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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Practice Committee of the American Society for Reproductive Medicine, American Society for Reproductive Medicine. Definition of infertility: a committee opinion. Available at: https://www.asrm.org/globalassets/_asrm/practice-guidance/practice-guidelines/pdf/definition-of-infertility.pdf. Review/Other-Dx N/A To define intertility in females. No abstract available. 4
2. Centers for Disease Control and Prevention, Key statistics from the National Survey of Family Growth, 2017. Available at: https://www.cdc.gov/nchs/nsfg/key_statistics.htm. Review/Other-Dx N/A To provide statistics for family growth. No abstract available. 4
3. World Health Organization: 1 in 6 people globally affected by infertility. Available at: https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility. Review/Other-Dx N/A How peopel are affected by infertility worldwide. No abstract avaialble. 4
4. Fauser B, Adamson GD, Boivin J, et al. Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature. Hum Reprod Update 2024;30:153-73. Review/Other-Dx n/a The concept of family building, the process by which individuals or couples create or expand their families, has been largely ignored in family-planning paradigms. Family building encompasses various methods and options for individuals or couples who wish to have children. It can involve biological means, such as natural conception, as well as ART, surrogacy, adoption, and foster care. Family-building acknowledges the diverse ways in which individuals or couples can create their desired family and reflects the understanding that there is no one-size-fits-all approach to building a family. Developing education programs for young adults to increase family-building awareness and prevent infertility is urgently needed No abstract available. 4
5. Hull MG, Glazener CM, Kelly NJ, et al. Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed). 1985; 291(6510):1693-1697. Review/Other-Dx 708 patients To study the incidence and range of causes of infertility in a representative British population, at least among those reaching specialist clinics; the estimated need for treatment; and its success. Failure of ovulation (amenorrhea or oligomenorrhoea) occurred in 21% of cases and was successfully treated (2 year conception rates of 96% and 78%). Tubal damage (14%) had a poor outlook (19%) despite surgery. Endometriosis accounted for infertility in 6%, although seldom because of tubal damage, cervical mucus defects or dysfunction in 3%, and coital failure in up to 6%. Sperm defects or dysfunction were the commonest defined cause of infertility (24%) and led to a poor chance of pregnancy (0%–27%) without donor insemination. Obstructive azoospermia or primary spermatogenic failure was uncommon (2%) and hormonal causes of male infertility rare. Infertility was unexplained in 28% and the chance of pregnancy (overall 72%) was mainly determined by duration of infertility. In vitro fertilization could benefit 80% of cases of tubal damage and 25% of unexplained infertility-that is, 18% of all cases, representing up to 216 new cases each year per million of the total population. 4
6. Healy DL, Trounson AO, Andersen AN. Female infertility: causes and treatment. Lancet. 1994; 343(8912):1539-1544. Review/Other-Dx N/A To review the causes and treatment of female infertility. No results stated in abstract. 4
7. Sallee C, Margueritte F, Marquet P, et al. Uterine Factor Infertility, a Systematic Review. J Clin Med 2022;11. Review/Other-Dx 188 studies This present systematic review underlines the lack of a consensual definition of uterine factor infertility (UFI). A total of 188 studies were included in qualitative synthesis. UFI accounted for 2.1 to 16.7% of the causes of female infertility. We tried to evaluate the proportion of the different causes of UFI: uterine agenesia, hysterectomies, uterine malformations, uterine irradiation, adenomyosis, synechiae and Asherman syndrome, uterine myomas and uterine polyps. However, the data available in countries and studies were highly heterogenous. 4
