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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
10. Miller SH. Anaphylactoid reaction after oral administration of diatrizoate meglumine and diatrizoate sodium solution. AJR. American Journal of Roentgenology. 168(4):959-61, 1997 Apr.AJR Am J Roentgenol. 168(4):959-61, 1997 Apr. Review/Other-Dx 1 patient Anaphylactoid reaction after oral administration of diatrizoate meglumine and diatrizoate sodium solution. No abstract available. 4
11. Kulinna-Cosentini C, Hodge JC, Ba-Ssalamah A. The role of radiology in diagnosing gastrointestinal tract perforation. [Review]. Best Practice & Research in Clinical Gastroenterology. 70:101928, 2024 Jun.Baillieres Best Pract Res Clin Gastroenterol. 70:101928, 2024 Jun. Review/Other-Dx N/A To differentiate innocuous from clinically-relevant, life-threatening postoperative complications to guide appropriate treatment. No results stated in abstract. 4
16. Norton-Gregory AA, Kulkarni NM, O'Connor SD, Budovec JJ, Zorn AP, Desouches SL. CT Esophagography for Evaluation of Esophageal Perforation. Radiographics. 41(2):447-461, 2021 Mar-Apr.Radiographics. 41(2):447-461, 2021 Mar-Apr. Review/Other-Dx N/A To familiarize radiologists with CT esophagography techniques and imaging findings of emergent esophageal conditions. No results stated in abstract. 4
17. Carbo AI, Kim RH, Gates T, D'Agostino HR. Imaging findings of successful and failed fundoplication. [Review]. Radiographics. 34(7):1873-84, 2014 Nov-Dec.Radiographics. 34(7):1873-84, 2014 Nov-Dec. Review/Other-Dx N/A Imaging findings are useful in detecting complications, providing anatomic information to identify the cause of surgical failure, and selecting appropriate medical or surgical management. No results stated in abstract. 4
19. Maniatis V, Chryssikopoulos H, Roussakis A, et al. Perforation of the alimentary tract: evaluation with computed tomography. Abdominal Imaging. 25(4):373-9, 2000 Jul-Aug.Abdom Imaging. 25(4):373-9, 2000 Jul-Aug. Review/Other-Dx 76 patients To assess the value of computed tomography (CT) in the diagnosis of perforation of the alimentary tract (AT). There were 65 true-positive and 11 false-negative cases. Levels of perforation were the esophagus (two), stomach (five), duodenum (12), small bowel (15), appendix (six), and colon (36). Causes were peptic ulcer (11), foreign body (five), trauma (seven), iatrogenic (nine), appendicitis (six), diverticulitis (21), Crohn disease (five), AT carcinoma (eight), and ischemia (four). Level and cause were correctly predicted in 55 and 51 instances, respectively. The sensitivity was estimated to 85.5%. 4
20. Lee D, Park MH, Shin BS, Jeon GS. Multidetector CT diagnosis of non-traumatic gastroduodenal perforation. Journal of Medical Imaging & Radiation Oncology. 60(2):182-6, 2016 Apr.J Med Imaging Radiat Oncol. 60(2):182-6, 2016 Apr. Observational-Dx 136 patients To identify reliable CT features and assess the diagnostic performance of 64-multidetector CT (MDCT) in diagnosing non-traumatic gastroduodenal perforation (GDP). The cause of GDP was peptic ulcer in 90 patients, gastric cancer in one patient, and foreign body of duodenal diverticulum in one patient. Extraluminal gas (97%) was most common CT feature of GDP, following by fluid or fat strand along gastroduodenum (89%), ascites (89%), wall defect and/or ulcer (84%), and wall thickening (72%). Of CT features, wall defect and/or ulcer showed the best positive likelihood ratios for GDP (36.83). Wall thickening also showed high positive likelihood ratios (10.52). Combined, these CT features showed 95% sensitivity and 93% specificity for localization of perforation site of GDP. 3
