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Chronic_Hand_and_Wrist_Pain_Apdx_0004_5e11a131
Chronic_Hand_and_Wrist_Pain_Apdx
6 (28737618) 4 17 (29732587) 4 18 (34100996) 4 46 (20566255) 4 CT arthrography wrist May be appropriate Limited ☢ <0.1 mSv 5 5 0 1 1 1 7 3 0 0 0 References Study Quality 22 (19233582) 3 23 (16304116) 2 21 (18480484) 4 6 (28737618) 4 18 (34100996) 4 CT wrist without IV contrast May be appropriate Limited ☢ <0.1 mSv 5 5 0 0 2 0 6 4 1 0 0 References Study Quality 24 (16615200) 4 27 (26553886) 3 6 (28737618) 4 25 (27554667) 2 28 (26710736) 3 26 (33040956) 4 Radiography wrist additional views May be appropriate Limited ☢ <0.1 mSv 5 5 2 0 1 3 6 0 0 1 0 References Study Quality 18 (34100996) 4 CT wrist with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 10 0 2 1 0 0 0 0 0 CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 10 1 1 1 0 0 0 0 0
Chronic_Hand_and_Wrist_Pain_Apdx_0005_055dec5c
Chronic_Hand_and_Wrist_Pain_Apdx
Radiographic arthrography wrist Usually not appropriate Limited ☢ <0.1 mSv 1 1 13 0 0 0 0 0 0 0 0 References Study Quality 45 (21467087) M MRI wrist without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 7 1 2 0 3 0 0 0 0 References Study Quality 35 (16498112) 3 9 (30171275) 4 3 (36436971) 4 2 (37236743) 4 Bone scan wrist Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 8 1 2 1 1 0 0 0 0 References Study Quality 19 (12364624) 4 20 (19756904) M Variant 3: Adult. Chronic hand pain. Radiographs normal or remarkable for nonspecific arthritis. Next imaging study. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 MRI hand without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 5 1 1 4 2 References Study Quality 50 (11818612) 3 49 (27236512) 3 13 (32115082) 4 54 (33345693) 2 53 (32558377) 4 52 (30637474) 4
Chronic_Hand_and_Wrist_Pain_Apdx_0006_6d62f68a
Chronic_Hand_and_Wrist_Pain_Apdx
44 (34137663) 4 51 (15729562) 4 US hand May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 4 3 4 1 1 References Study Quality 14 (23111854) 4 15 (28024659) 3 16 (31421023) 2 13 (32115082) 4 6 (28737618) 4 17 (29732587) 4 MRI hand without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 4 1 0 1 5 1 1 0 0 References Study Quality 48 (30978394) 4 47 (28216312) 4 CT hand with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 9 1 2 1 0 0 0 0 0 CT hand without IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 9 1 0 0 2 1 0 0 0 CT hand without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 9 1 2 0 1 0 0 0 0 Bone scan hand Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 1 2 1 0 0 0 0 0 CT arthrography hand Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 9 2 1 0 0 1 0 0 0 MR arthrography hand Usually not appropriate Expert Consensus O 0 mSv O 0 mSv
Chronic_Hand_and_Wrist_Pain_Apdx_0007_d22dea5d
Chronic_Hand_and_Wrist_Pain_Apdx
MR arthrography hand Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 1 1 0 0 1 1 0 0 Radiographic arthrography hand Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 9 1 0 1 1 1 0 0 0
Chronic_Hand_and_Wrist_Pain_Apdx_0008_4312f209
Chronic_Hand_and_Wrist_Pain_Apdx
Variant 4: Adult. Chronic wrist pain. Radiographs show old scaphoid fracture. Evaluate for nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis. Next imaging study. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 MRI wrist without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 4 2 7 References Study Quality 57 (17312277) 2 59 (20858790) 2 CT wrist without IV contrast Usually appropriate Limited ☢ <0.1 mSv 8 8 0 0 0 0 2 1 3 3 4 References Study Quality 27 (26553886) 3 28 (26710736) 3 MRI wrist without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 3 4 2 1 2 References Study Quality 57 (17312277) 2 58 (10628470) 2 CT arthrography wrist Usually not appropriate Limited ☢ <0.1 mSv 1 1 7 0 2 1 1 1 0 1 0 References Study Quality 22 (19233582) 3 CT wrist with IV contrast Usually not appropriate Limited ☢ <0.1 mSv 1 1 7 4 1 0 0 1 0 0 0
Chronic_Hand_and_Wrist_Pain_Apdx_0009_bb547ec6
Chronic_Hand_and_Wrist_Pain_Apdx
CT wrist with IV contrast Usually not appropriate Limited ☢ <0.1 mSv 1 1 7 4 1 0 0 1 0 0 0 References Study Quality 55 (30183133) 4
Chronic_Hand_and_Wrist_Pain_Apdx_0010_ae946f21
Chronic_Hand_and_Wrist_Pain_Apdx
CT wrist without and with IV contrast Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 8 1 1 1 2 0 0 0 0 Radiographic arthrography wrist Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 10 0 2 0 0 1 0 0 0 MR arthrography wrist Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 8 1 1 1 1 0 0 0 1 References Study Quality 31 (23812413) 3 56 (17449771) 1 Bone scan wrist Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 1 2 0 0 0 1 0 0 US wrist Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 1 2 0 0 0 1 0 0 Variant 5: Adult. Chronic hand or wrist pain. Radiographs normal or indeterminate. Symptoms suspicious for carpal tunnel syndrome. Next imaging study. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 MRI area of interest without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 3 4 2 0 2 References Study Quality 61 (28075090) 4 63 (31126663) 2
Chronic_Hand_and_Wrist_Pain_Apdx_0011_49cb0d18
Chronic_Hand_and_Wrist_Pain_Apdx
[ped] 6 6 0 0 1 1 3 4 2 0 2 References Study Quality 61 (28075090) 4 63 (31126663) 2 62 (31396669) 1 64 (29799270) 1 60 (27869627) 4 US area of interest May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 3 2 2 2 2 References Study Quality 66 (22244369) M
Chronic_Hand_and_Wrist_Pain_Apdx_0012_c26895bf
Chronic_Hand_and_Wrist_Pain_Apdx
65 (20963527) M 70 (25187592) 2 74 (28666673) 4 72 (32323256) 4 73 (34812067) 3 67 (28947163) Good 71 (30635201) 2 68 (30702462) Good 69 (34261588) 4 60 (27869627) 4 CT area of interest with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 10 3 0 0 0 0 0 0 0 CT area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 11 0 1 1 0 0 0 0 0 CT area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 11 1 1 0 0 0 0 0 0 Radiographic arthrography area of interest Usually not appropriate Expert Consensus Varies Varies 1 1 11 1 0 0 1 0 0 0 0 MRI area of interest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 0 2 0 0 0 1 0 0 Bone scan area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 13 0 0 0 0 0 0 0 0 Radiography wrist additional views Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 9 1 1 0 1 1 0 0 0
Chronic_Hand_and_Wrist_Pain_Apdx_0013_13d37b4a
Chronic_Hand_and_Wrist_Pain_Apdx
views Usually not appropriate Expert Consensus ☢ <0.1 mSv 1 1 9 1 1 0 1 1 0 0 0 MR arthrography area of interest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 1 1 0 0 0 0 0 0 CT arthrography area of interest Usually not appropriate Expert Consensus Varies Varies 1 1 11 1 1 0 0 0 0 0 0
Chronic_Hand_and_Wrist_Pain_Apdx_0014_0f25c0a2
Chronic_Hand_and_Wrist_Pain_Apdx
Variant 6: Adult. Chronic hand or wrist pain. Radiographs normal or show nonspecific arthritis. Suspect tendon injury, tenosynovitis, or tendon pathology. Next imaging study. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 MRI area of interest without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 2 11 References Study Quality 43 (27726753) 4 13 (32115082) 4 77 (31351544) 4 76 (12740463) 4 US area of interest Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 2 2 8 References Study Quality 79 (20033358) 3 13 (32115082) 4 6 (28737618) 4 78 (28960382) 1 77 (31351544) 4 80 (33934941) 2 46 (20566255) 4 MRI area of interest without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 3 8 1 0 0 0 References Study Quality 75 (16941192) 3 43 (27726753) 4 CT area of interest with IV contrast Usually not appropriate Expert
Chronic_Hand_and_Wrist_Pain_Apdx_0015_22f950a9
Chronic_Hand_and_Wrist_Pain_Apdx
75 (16941192) 3 43 (27726753) 4 CT area of interest with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 11 1 1 0 0 0 0 0 0
Chronic_Hand_and_Wrist_Pain_Apdx_0016_873e56c7
Chronic_Hand_and_Wrist_Pain_Apdx
CT area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 10 2 1 0 0 0 0 0 0 CT area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 10 2 0 1 0 0 0 0 0 Radiographic arthrography area of interest Usually not appropriate Expert Consensus Varies Varies 1 1 11 1 0 0 1 0 0 0 0 Bone scan area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 1 0 0 0 0 0 0 0 MR arthrography area of interest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 0 1 0 0 1 0 0 CT arthrography area of interest Usually not appropriate Expert Consensus Varies Varies 1 1 11 1 1 0 0 0 0 0 0
Chronic_Hand_and_Wrist_Pain_Apdx_0017_e12a52c8
Chronic_Hand_and_Wrist_Pain_Apdx
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.