8. Feldman MK, Wasnik AP, Adamson M, et al. ACR Appropriateness Criteria® Endometriosis. J Am Coll Radiol 2024;21:S384-S95. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for endometriosis. No results stated in abstract. 4
9. Sadowski EA, Ochsner JE, Riherd JM, et al. MR hysterosalpingography with an angiographic time-resolved 3D pulse sequence: assessment of tubal patency. AJR Am J Roentgenol. 2008; 191(5):1381-1385. Review/Other-Dx 17 patients To determine if tubal patency can be assessed by MR HSG using a clinically available MR angiographic sequence (3-D time-resolved imaging of contrast kinetics). MR HSG effectively shows tubal patency and can be considered when both conventional HSG and standard MRI are necessary for the evaluation of women with infertility, such as in women with suspected uterine anomalies or extrauterine disease. 4
10. Silberzweig JE. MR hysterosalpingography compared with conventional hysterosalpingography. AJR Am J Roentgenol. 2009; 192(6):W350. Review/Other-Dx N/A MR hysterosalpingography compared with conventional hysterosalpingography. No abstract available. 4
11. Ascher SM, Wasnik AP, Robbins JB, et al. ACR Appropriateness Criteria® Fibroids. J Am Coll Radiol 2022;19:S319-S28. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for fribroids. No results stated in abstract. 4
12. Mueller GC, Hussain HK, Smith YR, et al. Mullerian duct anomalies: comparison of MRI diagnosis and clinical diagnosis. AJR Am J Roentgenol. 2007; 189(6):1294-1302. Observational-Dx 103 patients To assess agreement between MRI and clinical diagnosis of MDA and identify causes of discrepancy. There was excellent agreement (kappa = 0.8) between MRI and clinical diagnoses of MDA. For evaluation of the uterus, there was agreement in 83/103 patients, disagreement in 15/103, and agreement could not be determined in 5/103 because of uncertain MRI diagnoses. The main causes of disagreement were MRI diagnosis of septate uteri with 2 cervices clinically diagnosed as didelphic, partial septate uteri clinically diagnosed as arcuate, and complex anomalies with features of more than one class. The main difficulties for MRI were the detection of small uteri or remnants, characterization of cervical dysgenesis and rare anomalies, overestimation of cervical mucosal folds, characterization of anomalies in the presence of fibroids, and delineation of vaginal abnormalities. 4
13. Mori K, Tokunaga Y, Sakumoto T, Nakashima A, Komesu I, Hata Y. A Uterine Motion Classification in MRI Data for Female Infertility. Curr Med Imaging. 16(5):479-490, 2020. Review/Other-Dx N/A The purpose of this study was to classify complicated uterine movements obtained by magnetic resonance imaging (MRI) scanner and investigate the relationship between uterine peristalsis and female infertility. Comparison results between the real MRI images and the simulated images showed that any five in our dataset uterine movement was successfully reproduced by a combination of these six fundamental movements. The point and surface vibration model appropriately mimicked the movements with the propagation velocity of 0.68 [mm/sec]. 4
14. Meylaerts LJ, Wijnen L, Ombelet W, Bazot M, Vandersteen M. Uterine junctional zone thickness in infertile women evaluated by MRI. J Magn Reson Imaging. 45(3):926-936, 2017 03. Experimental-Dx 28 To prospectively evaluate and compare the junctional zone (JZ) and outer myometrial thickness in infertile and healthy nulliparous women at different locations in the uterine wall during the menstrual cycle by magnetic resonance imaging (MRI). The JZ in the anovulating women at the posterior wall of the isthmus (4.2 mm) was significantly thicker compared to the control group (3.2, 3.0, and 2.9 mm, in respectively the three menstrual phases) (P = 0.027). The outer myometrium in the anovulating women was significantly thicker at all measured locations (average 11.5 mm) in comparison to the control group (8.1, 8.0, and 8.5 mm, in respectively the three menstrual phases) (P < 0.050). The infertile women on ovarian stimulation therapy showed a significantly thicker outer myometrium at the anterior wall (isthmus, midcorpus, and fundus) (P < 0.050) 1