21. Baghdanian AH, Baghdanian AA, Puppala S, Tana M, Ohliger MA. Imaging Manifestations of Peptic Ulcer Disease on Computed Tomography. [Review]. Semin Ultrasound CT MR. 39(2):183-192, 2018 Apr. Review/Other-Dx N/A To highlight imaging features of uncomplicated PUD on CT imaging in order to allow for early detection of this disease process on imaging and the prevention of potential high-grade complications by recommending esophagogastroduodenoscopy. No results stated in abstract. 4
22. Patel A, Lalwani N, Kielar A. Use of oral contrast in 2024: primer for radiologists. [Review]. Abdominal Radiology. 49(8):2953-2959, 2024 08.Abdom Radiol. 49(8):2953-2959, 2024 08. Review/Other-Dx N/A To discuss and review the indications for the judicious use of oral contrast in CT of the AP as of 2024, considering the latest advancements and ongoing debates in clinical practice. No abstract available. 4
23. American College of Radiology. ACR Committee on Drugs and Contrast Media. Manual on Contrast Media.  Available at: https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Contrast-Manual. Review/Other-Dx N/A Guidance document to assist radiologists in recognizing and managing the small but real risks inherent in the use of contrast media. No abstract available. 4
24. Bunting DM, Szczebiot L, Peyser PM. Pain after laparoscopic antireflux surgery. Annals of the Royal College of Surgeons of England. 96(2):95-100, 2014 Mar.Ann R Coll Surg Engl. 96(2):95-100, 2014 Mar. Review/Other-Dx 17 studies To review the subject of pain following laparoscopic antireflux surgery. A total of 17 studies were included in the main analysis. Abdominal pain and chest pain following laparoscopic fundoplication were reported in 24.0% and 19.5% of patients respectively. Pain was mild or moderate in the majority and severe in 4%. Frequency of pain was not associated with operation type. The authors include their experience in managing patients with persistent, severe epigastric pain following laparoscopic anterior fundoplication. 4
25. Kamat R, Patankar R, Supe A, Dubey P, Thapar R, Kalikar V. Computed tomography roadmap for post-operative fundoplication imaging with a novel structured reporting checklist. Journal of Minimal Access Surgery. 21(2):153-161, 2025 Apr 01.J. minim. access surg.. 21(2):153-161, 2025 Apr 01. Review/Other-Dx 43 patients To create a standard CT reporting format which helped us in the management of even the most complex cases. The demographic characteristics, post-operative imaging and intraoperative findings were described. The different types of wrap failure - Hinder types and associated pathologies were analysed for relative frequency in wrap failures. The novel structured reporting included wrap integrity and failure complications in post-operative patients of LARS. 4
26. Rodriguez Carnero P, Herrasti Gallego A, Garcia Villafane C, Mendez Fernandez R, Rodriguez Gonzalez R. Multislice computed tomography for the study of complications of gastric fundoplication. Radiologia. 56(5):435-9, 2014 Sep-Oct.RADIOLOGIA. 56(5):435-9, 2014 Sep-Oct. Review/Other-Dx N/A To describe a new technique using multislice computed tomography that we think can be useful to evaluate patients with suspected complications or late failure after gastric fundoplication. No results stated in abstract. 4
27. Wei CJ, Levenson RB, Lee KS. Diagnostic Utility of CT and Fluoroscopic Esophagography for Suspected Esophageal Perforation in the Emergency Department. AJR. American Journal of Roentgenology. 215(3):631-638, 2020 09.AJR Am J Roentgenol. 215(3):631-638, 2020 09. Observational-Dx 103 patients To evaluate the diagnostic utility of CT in emergency department (ED) patients with suspected esophageal perforation and assessed whether subsequent fluoroscopic esophagography is necessary. One hundred three patients met the inclusion criteria. Sensitivity, specificity, PPV, and NPV for diagnosing esophageal perforation were 100.0%, 79.8%, 32.1%, and 100.0%, respectively, with CT and 77.8%, 98.9%, 87.5%, and 97.9% with fluoroscopic esophagography. Combining CT and fluoroscopic esophagography did not improve sensitivity, specificity, PPV, or NPV relative to using CT alone. The true-positive esophageal perforation rate was 8.7% for CT and 6.8% for fluoroscopic esophagography. When CT showed only pneumomediastinum (n = 51) or no pneumomediastinum (n = 14), the NPV of CT was 100.0%. CT with oral contrast material had a PPV of 38.5%, whereas CT without oral contrast material had a PPV of 26.7%. 3