Chronic_Hand_and_Wrist_Pain_Apdx_0018_2983ddb5
Chronic_Hand_and_Wrist_Pain_Apdx
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.
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0000_26472735
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
American College of Radiology ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, No Acute Symptoms Variant 1: Adult female. Clinically suspected adnexal mass, no acute symptoms. Premenopausal or postmenopausal. Initial imaging. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 US duplex Doppler pelvis Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 1 4 1 7 References Study Quality 19 (9618853) 3 23 (18504770) 3 21 (9646799) 2 20 (10739694) 3 25 (7839975) 3 24 (11176291) 4 22 (31687921) 4 US pelvis transvaginal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 2 10 US pelvis transabdominal and US pelvis transvaginal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 1 11 References Study Quality 39 (11169340) 4 35 (14529661) 3 32 (19244063) 3 23 (18504770) 3 27 (10586480) 3
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0001_0bedfd0b
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
26 (10201081) 3 37 (30149950) 4 36 (25320247) 3 43 (28727500) 3 44 (31770022) 3 34 (30303910) 3 22 (31687921) 4 28 (27776067) 4 30 (32736853) 4 29 (34474226) 4 41 (31549945) 4 45 (32809166) 2 31 (12634641) 4 33 (20505067) 4 42 (23358210) 3 38 (24937676) 3 40 (36520422) 3 US pelvis transabdominal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 4 5 4 1 MRI pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 3 3 6 0 1 0 References Study Quality 15 (31482379) 3 16 (35040672) 4 MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 3 2 4 3 0 1 0 References Study Quality 17 (7824738) 2 18 (33725187) 3
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0002_762b1f68
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 3 5 2 1 2 1 0 0 0 CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 6 5 3 0 0 0 0 0 0 CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 4 5 3 0 2 0 0 0 0 FDG-PET/CT skull base to mid- thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 13 0 1 0 0 0 0 0 0 Variant 2: Adult female. Adnexal mass, likely benign, no acute symptoms. Premenopausal. Follow-up imaging. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 US pelvis transvaginal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 3 2 9 US pelvis transabdominal and US pelvis transvaginal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 1 1 11 References Study Quality
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0003_922d6ab2
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 1 1 11 References Study Quality 51 (27282774) 3 24 (11176291) 4 48 (30419104) 3 34 (30303910) 3 22 (31687921) 4 50 (30737137) 2 53 (29112653) 3 55 (29702449) Good 41 (31549945) 4 45 (32809166) 2 33 (20505067) 4
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0004_7b09ffdd
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
46 (20096820) 4 47 (21762355) 3 49 (23583217) 4 52 (21351179) 3 54 (35315722) 3 US duplex Doppler pelvis Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 1 4 3 5 US pelvis transabdominal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 4 6 3 1 MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 0 1 8 4 1 0 0 0 References Study Quality 17 (7824738) 2 18 (33725187) 3 MRI pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 1 0 0 8 5 1 1 0 0 References Study Quality 15 (31482379) 3 16 (35040672) 4 CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 3 8 2 0 0 0 1 0 0 CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 6 7 1 0 0 0 0 0 0 CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped]
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0005_2ab512ea
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 5 6 3 0 0 0 0 0 0 FDG-PET/CT skull base to mid- thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 11 2 1 0 0 0 0 0 0 Variant 3: Adult female. Adnexal mass, likely benign, no acute symptoms. Postmenopausal. Follow-up Imaging.
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0006_eb247e58
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 US pelvis transvaginal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 3 2 9 US pelvis transabdominal and US pelvis transvaginal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 2 11 References Study Quality 58 (12962948) 4 56 (23001924) 3 59 (20503240) 3 48 (30419104) 3 34 (30303910) 3 55 (29702449) Good 57 (31396641) 3 41 (31549945) 4 46 (20096820) 4 47 (21762355) 3 US duplex Doppler pelvis Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 0 5 1 6 US pelvis transabdominal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 0 2 7 3 1 MRI pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 4 8 0 1 0 References Study Quality 15 (31482379) 3 16 (35040672) 4 MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0007_3210e0f4
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
16 (35040672) 4 MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 6 4 3 0 0 0 References Study Quality
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0008_94b1718c
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
17 (7824738) 2 18 (33725187) 3 CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 3 7 1 1 0 2 0 0 0 CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 6 7 1 0 0 0 0 0 0 CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 6 5 2 0 1 0 0 0 0 FDG-PET/CT skull base to mid- thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 2 2 0 0 0 0 0 0 Variant 4: Adult female. Adnexal mass, indeterminate on initial pelvic US, no acute symptoms. Premenopausal or postmenopausal. Next imaging study for characterization. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 MRI pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 1 1 11 References Study Quality 69 (24183731) 4
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0009_b05a4faa
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
[ped] 9 9 0 0 0 0 0 1 1 1 11 References Study Quality 69 (24183731) 4 73 (22095438) 2 77 (22105841) 3 81 (19214523) 3 79 (21193596) 2 84 (29467113) 3 68 (27770228) 4 85 (27583370) 3 43 (28727500) 3 72 (31977064) 3 82 (33484725) 4
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0010_247a85f8
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
75 (27367786) 3 71 (33929901) 4 83 (32715577) 2 16 (35040672) 4 70 (23468574) 2 74 (20419493) 3 76 (22814827) 3 78 (18581400) 3 80 (18972356) 3 MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 4 10 1 0 0 References Study Quality 17 (7824738) 2 72 (31977064) 3 86 (30177450) 4 18 (33725187) 3 16 (35040672) 4 70 (23468574) 2 CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 4 4 3 0 2 1 0 0 0 CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 7 3 3 0 1 0 0 0 0 CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 4 5 1 0 3 1 0 0 0 FDG-PET/CT skull base to mid- thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 9 1 4 0 0 0 0 0 0 References Study Quality 65 (24463640) 3 62 (34112736) 4
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0011_7e63db75
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
63 (15599527) 4 64 (29399968) 3 66 (18423470) 3 67 (20093590) 4 Variant 5: Adult female. Adnexal mass, indeterminate on initial pelvic US, no acute symptoms. Premenopausal. Follow-up imaging. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 US pelvis transvaginal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 1 3 2 7 US pelvis transabdominal and US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 0 2 2 9 References Study Quality 60 (29480762) 3 44 (31770022) 3 72 (31977064) 3 22 (31687921) 4 16 (35040672) 4 MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 1 4 5 2 References Study Quality 16 (35040672) 4 US duplex Doppler pelvis Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 1 1 3 2 6 MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 4 1 6 2 0 0
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0012_c9b00b57
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 4 1 6 2 0 0 References Study Quality 17 (7824738) 2 72 (31977064) 3
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0013_536d2462
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
86 (30177450) 4 18 (33725187) 3 16 (35040672) 4 70 (23468574) 2 US pelvis transabdominal May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 1 0 0 0 2 5 5 1 0 CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 6 3 2 2 1 0 0 0 0 CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 7 5 2 0 0 0 0 0 0 CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 6 3 2 1 2 0 0 0 0 FDG-PET/CT skull base to mid- thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 12 2 0 0 0 0 0 0 0 Variant 6: Adult female. Adnexal mass, indeterminate on initial pelvic US, no acute symptoms. Postmenopausal. Follow-up imaging. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 US duplex Doppler pelvis Usually appropriate Expert
