ACR appropriateness criteria

Question 1

Adult
Acute cervical pain without radiculopathy
No trauma or red flags

Answer 1

radiography of cervical spine

Question 2

Adult
Acute cervical pain with radiculopathy
No trauma or red flags

Answer 2

radiography of cervical spine
MRI of cervical spine without contrast

Question 3

Adult
Prior cervical spine surgery
Acute cervical pain or radiculopathy
No trauma or red flags

Answer 3

Radiography of cervical spine
Radiography flex-ex lateral views of cervical spine
MRI cervical spine with and without contrast

CT cervical spine without contrast
CT myelography

Question 4

Adult
Suspected cervicogenic HA
No neurologic deficit

Answer 4

MRI of cervical spine without contrast

Question 5

Adult
Chronic cervical pain without radiculopathy
No trauma

Answer 5

radiography of cervical spine
MRI cervical spine without contrast

Question 6

Adult
Chronic cervical pain with radiculopathy
No trauma

Answer 6

MRI cervical spine without contrast

Radiography cervical spine
CT cervical spine without contrast

Question 7

Acute onset myelopathy

Answer 7

MRI with and without contrast

CT myelopgraphy
CT of spine with contrast
CT of spine without contrast

Question 8

Chronic or progressive myelopathy

Answer 8

MRI with and without contrast

CT myelopgraphy
CT of spine with contrast
CT of spine without contrast

Question 9

Age 16-65
Acute c spine blunt trauma
Imaging not indicated by CCR or NEXUS
Low risk

Answer 9

none

Question 10

Age 16-65
Acute c spine blunt trauma
Imaging is indicated by CCR or NEXUS

Answer 10

CT cervical spine without contrast

Question 11

Age 16-65
Acute c spine blunt trauma
No unstable injury
Collar for neck pain
No new neurologic symptoms

Answer 11

CT cervical spine without contrast

Radiography cervical spine
MRI cervical spine without contrast

Question 12

Age 16-65
Acute cervical, thoracic, or lumbar spine blunt trauma
Suspected ligamentous, spinal cord, or nerve root injury
With or without trauma identified on CT

Answer 12

MRI spine area of interest without contrast

Question 13

Age 3-16
Acute cervical spine trauma
Low risk criteria (PECARN or NEXUS)

Answer 13

none

Question 14

Age 3-16
Acute cervical spine trauma
At least one risk factor (PECARN or NEXUS)

Answer 14

Radiography of cervical spine

CT cervical spine without contrast
MRI cervical spine without contrast

Question 15

PECARN

Answer 15

high risk for cervical injury if:
- Altered mental status
- Focal neurologic findings
- Neck pain
- Torticollis
- Substantial torso injury
- Conditions predisposing to cervical spine injury
- Diving
- High-risk motor vehicle crash