
CT myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 8: Chronic cervical or neck pain. No neurologic findings. Radiographs show degenerative changes. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI cervical spine without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 2 3 6 6
References Study Quality
112 (19333104) 3
111 (10947922) 4
20 (25430861) 4
113 (21269888) 4
22 (26571180) 3
21 (8107998) 3
23 (9460946) 2
114 (28139306) 4
115 (27492725) 4
CT cervical spine without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 2 0 3 7 3 4 0
References Study Quality
24 (17379279) Inadequate
CT myelography cervical spine May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 5 1 1 5 4 1 1 0 0
Discography cervical spine Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 11 4 2 1 0 0 0 0 0
References Study Quality
1 (18204385) 4
Facet injection/medial branch block cervical spine Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 10 2 2 2 1 1 0 0 0
References Study Quality
109 (18295649) 4
110 (15168223) 4
Radiographic myelography cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 10 1 1 4 2 0 0 0 0
References Study Quality
116 (5643913) 4
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 4 0 1 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 4 0 1 0 0 0 0
MRI cervical spine with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 8 3 5 2 0 1 0 0 0
References Study Quality
112 (19333104) 3
111 (10947922) 4
20 (25430861) 4
113 (21269888) 4
22 (26571180) 3
21 (8107998) 3
23 (9460946) 2
114 (28139306) 4
115 (27492725) 4
MRI cervical spine without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 3 3 6 2 4 0 1 0 0
References Study Quality
112 (19333104) 3
111 (10947922) 4
20 (25430861) 4
113 (21269888) 4
22 (26571180) 3
21 (8107998) 3
23 (9460946) 2
114 (28139306) 4
115 (27492725) 4
Bone scan whole body with SPECT or SPECT/CT neck Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 7 4 1 1 0 0 0
References Study Quality
26 (23412368) 3
106 (19643679) 4
CT cervical spine with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 1 2 2 0 0 0 0
References Study Quality
24 (17379279) Inadequate
CT cervical spine without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 1 3 1 0 0 0 0
References Study Quality
24 (17379279) Inadequate
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 2 2 1 0 0 0 0
Variant 9: Chronic cervical or neck pain without or with radiculopathy. Radiographs show ossification in the posterior longitudinal ligament (OPLL). Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT cervical spine without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 1 2 1 2 5 6
References Study Quality
120 (23179977) 4
MRI cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 1 1 1 2 8 4 1
References Study Quality
122 (1636514) 3
CT myelography cervical spine May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 1 3 4 4 3 2 1 1
References Study Quality
121 (24153172) 3
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 2 1 0 0 0 0 0 0
Facet injection/medial branch block cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 2 1 0 0 0 0 0 0
Radiographic myelography cervical spine Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 9 0 5 3 1 0 0 0 0
References Study Quality
17 (-3130497) 4
MRA neck with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 3 0 1 0 0 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 3 0 1 0 0 0 0
MRI cervical spine with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 2 2 1 2 1 0 0 0
References Study Quality
122 (1636514) 3
MRI cervical spine without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 2 1 3 3 0 1 0 0
References Study Quality
122 (1636514) 3
Bone scan whole body with SPECT or SPECT/CT neck Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 2 2 1 0 0 0 0 0
CT cervical spine with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 2 1 0 2 0 0 0
References Study Quality
120 (23179977) 4
CT cervical spine without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 2 2 2 0 0 0 0
References Study Quality
120 (23179977) 4
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 1 2 2 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.