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Appropriateness Criteria

Variant 1: Chronic wrist pain. With or without prior injury. Best initial study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography wrist Usually appropriate Expert Consensus ☢ <0.1 mSv 9 9 0 0 0 0 0 0 0 0 0
US wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 14 0 0 0 0 0 0 0 0
MR arthrography wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
MRI wrist without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
MRI wrist without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0
Variant 2: Chronic wrist pain. Routine radiographs normal or nonspecific. Persistent symptoms. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI wrist without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
3 (16424247) 3
12 (16932876) 4
26 (17179363) 3
MR arthrography wrist May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 0 0 0 0 0 0 0 0
References Study Quality
3 (16424247) 3
12 (16932876) 4
26 (17179363) 3
US wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 12 0 0 2 0 0 0 0 0
MRI wrist without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
3 (16424247) 3
12 (16932876) 4
26 (17179363) 3
CT arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0
Variant 3: Chronic wrist pain. Routine radiographs normal or nonspecific. Suspect inflammatory arthritis. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI wrist without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
27 (20810395) 3
28 (21318271) 3
29 (16941192) 3
31 (18718987) 2
32 (21068093) 3
33 (18388160) 1
34 (16219706) 3
30 (18307764) 1
MRI wrist without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 0 0 0 0
References Study Quality
27 (20810395) 3
28 (21318271) 3
29 (16941192) 3
31 (18718987) 2
32 (21068093) 3
33 (18388160) 1
34 (16219706) 3
30 (18307764) 1
US wrist May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 9 2 0 0 1
References Study Quality
27 (20810395) 3
28 (21318271) 3
31 (18718987) 2
32 (21068093) 3
33 (18388160) 1
34 (16219706) 3
35 (23111854) 4
20 (22476781) 2
Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 13 0 0 1 0 0 0 0 0
MR arthrography wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 3 3 0 0 0 0 0 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0
Variant 4: Chronic wrist pain. Radiographs normal or show nonspecific arthritis. Exclude infection. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Image-guided aspiration wrist Usually appropriate Expert Consensus Varies 9 9 0 0 0 0 0 0 0 0 0
US wrist May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 5 0 2 0 4 1 1 0 0
MRI wrist without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 6 0 1 0 3 1 1 0 1
Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 14 0 0 0 0 0 0 0 0
MR arthrography wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
MRI wrist without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 12 0 1 0 1 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0
Variant 5: Ulnar-sided chronic wrist pain. Radiographs normal or nonspecific. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MR arthrography wrist Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 0 0 0 0
References Study Quality
7 (21467087) M
26 (17179363) 3
8 (23812413) 3
38 (17449771) 1
39 (19098183) 2
MRI wrist without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
12 (16932876) 4
36 (9168716) 3
37 (18762112) 2
CT arthrography wrist May be appropriate Strong ☢ <0.1 mSv 5 5 1 0 0 1 7 1 3 1 0
References Study Quality
40 (18665366) 2
8 (23812413) 3
38 (17449771) 1
US wrist Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
41 (21078815) 4
42 (18204008) 3
Radiographic arthrography wrist Usually not appropriate Limited ☢ <0.1 mSv 3 3 0 0 0 0 0 0 0 0 0
References Study Quality
7 (21467087) M
MRI wrist without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 0 4 2 1 2 0 0 0
References Study Quality
12 (16932876) 4
36 (9168716) 3
37 (18762112) 2
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0
Variant 6: Radial-sided chronic wrist pain. Radiographs normal or nonspecific. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI wrist without IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
8 (23812413) 3
10 (15122464) 4
38 (17449771) 1
39 (19098183) 2
US wrist May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 0 11 1 0 0 0
References Study Quality
18 (21613443) 3
19 (20033358) 3
41 (21078815) 4
42 (18204008) 3
MR arthrography wrist May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 0 0 0 0 0
References Study Quality
3 (16424247) 3
43 (9194225) 3
8 (23812413) 3
38 (17449771) 1
44 (10194719) 2
CT arthrography wrist May be appropriate Limited ☢ <0.1 mSv 6 6 0 0 0 0 0 0 0 0 0
References Study Quality
16 (16304116) 2
8 (23812413) 3
Radiographic arthrography wrist Usually not appropriate Limited ☢ <0.1 mSv 3 3 0 0 0 0 0 0 0 0 0
References Study Quality
45 (2661651) 3
MRI wrist without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 5 2 2 0 5 0 0 0 0
References Study Quality
8 (23812413) 3
10 (15122464) 4
38 (17449771) 1
39 (19098183) 2
