American College of Radiology
ACR Appropriateness Criteria®

Cervical Neck Pain or Cervical Radiculopathy

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
29 (24968795) 4
28 (9224245) 4
27 (17450072) 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
23 (9460946) 2
22 (26571180) 3
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
25 (24314582) 4
24 (17379279) Inadequate
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
25 (24314582) 4
24 (17379279) Inadequate
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
23 (9460946) 2
22 (26571180) 3
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
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
25 (24314582) 4
24 (17379279) Inadequate
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
X-ray myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 3 1 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 1 2 2 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
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
23 (9460946) 2
22 (26571180) 3
Tc-99m bone scan whole body with SPECT/CT neck Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 1 1 13 1 4 0 0 0 0 0 0
References Study Quality
26 (23412368) 3
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
41 (27318668) 3
40 (2398088) 3
39 (17204882) 4
35 (2847516) 4
33 (21047885) 2
23 (9460946) 2
21 (8107998) 3
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
36 (16632616) 2
35 (2847516) 4
Radiography cervical spine May be appropriate (Disagreement) Expert Opinion ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 5 6 0 0 1 4 3 6 1 1 2
References Study Quality
42 (14077981) 4
X-ray 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
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
41 (27318668) 3
40 (2398088) 3
39 (17204882) 4
35 (2847516) 4
33 (21047885) 2
23 (9460946) 2
21 (8107998) 3
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
38 (9534693) 2
37 (3823440) 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 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
36 (16632616) 2
35 (2847516) 4
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
36 (16632616) 2
35 (2847516) 4
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
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
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
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
41 (27318668) 3
40 (2398088) 3
39 (17204882) 4
35 (2847516) 4
33 (21047885) 2
23 (9460946) 2
21 (8107998) 3
Tc-99m bone scan whole body with SPECT/CT neck Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 14 1 2 0 1 0 0 0 0
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
66 (23578991) 3
65 (19096562) 4
64 (18628706) 4
63 (21178831) 3
62 (24183750) 4
61 (19665192) 4
60 (23242622) 2
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
53 (26430596) 3
52 (23479714) 4
51 (23318108) Not Assessed
50 (23118135) 4
49 (16889148) 2
48 (18469691) 2
MRI cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 7 2 0 1 1 1 1 6 4 3
References Study Quality
55 (11371319) 4
54 (-3127628) 4
23 (9460946) 2
22 (26571180) 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
57 (2119123) 4
56 (2966418) 2
55 (11371319) 4
54 (-3127628) 4
23 (9460946) 2
22 (26571180) 3
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
X-ray 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
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
53 (26430596) 3
52 (23479714) 4
51 (23318108) Not Assessed
50 (23118135) 4
49 (16889148) 2
48 (18469691) 2
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
57 (2119123) 4
56 (2966418) 2
55 (11371319) 4
54 (-3127628) 4
23 (9460946) 2
22 (26571180) 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
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
53 (26430596) 3
52 (23479714) 4
51 (23318108) Not Assessed
50 (23118135) 4
49 (16889148) 2
48 (18469691) 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
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
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
Tc-99m bone scan whole body with SPECT/CT neck Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 1 1 10 1 4 1 2 0 0 0 0
References Study Quality
59 (9171175) 3
58 (11037993) 1
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
80 (12594568) 4
79 (15776239) 3
78 (11199429) 2
77 (12802004) 2
76 (3875878) 2
69 (25952173) 4
68 (25296275) 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
70 (22677300) 4
69 (25952173) 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
80 (12594568) 4
79 (15776239) 3
78 (11199429) 2
77 (12802004) 2
76 (3875878) 2
69 (25952173) 4
68 (25296275) 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
70 (22677300) 4
69 (25952173) 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
82 (11316355) 4
81 (11316362) 4
MRI cervical spine with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 4 3 2 3 2 2 4 2 0 1
References Study Quality
80 (12594568) 4
79 (15776239) 3
78 (11199429) 2
77 (12802004) 2
76 (3875878) 2
69 (25952173) 4
68 (25296275) 4
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
70 (22677300) 4
69 (25952173) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 8 1 7 1 1 1 0 0 0
References Study Quality
73 (9364643) 4
72 (25475377) 4
71 (29256136) 2
Tc-99m bone scan whole body with SPECT/CT neck Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 7 1 4 0 4 1 1 0 0
References Study Quality
76 (3875878) 2
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
In-111 WBC scan whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 2 2 9 1 3 2 1 2 0 0 0
Ga-67 scan whole body Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 7 3 9 0 0 0 0 0 0
References Study Quality
75 (26848173) 2
74 (11129162) 3
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
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
