ACR Appropriateness Criteria Flashcards
New or increasing nontraumatic cervical or neck pain. No red flags. INTIAL IMAGING
radiography cervical spine usually appropriate
Others:
- MRI cervical spine w/o IV contrast may be appropriate (disagreement)
- CT cervical spine w/o IV contrast may be appropriate
New or increasing nontraumatic cervical radiculopathy. No red flags. INITIAL IMAGING.
MRI cervical spine without IV contrast usually appropriate
Others:
CT cervical spine without IV contrast or MRI cervical spine with or without IV contrast may be appropriate
Chronic cervical or neck pain. INITIAL IMAGING.
radiography of cervical spine usually appropriate
Others:
- MRI cervical spine w/o IV contrast may be appropriate (disagreement)
Child 3-16 years old. Acute cervical spine trauma, meets low risk criteria (based on PECARN or NEXUS). INITIAL IMAGING.
imaging usually not appropriate
Acute onset myelopathy. INITIAL IMAGING
MRI spine area of interest with OR without IV contrast usually appropriate.
Others:
- CT myelography spine area of interest may be appropriate
- CT spine area of interest w/or w/o IV contrast may be appropriate
Chronic or progressive myelopathy. INITIAL IMAGING.
MRI spine area of interest without and with IV contrast usually appropriate
Others:
- CT myelography spine area of interest may be appropriate
- CT spine area of interest w/or w/o IV contrast may be appropriate
Age greater than or equal to 16 years and less than 65 years. Suspected acute blunt cervical spine trauma. Imaging not indicated by NEXUS or CCR clinical criteria. Patient meets low risk criteria. INITIAL IMAGING.
imaging usually not appropriate
Age greater than or equal to 16 years and less than 65 years. Suspected acute cervical spine blunt trauma. Imaging indicated by NEXUS or CCR clinical criteria. INITIAL IMAGING
CT cervical spine without IV contrast usually appropriate
Others:
- Radiography of the cervical spine may be appropriate
Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Confirmed or suspected cervical spinal cord or nerve root injury, with or without traumatic injury identified on cervical CT. NEXT IMAGING STUDY.
MRI cervical spine without IV contrast usually appropriate
Others:
- CT myelography cervical spine may be appropriate
Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Clinical or imaging findings suggest ligamentous injury. NEXT IMAGING STUDY AFTER CT CERVICAL SPINE WITHOUT IV CONTRAST.
MRI cervical spine without IV contrast usually appropriate
Child 3-16 years of age, acute cervical spine trauma, meets low risk criteria (based on NEXUS/PECARN). INITIAL IMAGING
imaging usually not appropriate
Child 3-16 years old, acute cervical spine trauma, at least one risk factor with reliable clinical examination (based on PECARN, NEXUS). INITIAL IMAGING.
radiography cervical spine usually appropriate
Others:
CT or MRI cervical spine without IV Contrast may be appropriate (disagreement)
Age greater than or equal to 16 years. Blunt trauma meeting criteria for thoracic and lumbar imaging. INITIAL IMAGING
CT thoracic and lumbar spine without IV contrast usually appropriate
Others:
Radiography thoracic and lumbar spine may be appropriate
Age greater than or equal to 16 years. Acute thoracic or lumbar spine injury detected on radiographs or noncontrast CT. Neurologic abnormalities. NEXT IMAGING STUDY.
MRI thoracic and lumbar spine without IV contrast.
Others:
CT myelography thoracic and lumbar spine may be appropriate.
Child, younger than 16 years of age, suspected thoracolumbar spine trauma. INITIAL IMAGING.
radiography thoracic and lumbar spine usually appropriate
Others:
CT or MRI of thoracic and lumbar spine without IV contrast may be appropriate (disagreement)
Suspected rib fractures from minor blunt trauma (injury confined to ribs). INITIAL IMAGING.
radiography of chest usually appropriate
Others:
Radiography rib views may be appropriate
Neurogenic thoracic outlet syndrome. INITIAL IMAGING and FOLLOW UP IMAGING after surgery or intervention
All usually appropriate:
- MRI chest without and with IV contrast
- Radiography chest
Others:
CT or CTA with IV contrast may be appropriate, US duplex doppler subclavian artery and vein may be appropriate
Arterial thoracic outlet syndrome. Initial imaging and follow up imaging after surgery or intervention. (5)
All usually appropriate:
- CTA chest with IV contrast
- MRA chest without and with IV contrast
- radiography of chest
- US duplex doppler subclavian artery and vein
- arteriography upper extremity
Others:
CT chest with IV contrast, MRI chest with and without IV contrast, MRA chest without contrast, MRI chest without IV contrast, CT chest without IV contrast also all may be appropriate
Child. Congenital scoliosis. INITIAL IMAGING.
Either usually appropriate:
- radiography complete spine
- MRI complete spine without IV contrast
Others:
CT area of spine of interest without IV contrast may be appropriate
Child (0-9 years of age). Early onset idiopathic scoliosis. INITIAL IMAGING.