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0014_3ea7bf29
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
1 2 3 4 5 6 7 8 9 US duplex Doppler pelvis Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 2 1 1 3 7 US pelvis transvaginal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 2 1 4 7 US pelvis transabdominal and US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 1 3 9 References Study Quality 90 (27876070) 3 60 (29480762) 3
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0015_1fe3e4fd
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
88 (25068555) 3 44 (31770022) 3 72 (31977064) 3 89 (33992598) 3 91 (28118296) 4 16 (35040672) 4 MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 6 3 4 References Study Quality 16 (35040672) 4 87 (25273949) 3 US pelvis transabdominal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 1 5 5 0 2 MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 3 11 2 0 0 References Study Quality 17 (7824738) 2 72 (31977064) 3 86 (30177450) 4 18 (33725187) 3 16 (35040672) 4 70 (23468574) 2 CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 4 4 3 1 1 0 1 0 0 CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 7 4 3 0 0 0 0 0 0 CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 5 3 2 0 3 0 1 0 0
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0016_897d3776
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
FDG-PET/CT skull base to mid- thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 2 1 0 0 1 0 0 0 Variant 7: Adult female. Adnexal mass, suspicious for malignancy on pelvic US, no acute symptoms. Premenopausal or postmenopausal. Next imaging study for characterization. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 MRI pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 2 0 13 References Study Quality 61 (21156740) 3 73 (22095438) 2 77 (22105841) 3 23 (18504770) 3 79 (21193596) 2 60 (29480762) 3 68 (27770228) 4 36 (25320247) 3 44 (31770022) 3 72 (31977064) 3 22 (31687921) 4 75 (27367786) 3 16 (35040672) 4 33 (20505067) 4 54 (35315722) 3 70 (23468574) 2 74 (20419493) 3 76 (22814827) 3 78 (18581400) 3
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0017_96413cdd
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
94 (35230183) 3 MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 2 6 4 1 0 References Study Quality 17 (7824738) 2 72 (31977064) 3 86 (30177450) 4 18 (33725187) 3 16 (35040672) 4 70 (23468574) 2 CT pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 5 5 5 1 7 0 0 1 0 0 2 CT pelvis with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 3 3 4 4 6 0 0 0 1 1 0 References Study Quality 92 (29724422) 4 FDG-PET/CT skull base to mid- thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 3 3 7 0 5 0 3 1 0 0 0 References Study Quality 93 (23988417) 2 CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 2 2 0 1 0 1 0 0 Variant 8: Female. Clinically suspected adnexal mass, no acute symptoms. Pregnant. Initial imaging. Procedure Appropriateness
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0018_421d3a85
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 US pelvis transvaginal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 2 4 7
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0019_1bd6ed21
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
US pelvis transabdominal and US pelvis transvaginal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 2 10 References Study Quality 108 (26482730) 3 109 (24496773) 4 100 (9315194) 4 110 (27484484) 4 103 (33515746) Good 28 (27776067) 4 101 (32347749) 4 102 (10214838) 3 104 (21194826) 4 105 (16310839) 4 106 (15863550) 3 107 (10411786) 4 111 (11127014) 4 112 (33671023) 3 113 (34902893) 4 US duplex Doppler pelvis Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 6 3 4 References Study Quality 19 (9618853) 3 23 (18504770) 3 21 (9646799) 2 20 (10739694) 3 25 (7839975) 3 24 (11176291) 4 22 (31687921) 4 US pelvis transabdominal Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 2 5 5 1
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0020_279c43af
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 6 5 3 1 0 0 References Study Quality 17 (7824738) 2 95 (-3188538) 4 18 (33725187) 3 15 (31482379) 3 16 (35040672) 4 MRI pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 1 5 1 1 0 1 0 0 References Study Quality 97 (27599330) 3 99 (28668416) 2 95 (-3188538) 4 96 (22003244) 3 98 (-3195845) 4 CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 11 3 0 0 0 0 0 0 0 CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 11 3 0 0 0 0 0 0 0 CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 12 2 0 0 0 0 0 0 0 FDG-PET/CT skull base to mid- thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 14 0 0 0 0 0 0 0 0
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0021_faff8dc4
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 14 0 0 0 0 0 0 0 0 Variant 9: Female . Adnexal mass, indeterminate on initial pelvic US, no acute symptoms. Pregnant. Next imaging study for characterization. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0022_a4f84c93
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 MRI pelvis without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 4 2 8 References Study Quality 61 (21156740) 3 108 (26482730) 3 110 (27484484) 4 60 (29480762) 3 95 (-3188538) 4 72 (31977064) 3 86 (30177450) 4 18 (33725187) 3 16 (35040672) 4 70 (23468574) 2 114 (27130065) 3 MRI pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 0 8 5 1 0 1 0 0 References Study Quality 97 (27599330) 3 99 (28668416) 2 95 (-3188538) 4 96 (22003244) 3 98 (-3195845) 4 CT pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 3 0 0 0 1 0 0 0 CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 3 0 1 0 0 0 0 0 CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0023_2746106a
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 11 2 0 0 0 1 0 0 0
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0024_a55edd75
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
FDG-PET/CT skull base to mid- thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 13 0 1 0 0 0 0 0 0
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0025_e12a52c8
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
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.
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx_0026_2983ddb5
Clinically_Suspected_Adnexal_Mass _No_Acute_Symptoms_Apdx
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.
Suspected_Pulmonary_Embolism_Apdx_0000_efa1a93f
Suspected_Pulmonary_Embolism_Apdx
American College of Radiology ACR Appropriateness Criteria® Suspected Pulmonary Embolism Variant 1: Suspected pulmonary embolism. Low or intermediate pretest probability with a negative D-dimer. Initial Imaging. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 8 4 2 1 1 1 0 0 1 References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 8 (21969343) M CTA chest with IV contrast with CTV lower extremities Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 8 5 2 2 0 0 1 0 0 References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 8 (21969343) M US duplex Doppler lower extremity Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 9 7 1 1 0 0 0 0 0
Suspected_Pulmonary_Embolism_Apdx_0001_a3eee346
Suspected_Pulmonary_Embolism_Apdx
References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 8 (21969343) M CTA pulmonary arteries with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 8 5 5 0 0 0 0 0 0 References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 8 (21969343) M CT chest with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 12 4 2 0 0 0 0 0 0 References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 8 (21969343) M CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 3 2 1 1 0 0 1 0 References Study Quality 12 (20592294) 4 13 (21047572) 4
Suspected_Pulmonary_Embolism_Apdx_0002_d2cbf726
Suspected_Pulmonary_Embolism_Apdx
14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 8 (21969343) M Arteriography pulmonary with right heart catheterization Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 17 0 0 0 0 0 0 1 0 References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 19 (8222808) 3 18 (6859705) 4 17 (16515356) 3 8 (21969343) M MRA pulmonary arteries without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 4 3 0 0 0 0 1 0 References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 8 (21969343) M MRA pulmonary arteries without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 4 2 0 0 0 1 0 0 References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1
Suspected_Pulmonary_Embolism_Apdx_0003_4c4c748c
Suspected_Pulmonary_Embolism_Apdx