28. Evans BA, Craig WY, Cinelli CM, Siegel SG. CT esophagogram in the emergency setting: typical findings and suggested workflow. Emergency Radiology. 31(1):33-44, 2024 Feb.EMERG. RADIOL.. 31(1):33-44, 2024 Feb. Review/Other-Dx 139 patients To assess the diagnostic performance of CT and CTE when interpreted by expert and generalist radiologists and created an imaging workflow guide. EP was diagnosed in 46/139 (33%) encounters. The most common CT/CTE findings in EP were esophageal wall thickening (46/46, 100%), pneumomediastinum (42/46, 91%), and mediastinal stranding (39/46, 85%). CT and CTE sensitivity for detecting EP was 89% and 89% for expert radiologists, respectively, and 79% and 82% for general radiologists, compared with 46% for FE. Inter-reader agreement for detecting EP by CT and CTE was kappa 0.35 and 0.42 (both p < .001) between expert and generalist radiologists. We present radiographic images for key CT/CTE findings and a suggested workflow for the evaluation of possible EP. 4
29. Suarez-Poveda T, Morales-Uribe CH, Sanabria A, et al. Diagnostic performance of CT esophagography in patients with suspected esophageal rupture. Emergency Radiology. 21(5):505-10, 2014 Oct.EMERG. RADIOL.. 21(5):505-10, 2014 Oct. Observational-Dx 64 patients To assess the diagnostic performance of CT esophagography in patients with a suspicion of esophageal rupture. A total of 64 patients were recruited (age 26.5 years, 90 % male, 82 % trauma). Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were 77.7 % (95 % confidence interval (CI) 45-100), 94.3 % (87.2-100), 14 (9.81-19.9), and 0.24 (0.05-1.22), respectively. The final model for predicting rupture included five variables: age (odds ratio (OR) 1.03; 95 % CI, 0.95-1.11; p=0.04), leakage of contrast media into the mediastinum or pleural space (OR 10.0; 95 % CI, 0.64-156.9; p=0.10), extraluminal air or fluid collections (OR 43.1; 95 % CI, 1.52-1217.3; p=0.027), esophageal wall thickening (OR 10.1; 95 % CI, 0.50-202.8; p=0.12), and left pneumothorax or pleural effusion (OR 6.5; 95 % CI, 0.31-132.7; p=0.2). The overall agreement was 0.40 (95 % CI, 0.09-0.72) for the predictive model. The model sensitivity was 50.0 %, and the specificity was 98.4 %. CT esophagography shows a good diagnostic performance in patients with a suspected esophageal rupture. 3
30. Johnson LN, Moran SK, Bhargava P, et al. Fluoroscopic Evaluation of Duodenal Diseases. Radiographics. 42(2):397-416, 2022 Mar-Apr.Radiographics. 42(2):397-416, 2022 Mar-Apr. Review/Other-Dx N/A To examine the broad spectrum of conditions that can involve the duodenum, including congenital, infectious, inflammatory, and neoplastic abnormalities, and review their typical appearances at fluoroscopy. No results stated in abstract. 4
31. Miller RE, Nelson SW. The roentgenologic demonstration of tiny amounts of free intraperitoneal gas: experimental and clinical studies. Am J Roentgenol Radium Ther Nucl Med. 1971 Jul;112(3):574-85. Review/Other-Dx N/A To clarify 2 questions; 1) “What is the minimum volume of intraperitoneal gas which can be demonstrated by the best radiologic technique?”; and 2) “What is the best radiologic technique for the demonstration of this minimum volume?” No abstract available. 4
32. Gans SL, Stoker J, Boermeester MA. Plain abdominal radiography in acute abdominal pain; past, present, and future. International journal of general medicine. 5:525-33, 2012.Int J Gen Med. 5:525-33, 2012. Review/Other-Dx N/A No results stated in abstract No results stated in abstract 4
