Variant 1: Suspected stress (fatigue) fracture, excluding vertebrae. First imaging study.
Variant 2: Suspected stress (fatigue) fracture, hip. Negative radiographs. Next imaging study.
Variant 3: Suspected stress (fatigue) fracture, excluding hip and vertebrae. Negative radiographs. Next imaging study.
Variant 4: Suspected stress (fatigue) fracture, excluding vertebrae. Negative radiographs. Immediate “need-to-know” diagnosis. Next imaging study.
Variant 5: Confirmed stress (fatigue) fracture, excluding vertebrae. Follow-up imaging study for “return-to-play” evaluation.
Variant 6: Suspected stress (insufficiency) fracture, pelvis or hip. First imaging study.
Variant 7: Suspected stress (insufficiency) fracture, pelvis or hip. Negative radiographs. Next imaging study.
Variant 8: Suspected stress (insufficiency) fracture of lower extremity, excluding pelvis and hip. First imaging study.
Variant 9: Suspected stress (insufficiency) fracture of lower extremity, excluding pelvis and hip. Negative radiographs. Next imaging study.
Variant 10: Follow-up imaging study for characterizing nonspecific focal uptake on Tc-99m MDP bone scintigraphy, suspected to be a stress fracture.
Variant 11: Suspect stress (fatigue or insufficiency) fracture, pelvis or hip or sacrum. Pregnant patient.
Variant 12: Suspect stress (fatigue or insufficiency) fracture of the long bones. Pregnant patient.
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.