15 (19620439) 3 16 (18343077) 3 8 (21969343) M V/Q scan lung Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 5 1 0 0 0 0 0 0 References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 8 (21969343) M US echocardiography transthoracic resting Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 5 1 0 1 0 0 0 1 References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 8 (21969343) M US echocardiography transesophageal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 15 2 0 0 0 0 0 0 1 References Study Quality 12 (20592294) 4 13 (21047572) 4 14 (20740096) 1 15 (19620439) 3 16 (18343077) 3 8 (21969343) M
Suspected_Pulmonary_Embolism_Apdx_0004_c333b815
Suspected_Pulmonary_Embolism_Apdx
Variant 2: Suspected pulmonary embolism. Low or intermediate pretest probability with a positive D-dimer. Initial imaging. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 CTA pulmonary arteries with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 1 0 0 0 0 1 1 1 14 References Study Quality 20 (14657313) 1 22 (12500376) 4 23 (16097441) 3 21 (8284406) 2 24 (14658001) 3 V/Q scan lung Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 0 2 0 5 7 3 1 References Study Quality 59 (7152856) 4 10 (8372182) 3 61 (17060547) 1 58 (18165667) 1 1 (28671347) 4 60 (17625390) 2 MRA pulmonary arteries without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 0 1 13 1 2 0 0 References Study Quality 34 (16794142) 2 35 (16714660) 2 36 (12020524) 1 38 (16632150) 3 39 (22375614) 4
Suspected_Pulmonary_Embolism_Apdx_0005_249a5e6e
Suspected_Pulmonary_Embolism_Apdx
40 (21347594) 4 21 (8284406) 2 24 (14658001) 3 42 (22664742) 3 41 (23553735) 3 37 (18308025) 3 1 (28671347) 4 CTA triple rule out May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 1 6 3 2 2 3 0 0 1 References Study Quality 29 (16738268) 2 30 (9442137) 3 28 (17675613) 1 31 (26124909) 3 CTA chest with IV contrast with CTV lower extremities Usually not appropriate Strong ☢☢☢ 1-10 mSv 3 3 2 7 4 4 1 0 0 0 0 References Study Quality 25 (11323478) 1 27 (18212216) 3 26 (10966705) 2 MRA pulmonary arteries without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 5 4 4 2 1 1 1 0 0 References Study Quality 41 (23553735) 3 44 (20368649) 2 43 (28116500) 2 US duplex Doppler lower extremity Usually not appropriate Moderate O 0 mSv O 0 mSv [ped] 3 3 2 7 4 0 3 2 0 0 0 References Study Quality 46 (15845793) 3
Suspected_Pulmonary_Embolism_Apdx_0006_063c5eb2
Suspected_Pulmonary_Embolism_Apdx
45 (18043357) 3 49 (19427980) 1 47 (17555069) 4 48 (17179348) 1 CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 7 8 2 1 0 0 0 0 0 CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 7 7 2 1 1 0 0 0 0 CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 4 8 4 2 0 0 0 0 0 Arteriography pulmonary with right heart catheterization Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 9 3 5 1 0 0 0 0 0 References Study Quality 19 (8222808) 3 18 (6859705) 4 17 (16515356) 3 32 (15333370) 3 33 (1735144) 3 US echocardiography transthoracic resting Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 6 4 4 1 1 1 0 1 0 References Study Quality 56 (8090877) 4 52 (17000366) 1 53 (12514752) 2 54 (10407975) 2 55 (8162798) 4 57 (2108571) 3 51 (26669928) 3 50 (8752195) 2
Suspected_Pulmonary_Embolism_Apdx_0007_9b69591b
Suspected_Pulmonary_Embolism_Apdx
US echocardiography transesophageal Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 9 5 3 0 0 1 0 0 0 References Study Quality 56 (8090877) 4 52 (17000366) 1 53 (12514752) 2 54 (10407975) 2 55 (8162798) 4 57 (2108571) 3 51 (26669928) 3 50 (8752195) 2 Variant 3: Suspected pulmonary embolism. High pretest probability. Initial Imaging. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 CTA pulmonary arteries with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 1 0 0 0 0 0 0 1 16 References Study Quality 20 (14657313) 1 22 (12500376) 4 23 (16097441) 3 21 (8284406) 2 24 (14658001) 3 V/Q scan lung Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 2 0 0 1 2 6 6 1 References Study Quality 59 (7152856) 4 10 (8372182) 3 61 (17060547) 1
Suspected_Pulmonary_Embolism_Apdx_0008_e13ade32
Suspected_Pulmonary_Embolism_Apdx
58 (18165667) 1 1 (28671347) 4 60 (17625390) 2 MRA pulmonary arteries without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 1 2 11 2 1 0 0 References Study Quality 34 (16794142) 2 35 (16714660) 2 36 (12020524) 1 38 (16632150) 3 39 (22375614) 4 40 (21347594) 4 21 (8284406) 2 24 (14658001) 3 42 (22664742) 3 41 (23553735) 3 37 (18308025) 3 1 (28671347) 4 US duplex Doppler lower extremity May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 4 6 2 1 2 3 0 0 0 References Study Quality 46 (15845793) 3 45 (18043357) 3 49 (19427980) 1 47 (17555069) 4 48 (17179348) 1 US echocardiography transthoracic resting May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 5 3 1 3 4 1 0 1 0 References Study Quality 56 (8090877) 4 52 (17000366) 1
Suspected_Pulmonary_Embolism_Apdx_0009_26856bb4
Suspected_Pulmonary_Embolism_Apdx
53 (12514752) 2 54 (10407975) 2 55 (8162798) 4 57 (2108571) 3 51 (26669928) 3 50 (8752195) 2 CTA triple rule out Usually not appropriate Strong ☢☢☢ 1-10 mSv 3 3 2 6 3 2 3 2 0 0 0 References Study Quality 29 (16738268) 2 30 (9442137) 3 28 (17675613) 1 31 (26124909) 3 CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 6 7 5 0 0 0 0 0 0 CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 7 6 4 0 0 0 0 0 1 CTA chest with IV contrast with CTV lower extremities Usually not appropriate Strong ☢☢☢ 1-10 mSv 2 2 6 7 3 1 0 1 0 0 0 References Study Quality 25 (11323478) 1 27 (18212216) 3 26 (10966705) 2 Arteriography pulmonary with right heart catheterization Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 8 3 3 1 1 0 2 0 0 References Study Quality 19 (8222808) 3 18 (6859705) 4 17 (16515356) 3 32 (15333370) 3
Suspected_Pulmonary_Embolism_Apdx_0010_1fac54f6
Suspected_Pulmonary_Embolism_Apdx
33 (1735144) 3 MRA pulmonary arteries without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 3 9 2 3 0 1 0 0 0 References Study Quality 34 (16794142) 2 24 (14658001) 3 43 (28116500) 2 US echocardiography transesophageal Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 8 6 2 0 1 1 0 0 0 References Study Quality 56 (8090877) 4 52 (17000366) 1 53 (12514752) 2 54 (10407975) 2 55 (8162798) 4 57 (2108571) 3 51 (26669928) 3 50 (8752195) 2 CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 4 3 1 0 0 0 0 0 Variant 4: Suspected pulmonary embolism. Pregnant patient. Initial Imaging. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 US duplex Doppler lower extremity Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 1 1 4 5 6 References Study Quality 46 (15845793) 3 45 (18043357) 3
Suspected_Pulmonary_Embolism_Apdx_0011_459bc765
Suspected_Pulmonary_Embolism_Apdx
49 (19427980) 1 47 (17555069) 4 48 (17179348) 1 67 (31557394) Good Radiography chest Usually appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 8 8 0 0 0 0 0 1 3 9 5 CTA pulmonary arteries with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv 8 8 1 1 0 0 0 3 3 6 4 References Study Quality 64 (25811355) 4 63 (28500985) 3 65 (30357273) 2 62 (28487206) 4 V/Q scan lung Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 1 1 0 0 0 4 5 6 1 References Study Quality 61 (17060547) 1 68 (8284407) 2 69 (8134561) 4 74 (20729418) 2 58 (18165667) 1 3 (22086989) 4 1 (28671347) 4 70 (22347929) 4 71 (9530317) 4 72 (1575198) 4 73 (17342484) 3 CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 9 9 0 0 0 0 0 0 0
Suspected_Pulmonary_Embolism_Apdx_0012_3969b48b
Suspected_Pulmonary_Embolism_Apdx
MRA pulmonary arteries without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 4 7 4 3 0 0 0 0 0 References Study Quality 34 (16794142) 2 24 (14658001) 3 43 (28116500) 2 US echocardiography transthoracic resting Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 5 5 1 2 3 1 0 1 0 References Study Quality 56 (8090877) 4 52 (17000366) 1 53 (12514752) 2 54 (10407975) 2 55 (8162798) 4 57 (2108571) 3 51 (26669928) 3 50 (8752195) 2 CTA triple rule out Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 7 8 3 0 0 0 0 0 0 CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 11 4 1 0 1 1 0 0 0 CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 5 3 0 0 0 0 0 0 CTA chest with IV contrast with CTV lower extremities Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 10 4 2 0 1 1 0 0 0 References Study Quality 25 (11323478) 1 27 (18212216) 3
Suspected_Pulmonary_Embolism_Apdx_0014_f631d34e
Suspected_Pulmonary_Embolism_Apdx
Arteriography pulmonary with right heart catheterization Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 1 1 14 0 0 4 0 0 0 0 0 References Study Quality 32 (15333370) 3 33 (1735144) 3 MRA pulmonary arteries without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 2 4 0 0 1 1 0 0 References Study Quality 66 (-3188535) 4 US echocardiography transesophageal Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 5 1 0 0 1 0 0 0 References Study Quality 56 (8090877) 4 52 (17000366) 1 53 (12514752) 2 54 (10407975) 2 55 (8162798) 4 57 (2108571) 3 51 (26669928) 3 50 (8752195) 2
Suspected_Pulmonary_Embolism_Apdx_0015_e12a52c8
Suspected_Pulmonary_Embolism_Apdx
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.