Either usually appropriate:
- radiography complete spine
- MRI complete spine without IV contrast
Traumatic shoulder pain. Any etiology. INITIAL IMAGING
x-ray shoulder usually appropriate
Traumatic shoulder pain. Nonlocalized shoulder pain. Negative radiographs. NEXT IMAGING study.
MRI shoulder without IV contrast usually appropriate
Others:
CT arthrography of shoulder, MR arthrography of shoulder, US shoulder (disagreement) may be appropriate
Traumatic shoulder pain. Radiographs normal. Physical exam and history consistent with dislocation or instability. Next imaging study.
Either usually appropriate:
- MR arthrography of shoulder
- MRI shoulder without IV contrast
Others:
CT arthrography shoulder and CT shoulder without IV contrast may also both be appropriate
Traumatic shoulder pain. Radiographs normal. Physical examination findings consistent with rotator cuff tear. Next imaging study.
Following 3 all usually appropriate:
- MRI shoulder without IV contrast
- MR arthrography shoulder
- US shoulder
Others:
CT arthrography of shoulder may be appropriate
Atraumatic shoulder pain. INITIAL IMAGING.
X-Ray shoulder usually appropriate
Atraumatic shoulder pain. Suspect rotator cuff disorders (tendinosis, tear, calcific tendinitis). Initial radiographs normal or inconclusive. NEXT IMAGING STUDY.
Either usually appropriate:
- MRI shoulder without IV contrast
- US shoulder
Others:
MR arthrography of shoulder or CT arthrography of shoulder may both be appropriate
Atraumatic shoulder pain. Suspect labral tear and instability. Initial radiographs normal or inconclusive. NEXT IMAGING STUDY.
Either usually appropriate:
- MR arthrography of shoulder
- MRI of shoulder without IV contrast
Others:
CT arthrography of shoulder may be appropriate
Evaluation for chronic elbow pain. INITIAL IMAGING.
X-ray elbow
Chronic elbow pain: Mechanical symptoms (locking, clicking, limited motion); suspect intra-articular osteocartilaginous body or synovial abnormality; radiographs non-diagnostic. NEXT IMAGING STUDY
Either usually appropriate:
- MRI elbow without contrast
- MR arthrography elbow
Others:
CT elbow without contrast, CT arthrography elbow also may be appropriate
Chronic elbow pain: suspect chronic epicondylitis, refractory to empirical treatment; radiographs nondiagnostic. NEXT IMAGING STUDY.
MRI elbow without contrast
Others:
US elbow may also be appropriate
Chronic wrist pain: with or without prior injury. Best initial imaging.
x-ray wrist
Chronic wrist pain: Routine radiographs normal or nonspecific. Persistent symptoms. Next study.
MRI wrist without contrast usually appropriate
Others:
MR arthrography wrist may be appropriate
Chronic wrist pain: Radiographs normal or non-specific. Suspect carpal tunnel syndrome. Next study.
US wrist and MRI wrist without and with IV contrast may be appropriate
Acute blunt or penetrating trauma to the hand or wrist. Initial imaging.
radiography to area of interest.
Suspect acute hand or wrist trauma. Initial radiographs negative or equivocal. Next imaging study
All usually appropriate:
- MRI area of interest without IV contrast
- Radiography area of interest repeat in 10-14 days
- CT area of interest without IV contrast
Acute wrist fracture on radiographs. Suspect wrist tendon or ligament trauma. Next imaging study.
all 4 usually appropriate:
- MR arthrography wrist
- MRI wrist without IV contrast
- CT arthrography wrist
- US wrist
what initial imaging study is most appropriate for a patient that is age greater than or equal to 16 years with blunt trauma meeting criteria for thoracic and lumbar imaging?
CT thoracic and lumbar spine
for a pt age greater than or equal to 16 years what next imaging study is most appropriate if acute thoracic/lumbar spine injury has been detected on radiographs or noncontrast CT with neurologic abnormalities?
MRI thoracic and lumbar spine
what initial imaging study is most appropriate for a child (younger than 16) with suspected thoracolumbar spine trauma?
Radiography thoracic and lumbar spine
what initial imaging study is most appropriate for a patient with acute low back pain with/without radiculopathy, no red flags and no prior management?
no imaging
what initial imaging study is most appropriate for a pt with subacute or chronic LBP with/without radiculopathy, no red flags, and no prior management?
no imaging
what initial imaging study would be most appropriate for a pt with subacute or chronic LBP with/without radiculopathy? Additionally, they are a surgical or intervention candidate with persistent or progressive symptoms during/following 6 weeks or optimal medical management.
MRI lumbar spine
What initial imaging study is most appropriate for a pt with LBP with suspected cauda equina syndrome?
MRI lumbar spine
What initial imaging study is most appropriate for a pt with LBP and a history of prior lumbar surgery with/without radiculopathy. They have new or progressing symptoms or clinical findings
Radiography lumbar spine
MRI lumbar spine
what initial imaging study is most appropriate for a pt with LBP with/without radiculopathy. Along with one or more of the following: low-velocity trauma, osteoporosis, elderly individual, or chronic steroid use.
radiography lumbar spine
MRI lumbar spine
CT lumbar spine
what initial imaging study is most appropriate for a pt with LBP with/without radiculopathy. Along with one or more of the following: suspicion of cancer, infection, or immunosuppression.
