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Inspect the appropriateness of conducting a Magnetic Resonance Imaging cervical spine with Intravenous contrast on a patient with the following characteristics: prior cervical spine surgery. New or increasing nontraumatic cervical or neck pain or radiculopathy. Initial imaging. | usually not appropriate | strong | usually appropriate | usually not appropriate | may be appropriate (disagreement) | may be appropriate | B |
Scrutinize the appropriateness of providing a Bone scan whole body with Single Photon Emission Computed Tomography or Single-photon Emission Computed Tomography / Computed Tomography area of interest on a patient with the following characteristics: renal cell carcinoma. Contraindication to both iodinated Computed Tomography and gadolinium-based Magnetic Resonance intravenous contrast. Staging. | may be appropriate | limited | may be appropriate | usually appropriate | may be appropriate (disagreement) | usually not appropriate | A |
Analyze the appropriateness of providing a Ultrasound pelvis on a patient with the following characteristics: pregnant woman. Right lower quadrant pain, fever, leukocytosis. Suspected appendicitis. Initial imaging. | may be appropriate | expert consensus | usually appropriate | may be appropriate | may be appropriate (disagreement) | usually not appropriate | B |
Judge the appropriateness of administering a Endoscopic internal biliary catheter (removable plastic stent) on a patient with the following characteristics: initial therapeutic procedure for a patient with dilated bile ducts and coagulopathy (INR >2.0 or platelet count <60 K). | usually appropriate | limited | usually not appropriate | may be appropriate | usually appropriate | may be appropriate (disagreement) | C |
Determine the appropriateness of executing a Computed Tomography area of interest without Intravenous contrast on a patient with the following characteristics: suspect primary bone tumor. Lesion on radiographs. Indeterminate or aggressive appearance for malignancy. Next imaging study. | may be appropriate | moderate | usually appropriate | usually not appropriate | may be appropriate | may be appropriate (disagreement) | C |
Assess how appropriate it would be to perform a Ultrasound axilla on a patient with the following characteristics: newly diagnosed. Clinical stage IIB-III (late stage) breast cancer at presentation. Evaluation for locoregional disease (includes IDC, or ILC, or NOS). | usually appropriate | strong | usually not appropriate | may be appropriate | may be appropriate (disagreement) | usually appropriate | D |
Consider the appropriateness of undertaking a Computed Tomography abdomen and pelvis with Intravenous contrast on a patient with the following characteristics: suspected deep pelvic hernia including obturator, sciatic, or perineal. Initial imaging. | usually appropriate | limited | may be appropriate | usually appropriate | usually not appropriate | may be appropriate (disagreement) | B |
Determine the appropriateness of executing a Transhepatic superior mesenteric vein catheterization and pharmacomechanical thrombolysis on a patient with the following characteristics: previously healthy with worsening diffuse abdominal pain for 2 weeks. Computed Tomography Angiography shows occlusion of the superior mesenteric vein and its major tributaries. Bowel appears normal. Serum lactate level is normal. Initial therapy. | usually appropriate | moderate | may be appropriate | usually not appropriate | usually appropriate | may be appropriate (disagreement) | C |
Probe the appropriateness of offering a Ultrasound pelvis transvaginal on a patient with the following characteristics: adult female. Adnexal mass, likely benign, no acute symptoms. Postmenopausal. Follow-up Imaging. | usually appropriate | expert consensus | may be appropriate | usually appropriate | usually not appropriate | may be appropriate (disagreement) | B |
Determine the appropriateness of executing a Computed Tomography Angiography coronary arteries with Intravenous contrast on a patient with the following characteristics: acute nonspecific chest pain; low probability of coronary artery disease. Initial imaging. | usually appropriate | expert consensus | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | C |
Evaluate the appropriateness of carrying out a Computed Tomography temporal bone without Intravenous contrast on a patient with the following characteristics: adult. Brief episodic vertigo. Triggered by specific head movements (eg, Dix-Hallpike maneuver). Initial imaging. | usually not appropriate | expert consensus | usually appropriate | may be appropriate (disagreement) | may be appropriate | usually not appropriate | D |
Survey the appropriateness of delivering a Magnetic Resonance Imaging pelvis without and with Intravenous contrast on a patient with the following characteristics: prostate cancer follow-up. Status post radical prostatectomy. Clinical concern for residual or recurrent disease. | usually appropriate | strong | usually appropriate | usually not appropriate | may be appropriate | may be appropriate (disagreement) | A |
Survey the appropriateness of delivering a Computed Tomography hip without and with Intravenous contrast on a patient with the following characteristics: chronic hip pain. Suspect noninfectious extra-articular abnormality, such as tendonitis or bursitis. Radiographs negative or nondiagnostic. Next imaging study. | usually not appropriate | expert consensus | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | D |
Inspect the appropriateness of conducting a Magnetic Resonance Angiography chest and abdomen without Intravenous contrast on a patient with the following characteristics: known arterial occlusion in the mesenteric or renal arterial system or renal infarcts. Suspected embolic etiology. Next imaging study to determine source. | may be appropriate | strong | may be appropriate | may be appropriate (disagreement) | usually not appropriate | usually appropriate | A |
Probe the appropriateness of offering a Ultrasound elbow on a patient with the following characteristics: chronic elbow pain. Suspect chronic epicondylalgia or tendon tear. Refractory to empirical treatment. Radiographs normal or nonspecific. Next imaging study. | usually appropriate | strong | may be appropriate | may be appropriate (disagreement) | usually not appropriate | usually appropriate | D |
