Variant 1: Chronic wrist pain. With or without prior injury. Best initial study.
Variant 2: Chronic wrist pain. Routine radiographs normal or nonspecific. Persistent symptoms. Next study.
Variant 3: Chronic wrist pain. Routine radiographs normal or nonspecific. Suspect inflammatory arthritis. Next study.
Variant 4: Chronic wrist pain. Radiographs normal or show nonspecific arthritis. Exclude infection. Next study.
Variant 5: Ulnar-sided chronic wrist pain. Radiographs normal or nonspecific. Next study.
Variant 6: Radial-sided chronic wrist pain. Radiographs normal or nonspecific. Next study.
Variant 7: Chronic wrist pain. Radiographs normal or nonspecific. Suspect Kienböck’s disease. Next study.
Variant 8: Chronic wrist pain. Kienböck’s disease on radiographs. Next study.
Variant 9: Chronic wrist pain. Palpable mass or suspected occult ganglion cyst. Radiographs normal or nonspecific. Next study.
Variant 10: Chronic wrist pain. Suspect occult fracture or stress fracture. Radiographs nondiagnostic. Next study.
Variant 11: Chronic wrist pain. Radiographs show old scaphoid fracture. Evaluate for nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis. Next study.
Variant 12: Chronic wrist pain. Radiographs normal or nonspecific. Suspect carpal tunnel syndrome. Next study.
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.