MRI lumbar
for a child with back pain and none of the following clinical red flags (constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neuro exam), what initial imaging is most appropriate?
no imaging
what initial imaging study is most appropriate for a pt with acute hip pain from a fall or minor trauma?
Radiography of hip and pelvis
what follow up imaging study is most appropriate for a pt with acute hip pain from a fall or minor trauma after they have negative radiographs but a fracture is still suspected?
MRI pelvis and affected hip
CT pelvis and hips
what is the first imaging test for a pt with chronic hip pain?
Pelvis and hip radiographs
if radiographs were negative, equivocal or nondiagnostic; what follow-up study is most appropriate for a pt with chronic hip pain and there are suspected extra-articular noninfectious soft-tissue abnormalities such as tendonitis?
MRI hip
US hip
if radiographs were negative, equivocal, or nondiagnostic; what follow-up study is most appropriate for a pt with chronic hip pain and suspected impingement?
MRI hip
CT arthrography hip
if radiographs were negative, equivocal, or nondiagnostic; what follow-up study is most appropriate for a pt with chronic hip pain and suspected labral tear with/without clinical findings consistent with or suggestive of impingement?
MR arthrography hip
CT arthrography hip
if radiographs were negative, equivocal, or showing mild osteoarthritis; what follow-up study is most appropriate for a pt with chronic hip and low back, pelvic, or knee pathology and you want to exclude the hip as the source?
MRI hip
image guided anesthetic +/- corticosteroid injection hip joint or surrounding structures
what imaging should be performed following a THA for a follow-up of the asymptomatic pt?
Radiograph hip
what initial imaging is most appropriate for an adult or child greater than or equal to 5 years of age with chronic knee pain
radiography knee
what next imaging procedure is most appropriate for an adult (or child greater/equal to 5) with chronic knee pain and initial knee x-rays being negative or demonstrating joint effusion?
MRI knee
what next imaging procedure is most appropriate for an adult (or child greater/equal to 5) with chronic knee pain and initial knee x-rays demonstrating osteochondritis dissecans (OCD), loose bodies, or a history of cartilage or meniscal repair?
MRI knee
what initial imaging procedure is most appropriate for an adult (or child aged 5 or older) who fell or had an acute twisting trauma to the knee with no focal tenderness or effusion and is able to walk?
No imaging required
X-rays may be appropriate but not always
what initial imaging procedure is most appropriate for an adult (or child aged 5 or older) who fell or had an acute twisting trauma to the knee with one or more of the following: focal tenderness or effusion and inability to bear weight?
Radiographs of knee
what follow-up study is most appropriate for an adult or skeletally mature child who has suffered a fall or an acute twisting trauma to the knee and no fracture was detected on radiographs but you suspect an occult fracture or internal degeneration?
MRI knee
what initial imaging is most appropriate for a child up to age 5 who has an acute limp with nonlocalized symptoms and there is no concern for infection?
radiographs of tibia/fibula
what initial imaging is most appropriate for a child up to age 5 with an acute limp, localized symptoms, and no concern for an infection?
Radiographs of LE area of interest
for an adult or child 5 years of age or older, which initial imaging procedure is most appropriate if they suffered an acute trauma to the ankle or they have persistent pain for more than 1 week but less than 3 weeks after an acute trauma to the ankle and they meet the Ottawa Ankle rules?
X-rays of ankle
for an adult or child 5 years or older, what initial imaging procedure is most appropriate if they have an acute trauma to the ankle but no exclusionary criteria and do not meet the Ottawa Ankle Rules?
No imaging requried
for an adult or child 5 years or older, what initial imaging procedure is most appropriate if:
- they had an acute trauma to the ankle
- exclusion criteria are present (neuro disoder, neuropathy, other)
- do not meet Ottawa Ankle Rules
Radiography of Ankle
what initial imaging procedure is most appropriate for an adult/child older than 5 with an acute trauma to the foot and the Ottawa rules are positive?
radiography of foot
radiography of foot w/weightbearing
what initial imaging procedure is most appropriate for an adult/child older than 5 with an acute trauma to the foot and the Ottawa rules are negative; but there is a suspected pathology in an anatomic area not addressed by Ottawa Rules?
radiography foot
radiography foot w/weightbearing
what initial imaging is most appropriate for someone with chronic ankle pain?
X-ray ankle
what next study is most appropriate for someone with chronic ankle pain but ankle radiographs are normal and there is suspected osteochondral lesions?
MRI ankle
what next study is most appropriate for someone with chronic ankle pain and ankle radiographs are normal/nonspecific and there is a suspected tendon abnormality?
MRI ankle
USI ankle
what next study is most appropriate for someone with chronic ankle pain, ankle radiographs are normal and pain is of uncertain etiology?
MRI ankle
what initial study is most appropriate for chronic ankle pain with unknown etiology?
radiography foot