33. Roh JJ, Thompson JS, Harned RK, Hodgson PE. Value of pneumoperitoneum in the diagnosis of visceral perforation. American Journal of Surgery. 146(6):830-3, 1983 Dec.Am J Surg. 146(6):830-3, 1983 Dec. Review/Other-Dx N/A The routine use of the left lateral decubitus film to detect pneumoperitoneum and the judicious use of gastrointestinal contrast studies should be part of the optimal management of patients with suspected visceral perforation. Visceral perforation resulted in pneumoperitoneum in only 51 percent of patients in this study. Pneumoperitoneum occurred in 14 percent of patients in whom the extraalimentary intraperitoneal air had sources other than a perforated viscus. 4
34. Wu CH, Chen CM, Chen CC, et al. Esophagography after pneumomediastinum without CT findings of esophageal perforation: is it necessary?. AJR. American Journal of Roentgenology. 201(5):977-84, 2013 Nov.AJR Am J Roentgenol. 201(5):977-84, 2013 Nov. Observational-Dx 103 patients To determine the necessity of fluoroscopic esophagography in patients with pneumomediastinum on CT but without CT findings of esophageal perforation. Esophageal perforation was diagnosed in 15 of the 103 patients. The CT findings were significantly correlated with esophageal perforation (p < 0.001 in the trauma group, and p = 0.001 in the nontrauma group). The respective sensitivity and negative predictive value (NPV) of CT versus fluoroscopic esophagography in the trauma group were 100% versus 66.7% and 100% versus 87.9%; in the nontrauma group, the sensitivity and NPV were 100% for CT and fluoroscopic esophagography. Thus, the sensitivity and NPV of CT were either superior or equal to those of fluoroscopic esophagography. 3
35. Levine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. [Review] [78 refs]. Radiology. 237(2):414-27, 2005 Nov. Review/Other-Dx N/A To review of gastroesophageal reflux disease, other types of esophagitis, benign and malignant esophageal tumors, varices, lower esophageal rings, diverticula, and esophageal motility disorders, all of which can be diagnosed with the aid of esophagography. No results stated in abstract. 4
36. Jobe BA, Richter JE, Hoppo T, et al. Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the Esophageal Diagnostic Advisory Panel. J Am Coll Surg. 217(4):586-97, 2013 Oct. Review/Other-Dx N/A To review data and personal experience with regard to appropriate preoperative evaluation for antireflux surgery and to construct an evidence and experience-based consensus that has practical application. The presence of reflux symptoms alone is not sufficient to support a diagnosis of GERD before antireflux surgery. Esophageal objective testing is required to physiologically and anatomically evaluate the presence and severity of GERD in all patients being considered for surgical intervention. It is critical to document the presence of abnormal distal esophageal acid exposure, especially when antireflux surgery is considered, and reflux-related symptoms should be severe enough to outweigh the potential side effects of fundoplication. Each testing modality has a specific role in the diagnosis and workup of GERD, and no single test alone can provide the entire clinical picture. Results of testing are combined to document the presence and extent of the disease and assist in planning the operative approach. 4
38. Dempsey DT.. Barium upper GI series in adults: a surgeon's perspective. [Review]. Abdom Radiol. 43(6):1323-1328, 2018 06. Review/Other-Dx N/A To provide information regarding barium upper GI series from a surgeon's perspective. No results stated in abstract. 4
39. Kitchin DR, Lubner MG, Menias CO, Santillan CS, Pickhardt PJ. MDCT diagnosis of gastroduodenal ulcers: key imaging features with endoscopic correlation. [Review]. Abdom Imaging. 40(2):360-84, 2015 Feb. Review/Other-Dx N/A To present an overview of the CT findings of both uncomplicated and complicated PUD, as well as several diagnostic pitfalls which can result in misdiagnosis from peptic ulcer mimics, to help facilitate improved recognition of PUD on abdominal CT, No results stated in abstract. 4