15. Freytag D, Gunther V, Maass N, Alkatout I. Uterine Fibroids and Infertility. Diagnostics (Basel) 2021;11. Review/Other-Dx N/A Uterine fibroids are the most common tumor in women, and their prevalence is high in patients with infertility. No results stated in abstract. 4
16. Wang SJ, Zhang MM, Duan N, et al. Using transvaginal ultrasonography and MRI to evaluate ovarian volume and follicle count of infertile women: a comparative study. Clin Radiol. 77(8):621-627, 2022 08. Observational-Dx 84 To compare two-dimensional (2D) transvaginal ultrasonography (TVUS) and 2D/three-dimensional (3D) magnetic resonance imaging (MRI) in estimating ovarian volume and follicle count. The OV from 3D MRI was 0.50 ml (95% confidence interval [CI], 0.25-0.74, p<0.001) smaller than that by 2D TVUS. OV from 2D MRI was 2.65 ml (95% CI, 2.36-2.95, p<0.001) and 3.15 ml (95% CI, 2.77-3.53, p<0.001) smaller than that from 3D MRI and 2D TVUS, respectively. The FC1-9 mm and total follicle count (tFC) estimated by 2D TVUS were 7.81 (95% CI, 6.96-8.66, p<0.001) and 7.82 (95% CI, 6.97-8.67) smaller than those from 2D MRI, respectively. Further analysis showed that 2D TVUS detected lower FC1-3 mm but higher FC4-6 mm than 2D MRI. No significant difference was shown in the results of FC7-9 mm and FC = 10 mm. 3
17. AIUM Practice Parameter for the Performance of a Focused Ultrasound Examination in Reproductive Endocrinology and Female Infertility. J Ultrasound Med 2019;38:E1-E3. Review/Other-Dx N/A Practice parameter for the performance of a focused ultrasound examination in reproductive endocrinology and female infertility No abstract available. 4
18. American College of Radiology. ACR–ACOG–AIUM–SPR–SRU Practice Parameter for the Performance of Ultrasound of the Female Pelvis. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=63+&releaseId=2 Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
19. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol 2023;189:G43-G64. Review/Other-Dx N/A What is the recommended assessment and management of those with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? No results stated in abstract. 4
20. Leonhardt H, Hellstrom M, Gull B, et al. Ovarian morphology assessed by magnetic resonance imaging in women with and without polycystic ovary syndrome and associations with antimullerian hormone, free testosterone, and glucose disposal rate. Fertil Steril. 101(6):1747-56.e1-3, 2014 Jun. Observational-Dx 58 patients with PCOS; 31 control patients To characterize ovarian morphology and perfusion by magnetic resonance imaging (MRI) in women with and without polycystic ovary syndrome (PCOS) and to investigate associations with antimullerian hormone (AMH), free T, and glucose disposal rate (GDR). Antral follicles of 1-3 and 4-6 mm, but not 7-9 mm, were more numerous, and total AFC (1-9 mm) was higher in women with PCOS. Ovarian volume was larger in women with PCOS. AMH and free T were higher and GDR was lower in women with PCOS. All values were more deranged in classic compared with nonclassic PCOS. There was a positive correlation between AMH and AFC, 1-3 mm (r = 0.81), and between AMH and total AFC (r = 0.87). In receiver operating characteristic analyses, the area under the curve was 0.89 for total AFC, 0.86 for AMH, and 0.90 for free T. PCOS was independently associated with AFC and free T but not with AMH or GDR when adjusted for age and body mass index. 4
21. Brown M, Park AS, Shayya RF, Wolfson T, Su HI, Chang RJ. Ovarian imaging by magnetic resonance in adolescent girls with polycystic ovary syndrome and age-matched controls. J Magn Reson Imaging. 38(3):689-93, 2013 Sep. Observational-Dx 21 controls; 19 PCOS girls To compare ovarian morphology in adolescent girls with and without polycystic ovary syndrome (PCOS) using magnetic resonance imaging (MRI). Mean antral follicle count (AFC) per ovary and ovarian volume were substantially greater in PCOS subjects compared to non-PCOS subjects. Mean follicle size was similar between groups. Follicles exceeding 10 mm were seen in 2/19 PCOS subjects versus 9/21 non-PCOS subjects. Consistently higher follicle counts were detected in images obtained at 2 mm compared to 6-mm slice thickness. 3