Suspected_Pulmonary_Embolism_Apdx_0016_2983ddb5
Suspected_Pulmonary_Embolism_Apdx
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.
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0000_958a9555
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
American College of Radiology ACR Appropriateness Criteria® Inflammatory Back Pain: Known or Suspected Axial Spondyloarthropathy Variant 1: Inflammatory back pain. Suspected axial spondyloarthritis. Initial imaging. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 Radiography sacroiliac joints Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 3 12 References Study Quality 15 (6231933) 4 17 (19297345) 3 38 (19433414) 4 47 (22081446) 2 42 (15309502) 2 39 (9858436) 4 40 (28957558) 2 45 (28283515) 2 46 (27744397) 3 48 (24909765) 2 16 (3262757) 4 22 (25837448) 4 41 (8970049) 2 43 (12759287) 2 44 (17610316) 3 Radiography sacroiliac joints and spine area of interest Usually appropriate Limited ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 0 0 2 13
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0001_c2190f99
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
References Study Quality 38 (19433414) 4 30 (31436026) 4 49 (29538011) 4 22 (25837448) 4 MRI sacroiliac joints without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 5 1 2 1 4 2 0 0 0 References Study Quality 17 (19297345) 3 36 (18975311) 2 16 (3262757) 4 37 (10493676) 2 22 (25837448) 4 MRI sacroiliac joints without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 7 1 0 2 4 0 1 0 0 References Study Quality 17 (19297345) 3 36 (18975311) 2 16 (3262757) 4 37 (10493676) 2 22 (25837448) 4 CT sacroiliac joints without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 8 0 4 1 2 0 0 0 0 CT sacroiliac joints without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 12 1 2 0 0 0 0 0 0 CT sacroiliac joints with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 1 2 0 0 0 0 0 0 US sacroiliac joints Usually not appropriate Expert Consensus O 0 mSv O 0 mSv
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0002_1d41f76d
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
US sacroiliac joints Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 3 0 0 0 1 0 0 0
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0003_2e54fcb0
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
CT spine area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 8 1 4 1 1 0 0 0 0 CT spine area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 12 1 2 0 0 0 0 0 0 CT spine area of interest with IV contrast Usually not appropriate Expert Consensus Varies Varies 1 1 12 1 2 0 0 0 0 0 0 MRI spine area of interest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 1 0 2 0 0 0 0 MRI spine area of interest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 0 2 1 3 1 0 0 0 Fluoride PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 12 1 2 0 0 0 0 0 0 Bone scan with SPECT or SPECT/CT spine area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 11 2 2 0 0 0 0 0 0 Bone scan with SPECT or SPECT/CT sacroiliac joints Usually not appropriate
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0004_43d20b77
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
1 1 11 2 2 0 0 0 0 0 0 Bone scan with SPECT or SPECT/CT sacroiliac joints Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 11 2 2 0 0 0 0 0 0 US spine area of interest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 3 0 0 0 1 0 0 0 Variant 2: Inflammatory back pain. Suspected axial spondyloarthritis. Additional imaging following radiographs. Next imaging study. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 MRI sacroiliac joints without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 1 2 2 0 3 8 References Study Quality 107 (19446974) 2 38 (19433414) 4 80 (21900284) 3
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0005_276a662a
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
36 (18975311) 2 63 (18006539) 3 83 (20496416) 2 110 (20032094) 3 108 (23418080) 4 75 (19116919) 4 78 (12694111) 4 79 (19454404) 4 19 (19297344) 3 93 (30770520) 2 77 (31422357) 4 104 (31292710) 2 98 (29449501) 3 76 (30544144) 3 94 (30097454) 2 81 (30247978) 1 86 (29513924) 4 95 (29629794) 3 105 (31096431) 4 100 (30086145) 2 91 (29177804) 2 111 (28749173) 2 109 (28593478) 3 45 (28283515) 2 3 (28110981) 4 99 (27994095) 2 101 (27908306) 2 106 (27865027) 3 92 (27651143) 2 90 (26709251) 2 82 (26681230) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0006_5cdec5c0
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
89 (26286018) 3 1 (27355535) 4 13 (19416801) 2 37 (10493676) 2 22 (25837448) 4 41 (8970049) 2 85 (23203670) 1 88 (24925836) 2 96 (24703519) 3 97 (18806131) 2 102 (18034343) 3 103 (24034836) 4 MRI sacroiliac joints without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 1 1 4 8 References Study Quality 107 (19446974) 2 38 (19433414) 4 80 (21900284) 3 36 (18975311) 2 63 (18006539) 3 83 (20496416) 2 110 (20032094) 3 108 (23418080) 4 75 (19116919) 4 78 (12694111) 4 79 (19454404) 4 19 (19297344) 3 93 (30770520) 2 77 (31422357) 4 104 (31292710) 2 98 (29449501) 3
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0007_165cac3d
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
76 (30544144) 3 94 (30097454) 2 81 (30247978) 1 86 (29513924) 4 95 (29629794) 3 105 (31096431) 4 100 (30086145) 2 91 (29177804) 2 111 (28749173) 2 109 (28593478) 3 45 (28283515) 2 3 (28110981) 4 99 (27994095) 2 101 (27908306) 2 106 (27865027) 3 92 (27651143) 2 90 (26709251) 2 82 (26681230) 4 89 (26286018) 3 1 (27355535) 4 13 (19416801) 2 37 (10493676) 2 22 (25837448) 4 41 (8970049) 2 85 (23203670) 1 88 (24925836) 2 96 (24703519) 3 97 (18806131) 2 102 (18034343) 3 103 (24034836) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0008_487927e3
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
MRI sacroiliac joints and spine area of interest without IV contrastUsually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 1 2 2 3 6 References Study Quality 107 (19446974) 2 59 (22736088) 4 63 (18006539) 3 129 (22595499) 2 110 (20032094) 3 108 (23418080) 4 9 (15650011) 2 123 (22586174) 4 116 (19019894) 3 117 (22893316) 4 10 (19404934) 2 118 (20083538) 2 11 (19666937) 3 19 (19297344) 3 114 (31161154) 1 111 (28749173) 2 60 (28663306) 4 109 (28593478) 3 112 (28365579) 4 3 (28110981) 4 61 (27889235) 4 119 (27483411) 4 62 (27608795) 4 122 (26669910) 3 89 (26286018) 3 124 (26275972) 4 1 (27355535) 4 12 (18562734) 3
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0009_7bcc17b1
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
22 (25837448) 4 113 (24451240) 2 115 (24574227) 4 120 (19565558) 2 121 (25510605) 2 125 (15458963) 3 126 (12687557) 3 127 (16206370) 2 128 (15778243) 2 MRI sacroiliac joints and spine area of interest without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 1 5 5 2 References Study Quality 107 (19446974) 2 59 (22736088) 4 63 (18006539) 3 129 (22595499) 2 110 (20032094) 3 108 (23418080) 4 9 (15650011) 2 123 (22586174) 4 116 (19019894) 3 117 (22893316) 4 10 (19404934) 2 118 (20083538) 2 11 (19666937) 3 19 (19297344) 3 114 (31161154) 1 111 (28749173) 2 60 (28663306) 4 109 (28593478) 3 112 (28365579) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0010_494af6f0
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
3 (28110981) 4 61 (27889235) 4 119 (27483411) 4 62 (27608795) 4 122 (26669910) 3 89 (26286018) 3 124 (26275972) 4 1 (27355535) 4 12 (18562734) 3 22 (25837448) 4 113 (24451240) 2 115 (24574227) 4 120 (19565558) 2 121 (25510605) 2 125 (15458963) 3 126 (12687557) 3 127 (16206370) 2 128 (15778243) 2 CT sacroiliac joints without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv 5 5 0 0 1 1 6 4 1 1 1 References Study Quality 55 (17939334) 2 47 (22081446) 2 54 (23842966) 4 19 (19297344) 3 56 (30351251) 1 45 (28283515) 2 3 (28110981) 4 57 (26670154) 3 1 (27355535) 4 22 (25837448) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0011_2b317446