40. Creteur V, Thoeni RF, Federle MP, et al. The role of single and double-contrast radiography in the diagnosis of reflux esophagitis. Radiology. 147(1):71-5, 1983 Apr. Observational-Dx 77 patients with esophagitis;25 patient with no esophagitis To study the role of single and double-contrast radiography for the diagnosis of reflux esophagitis. The respective sensitivities were 77% for the single-contrast examination, 80% for the double-contrast examination, and 88% for the combined examination method with no significant statistical difference (P = 0.05). The sensitivity increased for all methods with an increased severity of esophagitis. False positives more frequently occurred with double-contrast radiography, leading to similar accuracy rates for all methods (74% to 77%). 2
41. Koehler RE, Weyman PJ, Oakley HF. Single- and double-contrast techniques in esophagitis. AJR Am J Roentgenol. 135(1):15-9, 1980 Jul. Observational-Dx 52 patients To compare the relative efficacy of double- and single-contrast radiographs of the esophagus in the detection of esophagitis. The addition of double-contrast views to the examination increased the number of radiographic abnormalities seen and led to the radiographic detection of esophagitis in four patients in whom the diagnosis would otherwise have been missed. The use of double-contrast views did not lead to significant improvement in the overall accuracy, however, since their use was associated with an increase in the false-positive interpretation rate. Superficial mucosal irregularity, ulcers, and narrowing were the most specific radiographic abnormalities and all were detected more frequently on double-contrast views. 3
42. Fornari F, Gurski RR, Navarini D, Thiesen V, Mestriner LH, Madalosso CA. Clinical utility of endoscopy and barium swallow X-ray in the diagnosis of sliding hiatal hernia in morbidly obese patients: a study before and after gastric bypass. Obes Surg. 20(6):702-8, 2010 Jun. Observational-Dx 92 patients To assess the clinical utility of endoscopy and X-ray in the diagnosis of SHH in morbidly obese patients before and after gastric bypass (GBP). SHH was more prevalent when characterized by X-ray than endoscopy either before (33% vs. 17%; P = 0.017) or after GBP (26% vs. 7%; P = 0.001). Endoscopy showed low sensitivity (<or=40%) and high specificity (>or=94%) in diagnosing SHH. Before GBP, more patients with SHH had GERD compared to patients without SHH using either X-ray (83% vs. 58%; P = 0.016) or endoscopy (94% vs. 61%; P = 0.009). After GBP, only patients with radiologic evidence of SHH showed higher prevalence of GERD compared to patients without SHH (50% vs. 26%; P = 0.037). SHH patients also reported weekly or daily vomit more often than patients without SHH (59% vs. 32%; P = 0.026). 3
43. Katzka DA.. A gastroenterologist's perspective on the role of barium esophagography in gastroesophageal reflux disease. [Review]. Abdom Radiol. 43(6):1319-1322, 2018 06. Review/Other-Dx N/A To review the role of barium esophagography in gastroesophageal reflux disease from a gastroenterologist's perspective. No results stated in abstract. 4
44. Pauwels A, Boecxstaens V, Andrews CN, et al. How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery). Gut. 2019 Nov;68(11):1928-1941. Review/Other-Dx N/A To generate key recommendations in the selection of patients for antireflux surgery. Patients with heartburn with a satisfactory response to PPIs, patients with a hiatal hernia (HH), patients with oesophagitis Los Angeles (LA) grade B or higher and patients with Barrett's oesophagus are good candidates for antireflux surgery. An endoscopy prior to antireflux surgery is mandatory and a barium swallow should be performed in patients with suspicion of a HH or short oesophagus. Oesophageal manometry is mandatory to rule out major motility disorders. Finally, oesophageal pH (±impedance) monitoring of PPI is mandatory to select patients for antireflux surgery, if endoscopy is negative for unequivocal reflux oesophagitis. 4
