American College of Radiology
ACR Appropriateness Criteria®

Hematuria–Child

Variant 1: Child. Isolated microscopic hematuria (nonpainful, nontraumatic) without proteinuria. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys and bladder Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 2 3 8 0 1 0 1 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 0 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 0 1 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 2 0 0 0 1 0 0 0
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 4 0 0 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 9 2 2 1 0 0 0 0 0
Arteriography kidneys Usually not appropriate TBD TBD ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 0 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 9 4 1 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 9 5 0 0 0 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 2 2 0 0 1 0 0 0
Voiding urosonography Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 10 1 2 1 0 0 0 0 0
Variant 2: Child. Isolated microscopic hematuria (nonpainful, nontraumatic) with proteinuria. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys and bladder Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 0 4 3 4 2
Fluoroscopy voiding cystourethrography Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 7 6 0 0 1 0 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 0 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 3 1 1 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 2 0 0 0 0 1 0 0
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 1 0 0 0 0 0 0
Arteriography kidneys Usually not appropriate TBD TBD ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 0 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 8 1 5 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 9 3 2 0 0 0 0 0 0
Radiography abdomen and pelvis (KUB) Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 9 2 2 0 0 0 1 0 0
Voiding urosonography Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 9 3 1 1 0 0 0 0 0
Variant 3: Child. Isolated macroscopic hematuria (nonpainful, nontraumatic). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US kidneys and bladder Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 6 7
CT abdomen and pelvis with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 4 9 0 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 3 7 2 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 4 5 1 0 0 0 1 0
Fluoroscopy voiding cystourethrography Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 2 4 8 1 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 5 2 2 2 2 1 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 6 6 2 0 0 0 0 0
Radiography abdomen and pelvis (KUB) Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 2 1 7 3 0 0 0 1 0
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 4 2 1 0 0 0 0 0
Voiding urosonography Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 4 6 4 1 0 0 0 0 0
Arteriography kidneys Usually not appropriate TBD TBD ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 1 0 1 0 0 0 0
Variant 4: Child. Painful hematuria (nontraumatic). Suspected urolithiasis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis without IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
US kidneys and bladder Usually appropriate O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
Radiography abdomen and pelvis May be appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Arteriography kidneys Usually not appropriate TBD TBD ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Voiding urosonography Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 4 7 3 0 0 0 0 0 0
Variant 5: Child. Traumatic hematuria (macroscopic). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy retrograde urethrography May be appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
CT pelvis with bladder contrast (CT cystography) May be appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Arteriography kidneys Usually not appropriate TBD TBD ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
US kidneys and bladder Usually not appropriate O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 3 9 2 0 0 0 1 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Voiding urosonography Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 7 5 1 1 0 0 0 0 0
Variant 6: Child. Traumatic hematuria (microscopic). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT pelvis with bladder contrast (CT cystography) May be appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 3 5 4 1 0
Fluoroscopy retrograde urethrography May be appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 4 4 2 3 2 3 3 1 0 0 0
US kidneys and bladder May be appropriate O 0 mSv O 0 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy voiding cystourethrography Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Arteriography kidneys Usually not appropriate TBD TBD ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Radiography abdomen and pelvis Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
Voiding urosonography Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 3 11 0 0 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.