22. Fondin M, Rachas A, Huynh V, et al. Polycystic Ovary Syndrome in Adolescents: Which MR Imaging-based Diagnostic Criteria?. Radiology. 285(3):961-970, 2017 12. Observational-Dx 110 patients To evaluate the validity and reproducibility of magnetic resonance (MR) imaging-based ovarian morphologic measurements for diagnosis of polycystic ovary syndrome (PCOS) in adolescents. All criteria except sphericity index and absence of a dominant follicle were significantly associated with the level of suspicion of PCOS (P </= .05). The AUCs for FPO-9 (0.78; 95% confidence interval [CI]: 0.68, 0.87), FPO-5 (0.73; 95% CI: 0.62, 0.83), and OV (0.77; 95% CI: 0.68, 0.87) were significantly greater than 0.5; that was not true for sphericity index (AUC, 0.58; 95% CI: 0.47, 0.70). Sensitivity and specificity for peripheral distribution of follicles were 33% (95% CI: 19%, 49%) and 95% (95% CI: 85%, 99%), respectively; for absence of a dominant follicle, they were 90% (95% CI: 76%, 97%) and 27% (95% CI: 16%, 41%), respectively. Reproducibility was almost perfect for OV (ICC, 0.89), substantial for absence of a dominant follicle (kappa, 0.74), moderate for FPO-9 (ICC, 0.54) and FPO-5 (ICC, 0.61), and fair for peripheral distribution of follicles (kappa, 0.37). 3
23. Grigovich M, Kacharia VS, Bharwani N, Hemingway A, Mijatovic V, Rodgers SK. Evaluating Fallopian Tube Patency: What the Radiologist Needs to Know. Radiographics. 41(6):1876-18961, 2021 Oct. Review/Other-Dx n/a A comprehensive US infertility evaluation of the pelvis and fallopian tubes can be achieved in one setting by adding coronal three-dimensional imaging of the uterus, saline infusion son hysterography, and HyCoSy or HyFoSy to routine pelvic US. MR HSG and virtual CT HSG also depict tubal patency and uterine and adnexal pathologic conditions and may be considered in select patients. While laparoscopic chromo perturbation remains the standard for tubal patency evaluation, its disadvantages are its invasiveness and cost. Knowledge of the different fallopian tube tests and radiologic appearance of normal and abnormal fallopian tubes results in fewer pitfalls, accurate interpretation, and optimal patient care n/a 4
24. Dreyer K, van Rijswijk J, Mijatovic V, et al. Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women. N Engl J Med. 376(21):2043-2052, 2017 05 25. Observational-Dx 1,119 women Pregnancy rates among infertile women have been reported to increase after hysterosalpingography, but it is unclear whether the type of contrast medium used (oil-based or water-soluble contrast) influences this potential therapeutic effect. A total of 1119 women were randomly assigned to hysterosalpingography with oil contrast (557 women) or water contrast (562 women). A total of 220 of 554 women in the oil group (39.7%) and 161 of 554 women in the water group (29.1%) had an ongoing pregnancy (rate ratio, 1.37; 95% confidence interval [CI], 1.16 to 1.61; P<0.001), and 214 of 552 women in the oil group (38.8%) and 155 of 552 women in the water group (28.1%) had live births (rate ratio, 1.38; 95% CI, 1.17 to 1.64; P<0.001). Rates of adverse events were low and similar in the two groups. 4
25. Roest I, van Welie N, Mijatovic V, et al. Complications after hysterosalpingography with oil- or water-based contrast: results of a nationwide survey. Hum Reprod Open 2020;2020:hoz045. Review/Other-Dx 73 clinics What is the incidence of complications after hysterosalpingography (HSG) using oil-based contrast versus water-based contrast? The response rate was 96% (67/70) (during the study, one site closed and was not included while two clinics no longer performed HSGs). In the 67 clinics, 3289 HSGs with oil-based contrast and 1876 HSGs with water-based contrast were performed in 2017. The median amount of contrast used was 8.0 ml (interquartile range (IQR) 7.0-10.0) for oil-based contrast and 10.0 ml for water-based contrast (IQR 10.0-10.0). Antibiotic prophylaxis was administered in 