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
43 (12759287) 2 44 (17610316) 3 CT sacroiliac joints and spine area of interest without IV contrast May be appropriate Limited Varies Varies 5 5 0 0 0 1 12 1 2 0 0 References Study Quality 59 (22736088) 4 63 (18006539) 3 54 (23842966) 4 19 (19297344) 3 49 (29538011) 4 58 (29127092) 3 60 (28663306) 4 61 (27889235) 4 62 (27608795) 4 22 (25837448) 4 Bone scan with SPECT or SPECT/CT sacroiliac joints Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 3 3 5 0 3 5 2 0 0 0 0 References Study Quality 42 (15309502) 2 53 (28798229) 2 22 (25837448) 4 41 (8970049) 2 50 (20395643) 3 51 (6229308) 4 52 (25649319) 2 Bone scan with SPECT or SPECT/CT sacroiliac joints and spine area of interest Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 3 3 4 1 3 5 2 0 0 0 0 References Study Quality 42 (15309502) 2 53 (28798229) 2
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0012_027ff8bc
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
22 (25837448) 4 41 (8970049) 2 50 (20395643) 3 51 (6229308) 4 52 (25649319) 2 CT sacroiliac joints without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 12 0 1 1 1 0 0 0 0 References Study Quality 55 (17939334) 2 47 (22081446) 2 54 (23842966) 4 19 (19297344) 3 56 (30351251) 1 45 (28283515) 2 3 (28110981) 4 57 (26670154) 3 1 (27355535) 4 22 (25837448) 4 43 (12759287) 2 44 (17610316) 3 CT sacroiliac joints with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 12 1 1 0 1 0 0 0 0 References Study Quality 55 (17939334) 2 47 (22081446) 2 54 (23842966) 4 19 (19297344) 3 56 (30351251) 1 45 (28283515) 2 3 (28110981) 4 57 (26670154) 3
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0013_edaf5b25
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
1 (27355535) 4 22 (25837448) 4 43 (12759287) 2 44 (17610316) 3 US sacroiliac joints Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 11 1 1 1 0 1 0 0 0 References Study Quality 130 (10470902) 3 133 (22552315) 2 132 (17216679) 3 136 (30099591) Good 131 (24914033) 2 22 (25837448) 4 134 (15934066) 1 135 (19565547) 2 CT sacroiliac joints and spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 12 0 1 1 0 1 0 0 0 References Study Quality 59 (22736088) 4 63 (18006539) 3 54 (23842966) 4 19 (19297344) 3 49 (29538011) 4 58 (29127092) 3 60 (28663306) 4 61 (27889235) 4 62 (27608795) 4 22 (25837448) 4 CT sacroiliac joints and spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 12 1 1 1 0 0 0 0 0 References Study Quality
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0014_67dc7b83
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
59 (22736088) 4 63 (18006539) 3 54 (23842966) 4 19 (19297344) 3 49 (29538011) 4 58 (29127092) 3 60 (28663306) 4 61 (27889235) 4 62 (27608795) 4 22 (25837448) 4 Fluoride PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 10 1 2 1 1 0 0 0 0 References Study Quality 73 (20505935) 3 64 (22471910) 3 67 (31088514) 1 70 (30620270) 2 65 (29329443) 1 71 (29067775) 4 66 (27137206) 3 68 (26136491) 2 69 (22788874) 2 72 (26053386) 4 US sacroiliac joints and spine area of interest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 1 2 0 0 1 0 0 0 References Study Quality 130 (10470902) 3 132 (17216679) 3 131 (24914033) 2 22 (25837448) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0015_62447c66
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
Variant 3: Inflammatory back pain. Suspected axial spondyloarthritis. Negative radiographs and negative MRI of the sacroiliac joints. Next imaging study. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 Radiography spine area of interest Usually appropriate Limited Varies Varies 9 9 0 0 0 1 0 2 2 0 10 References Study Quality 38 (19433414) 4 MRI spine area of interest without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 1 5 8 References Study Quality 107 (19446974) 2 59 (22736088) 4 63 (18006539) 3 129 (22595499) 2 123 (22586174) 4 10 (19404934) 2 11 (19666937) 3 19 (19297344) 3 60 (28663306) 4 3 (28110981) 4 61 (27889235) 4 62 (27608795) 4 122 (26669910) 3 89 (26286018) 3 124 (26275972) 4 1 (27355535) 4 12 (18562734) 3 22 (25837448) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0016_23d808e1
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
115 (24574227) 4 120 (19565558) 2 121 (25510605) 2 125 (15458963) 3 126 (12687557) 3 127 (16206370) 2 128 (15778243) 2 MRI spine area of interest without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 2 3 2 7 References Study Quality 59 (22736088) 4 63 (18006539) 3 129 (22595499) 2 9 (15650011) 2 123 (22586174) 4 10 (19404934) 2 11 (19666937) 3 19 (19297344) 3 114 (31161154) 1 60 (28663306) 4 3 (28110981) 4 61 (27889235) 4 62 (27608795) 4 122 (26669910) 3 89 (26286018) 3 124 (26275972) 4 1 (27355535) 4 12 (18562734) 3 22 (25837448) 4 115 (24574227) 4 120 (19565558) 2
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0017_77fa962d
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
121 (25510605) 2 125 (15458963) 3 126 (12687557) 3 127 (16206370) 2 128 (15778243) 2 CT spine area of interest without IV contrast Usually appropriate Limited Varies Varies 7 7 0 0 0 0 5 2 5 1 2 References Study Quality 59 (22736088) 4 63 (18006539) 3 54 (23842966) 4 19 (19297344) 3 49 (29538011) 4 58 (29127092) 3 60 (28663306) 4 3 (28110981) 4 61 (27889235) 4 62 (27608795) 4 1 (27355535) 4 22 (25837448) 4 Bone scan with SPECT or SPECT/CT spine area of interest Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 2 2 7 1 3 2 1 0 1 0 0 References Study Quality 42 (15309502) 2 53 (28798229) 2 22 (25837448) 4 41 (8970049) 2 50 (20395643) 3 51 (6229308) 4 52 (25649319) 2
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0018_6bf52b21
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
CT spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 11 0 1 1 1 0 1 0 0 References Study Quality 59 (22736088) 4 63 (18006539) 3 54 (23842966) 4 19 (19297344) 3 49 (29538011) 4 58 (29127092) 3 60 (28663306) 4 3 (28110981) 4 61 (27889235) 4 62 (27608795) 4 1 (27355535) 4 22 (25837448) 4 CT spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 11 0 2 1 1 0 0 0 0 References Study Quality 59 (22736088) 4 63 (18006539) 3 54 (23842966) 4 19 (19297344) 3 49 (29538011) 4 58 (29127092) 3 60 (28663306) 4 3 (28110981) 4 61 (27889235) 4 62 (27608795) 4 1 (27355535) 4 22 (25837448) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0019_c6e58401
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
Fluoride PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 10 1 2 1 1 0 0 0 0 References Study Quality 73 (20505935) 3 64 (22471910) 3 67 (31088514) 1 70 (30620270) 2 65 (29329443) 1 71 (29067775) 4 66 (27137206) 3 68 (26136491) 2 69 (22788874) 2 72 (26053386) 4 US spine area of interest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 2 0 0 1 0 1 0 0 References Study Quality 132 (17216679) 3 22 (25837448) 4 Variant 4: Known axial spondyloarthritis. Follow-up for treatment response or disease progression. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 Radiography sacroiliac joints Usually appropriate Strong ☢☢ 0.1-1mSv 7 7 0 0 0 0 3 2 8 1 2 References Study Quality 30 (31436026) 4 149 (30220240) Good 147 (28970213) 1 142 (28684556) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0020_6f921a83
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