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0
Variant 7: Chronic wrist pain. Radiographs normal or nonspecific. Suspect Kienböck’s disease. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI wrist without IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 0
CT wrist without IV contrast May be appropriate Expert Consensus ☢ <0.1 mSv 5 5 0 0 0 0 0 0 0 0 0
US wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 14 0 0 0 0 0 0 0 0
MR arthrography wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
MRI wrist without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
CT arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 0 0 0 0 0 0 0 0 0
Variant 8: Chronic wrist pain. Kienböck’s disease on radiographs. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI wrist without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 0 0 0 0 0 0 0 0 0
CT wrist without IV contrast May be appropriate Expert Consensus ☢ <0.1 mSv 5 5 0 0 0 0 0 0 0 0 0
US wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 14 0 0 0 0 0 0 0 0
MR arthrography wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
MRI wrist without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
CT arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0
Variant 9: Chronic wrist pain. Palpable mass or suspected occult ganglion cyst. Radiographs normal or nonspecific. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US wrist Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 0 0 0
MRI wrist without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 0 0 0
References Study Quality
46 (17177022) 4
47 (16498112) 3
48 () 4
MRI wrist without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 0 0 0
References Study Quality
46 (17177022) 4
47 (16498112) 3
48 () 4
Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 13 0 1 0 0 0 0 0 0
MR arthrography wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0
Variant 10: Chronic wrist pain. Suspect occult fracture or stress fracture. Radiographs nondiagnostic. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI wrist without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
12 (16932876) 4
50 (19847413) 4
CT wrist without IV contrast Usually appropriate Expert Consensus ☢ <0.1 mSv 7 7 0 0 0 0 0 0 0 0 0
Radiography wrist additional views May be appropriate Expert Consensus ☢ <0.1 mSv 6 6 0 0 0 0 4 5 2 0 2
Bone scan with SPECT or SPECT/CT wrist May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 1 8 0 2 0 1
References Study Quality
51 (21408000) 4
52 (24404637) 4
53 (19756904) M
54 (15911954) 4
55 (23377415) 4
56 (23531735) 2
US wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 13 0 0 0 1 0 0 0 0
MR arthrography wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
MRI wrist without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
12 (16932876) 4
50 (19847413) 4
CT arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
Variant 11: Chronic wrist pain. Radiographs show old scaphoid fracture. Evaluate for nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI wrist without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 3 4 4 2
References Study Quality
60 (17312277) 2
57 (20858790) 2
58 (10628470) 2
59 (15855097) 2
CT wrist without IV contrast Usually appropriate Expert Consensus ☢ <0.1 mSv 8 8 1 0 0 0 1 0 3 3 6
MRI wrist without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 5 3 1 1 3
References Study Quality
60 (17312277) 2
57 (20858790) 2
58 (10628470) 2
59 (15855097) 2
US wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 13 0 1 0 0 0 0 0 0
MR arthrography wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 10 1 1 0 1 0 1 0 0
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 0 0 0 0 0 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0
Variant 12: Chronic wrist pain. Radiographs normal or nonspecific. Suspect carpal tunnel syndrome. Next study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US wrist May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 5 3 0 1 3
References Study Quality
62 (19280794) 3
63 (19037017) 3
64 (17989976) 3
65 (21076589) 3
21 (22244369) M
24 (22542258) M
66 (16632712) 4
22 (20963527) M
23 (25187592) 2
61 (24154903) 3
MRI wrist without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 0 0 6 3 0 1 2
References Study Quality
68 (17920190) 3
69 (18312102) 2
67 (9772842) 4
70 (24248989) 2
Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 14 0 0 0 0 0 0 0 0
MR arthrography wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 0 0 0 0 0 0 0
MRI wrist without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 0 1 0 2 0 0 0 0
References Study Quality
68 (17920190) 3
69 (18312102) 2
67 (9772842) 4
70 (24248989) 2
CT arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 14 0 0 0 0 0 0 0 0
CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 14 0 0 0 0 0 0 0 0
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 14 0 0 0 0 0 0 0 0
CT wrist without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 12 1 0 0 1 0 0 0 0
Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 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.