61% (41/67) of the clinics. Intravasation occurred in 4.8% of the HSGs performed with oil-based contrast and in 1.3% of the HSGs with water-based contrast (relative risk (RR), 3.6; CI, 2.4-5.4). Pulmonary embolism or death was not reported. Pelvic inflammatory disease (PID) occurred in 0.3% of the HSGs performed with oil-based contrast versus 0.4% with water-based contrast. PID occurred in 0.3% of the HSGs in clinics using antibiotic prophylaxis and 0.2% in clinics not using antibiotic prophylaxis. Allergic reactions were reported in one HSG performed with oil-based contrast (0.03%) compared with two HSGs performed with water-based contrast (0.1%). Anaphylactic reactions did not occur. The overall complication rate was 5.1% in the clinics that used oil-based contrast versus 1.8% in the clinics that used water-based contrast (RR, 2.8; CI, 1.9-4.0; P-value, <0.0001). 4
26. Dreyer K, van Eekelen R, Tjon-Kon-Fat RI, et al. The therapeutic effect of hysterosalpingography in couples with unexplained subfertility: a post-hoc analysis of a prospective multi-centre cohort study. Reprod Biomed Online. 38(2):233-239, 2019 Feb. Observational-Tx 4,556 couples To conduct a secondary analysis on a large nationwide prospective cohort to evaluate if hysterosalpingography (HSG) has a therapeutic effect and whether this is mediated by the medium used. The probability of natural conception within 24 months after first presentation at the fertility clinic was increased after HSG, regardless of the type of contrast medium used, compared with no HSG (adjusted hazard ratio 1.48, 95% CI 1.26 to 1.73, corresponding to an absolute increase in 6-month pregnancy rate of +6%). When this analysis was limited to HSGs that were made with water-contrast, the treatment effect remained (adjusted hazard ratio 1.40, 95% CI 1.16 to 1.70). 1
27. Merritt BA, Behr SC, Khati NJ. Imaging of Infertility, Part 1: Hysterosalpingograms to Magnetic Resonance Imaging. [Review]. Radiol Clin North Am. 58(2):215-225, 2020 Mar. Review/Other-Dx N/A This article provides an overview of the multimodality imaging assessment of female infertility and details the developmental and acquired pelvic abnormalities in which diagnostic imaging aids in evaluation. No results stated in the abstract. 4
28. Outwater EK, Siegelman ES, Chiowanich P, Kilger AM, Dunton CJ, Talerman A. Dilated fallopian tubes: MR imaging characteristics. Radiology. 208(2):463-9, 1998 Aug. Observational-Dx 38 patients To determine the magnetic resonance (MR) imaging characteristics of hydrosalpinx and the accuracy of MR imaging for distinguishing hydrosalpinx from other adnexal masses. On a per patient basis, the blinded readers correctly identified dilated fallopian tubes in 31 of 41 study patients and correctly excluded dilated tubes in a mean 34 of 38 control subjects. On T1-weighted images, hyperintense tubal fluid was significantly correlated with the presence of endometriosis in the pelvis at surgery (P < .002, chi 2). 3
29. AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography. J Ultrasound Med 2021;40:E39-E45. Review/Other-Dx N/A Practice parameter for the performance of sonohysterography and hysterosalpingo-contrast sonography. No abstract available. 4
30. Christianson MS, Legro RS, Jin S, et al. Comparison of sonohysterography to hysterosalpingogram for tubal patency assessment in a multicenter fertility treatment trial among women with polycystic ovary syndrome. J Assist Reprod Genet. 35(12):2173-2180, 2018 Dec. Observational-Dx 750 To compare saline infusion sonohysterography (SIS) versus hysterosalpingogram (HSG) for confirmation of tubal patency. Among women who ovulated, 414 (66.9%) had tubal patency confirmed by SIS and 187 (30.2%) had at least one tube patent on HSG. Multivariable analysis indicated that choice of HSG versus SIS did not have a significant relationship on likelihood of clinical pregnancy, after adjustment for treatment arm, BMI, duration of infertility, smoking, and education (OR 1.14, 95% CI0.77, 1.67, P=0.52). Ectopic pregnancy occurred more often in women who had tubal patency confirmed by HSG compared to SIS (2.8% versus 0.6%, P=0.02). 3