45. Levine MS, Rubesin SE, Herlinger H, Laufer I. Double-contrast upper gastrointestinal examination: technique and interpretation. [Review] [43 refs]. Radiology. 168(3):593-602, 1988 Sep.Radiology. 168(3):593-602, 1988 Sep. Review/Other-Dx N/A The development of double-contrast upper gastrointestinal examination: technique and interpretation. No abstract available. 4
46. Rubesin SE, Levine MS, Laufer I. Double-contrast upper gastrointestinal radiography: a pattern approach for diseases of the stomach. [Review] [104 refs]. Radiology. 246(1):33-48, 2008 Jan. Review/Other-Dx N/A To review the normal radiographic anatomy of the stomach in regards to double-contast upper gastrointestinal radiography. No results stated in abstract. 4
47. Levine MS, Carucci LR, DiSantis DJ, et al. Consensus Statement of Society of Abdominal Radiology Disease-Focused Panel on Barium Esophagography in Gastroesophageal Reflux Disease. AJR. American Journal of Roentgenology. 207(5):1009-1015, 2016 Nov.AJR Am J Roentgenol. 207(5):1009-1015, 2016 Nov. Review/Other-Dx N/A The Society of Abdominal Radiology established a panel to prepare a consensus statement on the role of barium esophagography in gastroesophageal reflux disease (GERD), as well as recommended techniques for performing the fluoroscopic examination and the gamut of findings associated with this condition. No results stated in abstract. 4
48. Guniganti P, Bradenham CH, Raptis C, Menias CO, Mellnick VM. CT of Gastric Emergencies. [Review]. Radiographics. 35(7):1909-21, 2015 Nov-Dec.Radiographics. 35(7):1909-21, 2015 Nov-Dec. Review/Other-Dx N/A To review the normal anatomy of the stomach and discuss emergent gastric disease with a focus on the usual clinical presentation, typical imaging appearance, and differentiating features, as well as potential imaging pitfalls. No results stated in abstract. 4
49. Eren S, Ciris F. Diaphragmatic hernia: diagnostic approaches with review of the literature. [Review] [52 refs]. European Journal of Radiology. 54(3):448-59, 2005 Jun.Eur J Radiol. 54(3):448-59, 2005 Jun. Review/Other-Dx 21 patients To review diaphragmatic hernia types associated with cases, and discuss the preferred imaging modalities for different DHs with review of the literature. Although its limited findings on DH and indirect findings about the diaphragmatic rupture, plain radiography is firstly preferred technique on DH. We found that ultrasound (US) is a useful tool on DH, on traumatic DH cases especially. Not only it shows diaphragmatic continuity and herniated organs, but also it reveals associated abdominal organ's pathologies. Computed tomography (CT) scan is most effective in many DH cases. It shows the herniated abdominal organs together with complications, such as intestinal strangulation, haemothorax, and rib fractures. We stressed that Multislice CT scan with coronal and sagittal reformatted images is the most effective and useful imaging technique on DH. 4
50. Lambert L, Grusova G, Burgetova A, Matras P, Lambertova A, Kuchynka P. The predictive value of computed tomography in the detection of reflux esophagitis in patients undergoing upper endoscopy. Clin Imaging. 49:97-100, 2018 May - Jun. Observational-Dx 72 RE patients; 108 matched patients without RE To evaluate for distal esophageal wall characteristics. In RE patients the distal esophageal wall thickness was greater (5.2+/-2.0mm) compared to patients without RE (3.5+/-1.2mm, p<0.0001) with AUC of 0.78 and 56% sensitivity, 88% specificity for a 5.0mm cut-off. 3
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