143 (28085226) 2 141 (26990518) 4 29 (29860356) 4 148 (30625261) 4 22 (25837448) 4 144 (21622969) 2 145 (26903442) 4 146 (26663907) 4 150 (9870884) 2 Radiography sacroiliac joints Usually appropriate Strong ☢☢ 0.1-1mSv 7 n/a 0 0 0 0 0 0 0 0 0 References Study Quality 30 (31436026) 4 149 (30220240) Good 147 (28970213) 1 142 (28684556) 4 143 (28085226) 2 141 (26990518) 4 29 (29860356) 4 148 (30625261) 4 22 (25837448) 4 144 (21622969) 2 145 (26903442) 4 146 (26663907) 4 150 (9870884) 2 Radiography sacroiliac joints Usually appropriate Strong ☢☢ 0.1-1mSv 7 n/a 0 0 0 0 0 0 0 0 0 References Study Quality 30 (31436026) 4 149 (30220240) Good 147 (28970213) 1
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0021_7d212f05
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
142 (28684556) 4 143 (28085226) 2 141 (26990518) 4 29 (29860356) 4 148 (30625261) 4 22 (25837448) 4 144 (21622969) 2 145 (26903442) 4 146 (26663907) 4 150 (9870884) 2 Radiography sacroiliac joints and spine area of interest Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 0 2 2 2 3 2 4 References Study Quality 30 (31436026) 4 149 (30220240) Good 155 (28939631) 2 154 (29611287) 2 143 (28085226) 2 151 (27696754) 3 141 (26990518) 4 29 (29860356) 4 148 (30625261) 4 156 (29984487) 2 22 (25837448) 4 144 (21622969) 2 145 (26903442) 4 150 (9870884) 2 152 (22127957) 2 153 (23956249) 4 157 (15051621) 2
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0022_f6a40e7b
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
MRI sacroiliac joints without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 4 2 3 2 2 References Study Quality 107 (19446974) 2 110 (20032094) 3 108 (23418080) 4 30 (31436026) 4 111 (28749173) 2 109 (28593478) 3 22 (25837448) 4 137 (20191486) 2 138 (16208659) 4 MRI sacroiliac joints and spine area of interest without IV contrastMay be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 1 3 4 3 1 2 References Study Quality 107 (19446974) 2 129 (22595499) 2 110 (20032094) 3 108 (23418080) 4 9 (15650011) 2 30 (31436026) 4 111 (28749173) 2 109 (28593478) 3 22 (25837448) 4 125 (15458963) 3 126 (12687557) 3 127 (16206370) 2 128 (15778243) 2 137 (20191486) 2 138 (16208659) 4 139 (17407241) 3
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0023_81e41db1
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
140 (16082639) 2 MRI sacroiliac joints without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 0 4 4 5 0 1 1 References Study Quality 107 (19446974) 2 110 (20032094) 3 108 (23418080) 4 30 (31436026) 4 111 (28749173) 2 109 (28593478) 3 22 (25837448) 4 137 (20191486) 2 138 (16208659) 4 MRI sacroiliac joints and spine area of interest without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 0 0 4 6 3 0 1 1 References Study Quality 107 (19446974) 2 129 (22595499) 2 110 (20032094) 3 108 (23418080) 4 9 (15650011) 2 30 (31436026) 4 111 (28749173) 2 109 (28593478) 3 22 (25837448) 4 125 (15458963) 3 126 (12687557) 3 127 (16206370) 2 128 (15778243) 2 137 (20191486) 2 138 (16208659) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0024_97c7bbd2
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
139 (17407241) 3 140 (16082639) 2 CT sacroiliac joints without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 5 2 1 3 3 0 1 0 0 References Study Quality 22 (25837448) 4 CT sacroiliac joints and spine area of interest without IV contrast Usually not appropriate Limited Varies Varies 3 3 4 2 8 0 1 0 1 0 0 References Study Quality 49 (29538011) 4 58 (29127092) 3 22 (25837448) 4 CT sacroiliac joints without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 1 1 12 1 2 0 0 0 0 0 0 References Study Quality 22 (25837448) 4 CT sacroiliac joints with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 1 2 0 0 0 0 0 0 References Study Quality 22 (25837448) 4 US sacroiliac joints Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0 References Study Quality 132 (17216679) 3 158 (26321072) 3 159 (23385982) 4 US sacroiliac joints Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 0 0 1 0 0 0 0 References Study Quality
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0025_6c1b3227
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 0 0 1 0 0 0 0 References Study Quality 132 (17216679) 3
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0026_d286fd04
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
158 (26321072) 3 159 (23385982) 4 CT sacroiliac joints and spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 12 1 2 0 0 0 0 0 0 References Study Quality 49 (29538011) 4 58 (29127092) 3 22 (25837448) 4 CT sacroiliac joints and spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 11 2 2 0 0 0 0 0 0 References Study Quality 49 (29538011) 4 58 (29127092) 3 22 (25837448) 4 Fluoride PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 1 2 1 0 0 0 0 0 Bone scan with SPECT or SPECT/CT sacroiliac joints Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 1 4 0 0 0 0 0 0 Bone scan with SPECT or SPECT/CT sacroiliac joints and spine area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 1 4 0 0 0 0 0 0 US sacroiliac joints and spine area of interest Usually not
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0027_2e6d0d13
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
10 mSv [ped] 1 1 10 1 4 0 0 0 0 0 0 US sacroiliac joints and spine area of interest Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 3 0 0 1 0 0 0 0 References Study Quality 132 (17216679) 3 158 (26321072) 3 159 (23385982) 4 Variant 5: Axial spondyloarthritis with spine ankylosis. Suspected fracture. Initial imaging.
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0028_d5878825
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 CT spine area of interest without IV contrast Usually appropriate Limited Varies Varies 9 9 0 0 0 0 1 1 0 1 12 References Study Quality 34 (16155161) 3 33 (18791749) 4 31 (19304705) 4 35 (20421858) 4 32 (28816877) 4 22 (25837448) 4 160 (18421455) 4 161 (15191110) 4 Radiography spine area of interest Usually appropriate Limited Varies Varies 8 8 1 0 0 0 1 1 2 3 7 References Study Quality 34 (16155161) 3 31 (19304705) 4 32 (28816877) 4 22 (25837448) 4 160 (18421455) 4 161 (15191110) 4 MRI spine area of interest without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 1 2 2 4 5 References Study Quality 34 (16155161) 3 33 (18791749) 4 31 (19304705) 4 35 (20421858) 4 162 (31054754) 4 32 (28816877) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0029_08d2c21c
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
22 (25837448) 4 160 (18421455) 4 161 (15191110) 4 CT spine area of interest without and with IV contrast Usually not appropriate Limited Varies Varies 1 1 12 1 2 0 0 0 0 0 0 References Study Quality 34 (16155161) 3 33 (18791749) 4 31 (19304705) 4 35 (20421858) 4 32 (28816877) 4 22 (25837448) 4 160 (18421455) 4 161 (15191110) 4 CT spine area of interest with IV contrast Usually not appropriate Limited Varies Varies 1 1 12 1 1 1 0 0 0 0 0 References Study Quality 34 (16155161) 3 33 (18791749) 4 31 (19304705) 4 35 (20421858) 4 32 (28816877) 4 22 (25837448) 4 160 (18421455) 4 161 (15191110) 4 MRI spine area of interest without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 0 1 0 0 1 0 1 0 References Study Quality 34 (16155161) 3 33 (18791749) 4 31 (19304705) 4
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0030_ad7bfa8a
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
35 (20421858) 4 162 (31054754) 4 32 (28816877) 4 22 (25837448) 4 160 (18421455) 4 161 (15191110) 4 Fluoride PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 14 1 0 0 0 0 0 0 0 Bone scan with SPECT or SPECT/CT spine area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3- 10 mSv [ped] 1 1 10 1 0 1 2 0 1 0 0 US spine area of interest Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 2 0 0 0 0 0 0 0
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0031_e12a52c8
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
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.