X-ray 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 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
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
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
94 (-3127654) 4
88 (25412631) 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
94 (-3127654) 4
88 (25412631) 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
97 (-3127649) 4
87 (18191356) 3
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
89 (6831145) 3
88 (25412631) 4
87 (18191356) 3
86 (17890090) 2
CT cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 6 0 0 2 5 0 7 3 2 0
References Study Quality
89 (6831145) 3
88 (25412631) 4
87 (18191356) 3
86 (17890090) 2
MRI cervical spine with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 4 1 3 5 4 0 3 2 1 0
References Study Quality
94 (-3127654) 4
88 (25412631) 4
Tc-99m bone scan whole body with SPECT/CT neck May be appropriate Limited ☢☢☢☢ 10-30 mSv 4 4 4 2 3 3 6 1 0 0 0
References Study Quality
96 (11142324) 4
95 (26339464) 4
36 (16632616) 2
FDG-PET/CT whole body Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 7 1 6 1 1 2 0 0 0
References Study Quality
93 (25533313) 2
92 (20015657) 4
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
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
89 (6831145) 3
88 (25412631) 4
87 (18191356) 3
86 (17890090) 2
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
X-ray 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 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
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
F-18 NaF 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
91 (28872551) 2
90 (27634981) 4
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
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
104 (14510932) 2
103 (2743413) 4
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
104 (14510932) 2
103 (2743413) 4
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
104 (14510932) 2
103 (2743413) 4
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
Tc-99m bone scan whole body with SPECT/CT neck Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 7 1 3 3 2 1 1 0 0
References Study Quality
106 (19643679) 4
105 (27262701) 4
36 (16632616) 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
104 (14510932) 2
103 (2743413) 4
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
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
104 (14510932) 2
103 (2743413) 4
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
104 (14510932) 2
103 (2743413) 4
Discography cervical spine Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 10 2 1 1 2 1 1 0 0
X-ray myelography cervical spine Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 2 3 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 10 1 1 4 1 1 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
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
104 (14510932) 2
103 (2743413) 4
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
108 (3787320) 2
107 (17347239) 4
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
23 (9460946) 2
22 (26571180) 3
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
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
23 (9460946) 2
22 (26571180) 3
Tc-99m bone scan whole body with SPECT/CT neck Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
106 (19643679) 4
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
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
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
X-ray 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 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
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
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
23 (9460946) 2
22 (26571180) 3
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
115 (27492725) 4
114 (28139306) 4
113 (21269888) 4
112 (19333104) 3
111 (10947922) 4
23 (9460946) 2
22 (26571180) 3
21 (8107998) 3
20 (25430861) 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
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
115 (27492725) 4
114 (28139306) 4
113 (21269888) 4
112 (19333104) 3
111 (10947922) 4
23 (9460946) 2
22 (26571180) 3
21 (8107998) 3
20 (25430861) 4
Tc-99m bone scan whole body with SPECT/CT neck Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 3 3 5 1 7 4 1 1 0 0 0
References Study Quality
106 (19643679) 4
26 (23412368) 3
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
23 (9460946) 2
22 (26571180) 3
21 (8107998) 3
20 (25430861) 4
114 (28139306) 4
113 (21269888) 4
112 (19333104) 3
111 (10947922) 4
115 (27492725) 4
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
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
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
110 (15168223) 4
109 (18295649) 4
X-ray 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 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
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
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
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
MRI cervical spine without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 7 0 1 1 1 1 2 8 4 1
References Study Quality
122 (1636514) 3
X-ray 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
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
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
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
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
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
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
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
Tc-99m bone scan whole body with SPECT/CT neck Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 13 2 2 1 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.