31. Exalto N, Stassen M, Emanuel MH. Safety aspects and side-effects of ExEm-gel and foam for uterine cavity distension and tubal patency testing. Reprod Biomed Online 2014;29:534-40. Review/Other-Dx n/a A state-of-the-art overview of the safety and side-effects of ExEm-gel for uterine cavity distension and ExEm-foam for tubalpatency testing is presented. As the gel is used for uterine cavity distention in diagnosticprocedures, direct influences of the components of GLYand HEC on various tissues of the female gynaecologic tractwere searched for. The osmotic dehydrating effect of GLY isthe main attribute, when used for systemic and topical therapeuticand tissue protective effects, but it is also responsiblefor its side-effects (Van de Beek et al., 2012). Theliterature search found that HEC is less hygroscopic and noside-effects or inappropriate tissue reactions were found; HEChas also been used as a placebo (Richardson et al., 2013). Formany years, GLY and HEC have been used for intra-vascular,intra-gastrointestinal, intra-peritoneal, intra-uterine andtopical application. No allergic reactions have beendescribed.Animal tests for systemic and genotoxicity of the gel werecarried out, with no resulting concerns about safety(Genotoxicity Report, 2009; Toxicity Report, 2007).Hydroxyethyl cellulose was resorbed by human mesothelialcells within 48 h in an in-vitro test (Resorption Test, 2013).Studies on in-vivo resorption are not yet available.The use of foam for tubal patency testing in infertile patientshighlights the necessity for looking at the influencesof the components on sperm cells, oocytes and zygotes. AlthoughHEC did not influence sperm motility, and GLY is usedas a cryoprotectant in cryopreservation of human sperm cells,studies on sperm cell toxicity and motility are needed beforeconcluding that this foam is safe for sperm cells (Benson et al.,2012; Shimonovitz et al., 1994). A comparable conclusion canbe drawn for the influence on oocytes. It will, however, bemore difficult to investigate these aspects (Fabbri, 2006). Itis reassuring that the gel did not influence blastocyst development,as was tested in one-cell frozen-thawed mouseembryo (Tucker, 2010). The data are overall reassuring. Assafety aspects in infertility treatment are of utmost importance,however, the safest strategy is to restrict clinical examinationswith gel to the pre-ovulatory phase of themenstrual cycle.Side-effects of GIS and HyFoSy mentioned in daily practiceare painful uterine contractions, vasovagal reaction, fluidloss and spotting, and do not differ from other comparablediagnostic procedures. The advantage of using gel is that itfills the uterine cavity slowly, and keeps the filling pressurelow, which is the best approach to avoid pain. Sufficient evidenceexists to conclude that there is no rationale for usingintrauterine application of lidocaine for pain reduction. 4
32. Hu H, Kirby A, Dowthwaite S, Mizia K, Zen M. Lipiodol flushing under ultrasound guidance at time of hystero-salpingo contrast sonography (HyCoSy): A retrospective observational study. Australian & New Zealand Journal of Obstetrics & Gynaecology. 62(5):755-760, 2022 10. Review/Other-Dx 326 To study the feasibility and tolerability of performing Lipiodol (ethiodised oil) flush concurrently with HyCoSy. To examine the in vivo sonographic visibility of Lipiodol vs normal saline. There were 412 patients who were referred for Lipiodol flushing. Of these, 86 patients did not have concurrent Lipiodol flush at HyCoSy performed due to strict exclusion criteria. Of the 326 patients who proceeded with Lipiodol flushing at HyCoSy, all cases were successful, with no cases of extravasation. There were no major complications. In vivo sonographic visualisation of Lipiodol was similar to that of the commonly used agitated 0.9% saline (n = 20; mean visibility score 4.3 ± 0.9 vs 4.0 ± 1.2). 4
33. Measuring Sex, Gender Identity, and Sexual Orientation. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
34. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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