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx_0032_2983ddb5
Inflammatory_Back_Pain_Known_or_Suspected_Axial_Spondyloarthropathy_Apdx
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.
Female_Breast_Cancer_Screening_Apdx_0000_5cc48dbf
Female_Breast_Cancer_Screening_Apdx
American College of Radiology ACR Appropriateness Criteria® Female Breast Cancer Screening Variant 1: Adult female. Breast cancer screening. Average risk. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 Mammography screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 0 References Study Quality 1 (21712474) 1 7 (26757170) 4 44 (26204111) 4 41 (28648873) 4 2 (24450666) 3 29 (29571797) 2 39 (29267146) 4 42 (28411671) 4 40 (27754936) 4 5 (26501536) 4 38 (25413699) Inadequate 34 (25415718) 4 35 (21257850) 4 36 (33141657) 3 43 (33223001) 4 37 (33650900) 3 11 (34154984) 4 30 (16775176) Good
Female_Breast_Cancer_Screening_Apdx_0001_cf08e70a
Female_Breast_Cancer_Screening_Apdx
6 (-3196037) 4 3 (37150275) 4 31 (20868890) 4 10 (38687505) 4 9 (38687503) 4 Digital breast tomosynthesis screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 0 References Study Quality 17 (25058084) 3 18 (24918774) 3 19 (23901124) 3 22 (25313245) 2 24 (23297332) 1 32 (28516226) Good 23 (29869961) 1 29 (29571797) 2 27 (28083822) 1 5 (26501536) 4 26 (25599513) 2 38 (25413699) Inadequate 34 (25415718) 4 21 (30107542) Good 35 (21257850) 4 20 (31078459) 1 25 (30777808) 3 36 (33141657) 3 28 (32721031) 3 37 (33650900) 3 11 (34154984) 4 30 (16775176) Good 33 (33706172) Good
Female_Breast_Cancer_Screening_Apdx_0002_97909c68
Female_Breast_Cancer_Screening_Apdx
6 (-3196037) 4 31 (20868890) 4 10 (38687505) 4 9 (38687503) 4 3 (37150275) 4 MRI breast without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 0 0 0 0 0 References Study Quality 45 (28221097) 1 46 (31774954) Good 13 (34794600) 4 47 (3528677) 4 31 (20868890) 4 US breast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 0 0 0 0 0 References Study Quality 52 (22723501) 2 57 (29736009) Good 29 (29571797) 2 54 (27501888) 1 59 (24951614) 3 13 (34794600) 4 56 (33434108) 3 43 (33223001) 4 58 (34406400) 2 55 (34134531) 4 53 (30316869) 1 30 (16775176) Good MRI breast without and with IV contrast abbreviated May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 0 0 0 0 0 References Study Quality
Female_Breast_Cancer_Screening_Apdx_0003_65347174
Female_Breast_Cancer_Screening_Apdx
48 (32096852) 1 13 (34794600) 4 31 (20868890) 4 Mammography with IV contrast Usually not appropriate Limited ☢☢ 0.1-1mSv 3 3 0 0 0 0 0 0 0 0 0 References Study Quality 13 (34794600) 4 MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0 Sestamibi MBI Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0 References Study Quality 49 (27186635) 3 50 (31880677) 4 51 (32524221) 2 43 (33223001) 4 MRI breast without IV contrast abbreviated Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0 Variant 2: Adult female. Breast cancer screening. Intermediate risk. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 Mammography screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 0 References Study Quality 1 (21712474) 1 7 (26757170) 4 44 (26204111) 4 41 (28648873) 4
Female_Breast_Cancer_Screening_Apdx_0004_74ce422d
Female_Breast_Cancer_Screening_Apdx
2 (24450666) 3 29 (29571797) 2 39 (29267146) 4 42 (28411671) 4 40 (27754936) 4 5 (26501536) 4 38 (25413699) Inadequate 34 (25415718) 4 35 (21257850) 4 36 (33141657) 3 43 (33223001) 4 37 (33650900) 3 11 (34154984) 4 30 (16775176) Good 6 (-3196037) 4 3 (37150275) 4 31 (20868890) 4 10 (38687505) 4 9 (38687503) 4 Digital breast tomosynthesis screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 0 References Study Quality 17 (25058084) 3 18 (24918774) 3 19 (23901124) 3 22 (25313245) 2 24 (23297332) 1 41 (28648873) 4 32 (28516226) Good 23 (29869961) 1 29 (29571797) 2
Female_Breast_Cancer_Screening_Apdx_0005_1128dfb8
Female_Breast_Cancer_Screening_Apdx
27 (28083822) 1 5 (26501536) 4 26 (25599513) 2 38 (25413699) Inadequate 34 (25415718) 4 21 (30107542) Good 35 (21257850) 4 20 (31078459) 1 25 (30777808) 3 36 (33141657) 3 28 (32721031) 3 43 (33223001) 4 37 (33650900) 3 11 (34154984) 4 30 (16775176) Good 33 (33706172) Good 6 (-3196037) 4 3 (37150275) 4 31 (20868890) 4 10 (38687505) 4 9 (38687503) 4 MRI breast without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 0 0 0 0 0 References Study Quality 67 (22474203) 1 68 (20177029) 1 70 (19884532) 1 72 (28655029) 3 76 (24934793) 3 75 (27097237) 4 71 (31063080) 3
Female_Breast_Cancer_Screening_Apdx_0006_000e32bc
Female_Breast_Cancer_Screening_Apdx
74 (31221620) 3 69 (25794083) 4 73 (32303988) Inadequate MRI breast without and with IV contrast abbreviated May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 0 0 0 0 0 References Study Quality 81 (28506511) 4 80 (25454099) 2 77 (24958821) 2 48 (32096852) 1 56 (33434108) 3 78 (33620293) 3 79 (31206889) 3 US breast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 0 0 0 0 0 References Study Quality 52 (22723501) 2 67 (22474203) 1 72 (28655029) 3 82 (30098212) 3 57 (29736009) Good 29 (29571797) 2 54 (27501888) 1 13 (34794600) 4 56 (33434108) 3 43 (33223001) 4 58 (34406400) 2 55 (34134531) 4 53 (30316869) 1 30 (16775176) Good
Female_Breast_Cancer_Screening_Apdx_0007_8ee6a6fb
Female_Breast_Cancer_Screening_Apdx
Mammography with IV contrast May be appropriate Strong ☢☢ 0.1-1mSv 5 5 0 0 0 0 0 0 0 0 0 References Study Quality 64 (30240292) 2 65 (31453765) 2 62 (33787291) 3 63 (31092346) 2 66 (39509749) 2 Sestamibi MBI Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 3 0 0 0 0 0 0 0 0 0 References Study Quality 50 (31880677) 4 51 (32524221) 2 43 (33223001) 4 MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0 MRI breast without IV contrast abbreviated Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0 Variant 3: Adult female 30 years of age or older. Breast cancer screening. High risk. Procedure Appropriateness Category SOE Adults RRL Peds RRL Rating Median Final Tabulations 1 2 3 4 5 6 7 8 9 Mammography screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 1 0 0 1 0 3 16 References Study Quality 96 (28886475) Inadequate 95 (34324686) 4 94 (37673117) 4 93 (36927127) 4
Female_Breast_Cancer_Screening_Apdx_0008_0a0b3301
Female_Breast_Cancer_Screening_Apdx
92 (27444927) 4 91 (21079137) 4 90 (31233143) 3 89 (19176458) Good 88 (26908327) Inadequate 44 (26204111) 4 43 (33223001) 4 42 (28411671) 4 41 (28648873) 4 40 (27754936) 4 39 (29267146) 4 38 (25413699) Inadequate 37 (33650900) 3 36 (33141657) 3 35 (21257850) 4 34 (25415718) 4 30 (16775176) Good 29 (29571797) 2 11 (34154984) 4 10 (38687505) 4 9 (38687503) 4 7 (26757170) 4 6 (-3196037) 4 5 (26501536) 4 3 (37150275) 4 2 (24450666) 3 1 (21712474) 1 MRI breast without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 1 0 2 3 14 References Study Quality 96 (28886475) Inadequate