Appraise the appropriateness of delivering a Computed Tomography Angiography head and neck with Intravenous contrast on a patient with the following characteristics: subacute or chronic head trauma with unexplained cognitive or neurologic deficit(s). Initial imaging. | usually not appropriate | expert consensus | may be appropriate | may be appropriate (disagreement) | usually not appropriate | usually appropriate | C |
Determine the appropriateness of executing a Magnetic Resonance Venography head without Intravenous contrast on a patient with the following characteristics: suspected dural venous sinus thrombosis. | usually appropriate | not specified | usually appropriate | may be appropriate | may be appropriate (disagreement) | usually not appropriate | A |
Survey the appropriateness of delivering a Magnetic Resonance Imaging abdomen and pelvis without Intravenous contrast on a patient with the following characteristics: low risk for placenta accreta spectrum disorder. No known clinical risk factors. Initial Imaging. | usually not appropriate | limited | may be appropriate | usually not appropriate | may be appropriate (disagreement) | usually appropriate | B |
Investigate the appropriateness of performing a Computed Tomography head without and with Intravenous contrast on a patient with the following characteristics: child. Clinical presentation suggestive of acute stroke, known or suspected cortical vein or dural venous sinus thrombosis. Initial imaging. | usually not appropriate | limited | usually not appropriate | usually appropriate | may be appropriate (disagreement) | may be appropriate | A |
Gauge the appropriateness of executing a Radiographic arthrography hip on a patient with the following characteristics: symptomatic hip arthroplasty patient, infection not excluded. Additional imaging following radiographs. | usually not appropriate | expert consensus | usually appropriate | may be appropriate | may be appropriate (disagreement) | usually not appropriate | D |
Investigate the appropriateness of performing a Computed Tomography ankle without and with Intravenous contrast on a patient with the following characteristics: adult or child 5 years of age or older. Acute trauma to the ankle. No exclusionary criteria present. Radiographs demonstrate fracture or potential osteochondral injury. Next study. | usually not appropriate | limited | usually not appropriate | usually appropriate | may be appropriate | may be appropriate (disagreement) | A |
Consider the appropriateness of providing a External beam radiation therapy on a patient with the following characteristics: hepatocellular cancer: Solitary tumor less than 3 cm, cirrhotic. | may be appropriate | strong | usually not appropriate | usually appropriate | may be appropriate (disagreement) | may be appropriate | D |
Investigate the appropriateness of performing a Magnetic Resonance arthrography knee on a patient with the following characteristics: adult or child 5 years of age or older. Fall or acute twisting trauma to the knee. Tibial plateau fracture on radiographs. Suspect additional bone or soft-tissue injury. Next study. | usually not appropriate | expert consensus | usually appropriate | usually not appropriate | may be appropriate | may be appropriate (disagreement) | B |
Determine the appropriateness of executing a Computed Tomography abdomen without and with Intravenous contrast on a patient with the following characteristics: child with FWS and neutropenia. | usually not appropriate | not specified | usually appropriate | may be appropriate | usually not appropriate | may be appropriate (disagreement) | C |
Inspect the appropriateness of conducting a Computed Tomography Angiography abdomen and pelvis with Intravenous contrast on a patient with the following characteristics: pulsatile abdominal mass, suspected abdominal aortic aneurysm. Initial imaging. | usually appropriate | strong | usually appropriate | may be appropriate | usually not appropriate | may be appropriate (disagreement) | A |
Determine the appropriateness of executing a Radiography skull on a patient with the following characteristics: head trauma with suspected intracranial venous injury due to clinical risk factors or positive findings on prior imaging. | usually not appropriate | expert consensus | usually not appropriate | may be appropriate | may be appropriate (disagreement) | usually appropriate | A |
Determine the appropriateness of administering a Magnetic Resonance Imaging chest without and with Intravenous contrast on a patient with the following characteristics: recent pneumonia with suspected parapneumonic effusion or empyema. Initial imaging. | usually not appropriate | strong | usually appropriate | may be appropriate (disagreement) | may be appropriate | usually not appropriate | D |
Examine the appropriateness of offering a Transarterial chemoembolization on a patient with the following characteristics: intrahepatic cholangiocarcinoma: Peripheral hepatic lobar cholangiocarcinoma, less than 3 cm; no biliary ductal dilatation, macroscopic vascular invasion, regional lymphadenopathy, or distant metastases. | may be appropriate | expert consensus | usually appropriate | may be appropriate | usually not appropriate | may be appropriate (disagreement) | B |
Gauge the appropriateness of executing a Ultrasound shoulder on a patient with the following characteristics: chronic shoulder pain. History of prior rotator cuff repair. Suspect rotator cuff disorders or subacromial subdeltoid bursitis. Initial radiographs normal or inconclusive. Next imaging study. | usually appropriate | limited | may be appropriate | usually appropriate | may be appropriate (disagreement) | usually not appropriate | B |
Probe the appropriateness of offering a Voiding urosonography on a patient with the following characteristics: child. Isolated microscopic hematuria (nonpainful, nontraumatic) without proteinuria. Initial imaging. | usually not appropriate | expert consensus | usually appropriate | usually not appropriate | may be appropriate (disagreement) | may be appropriate | B |
Assess how appropriate it would be to perform a Fluorodeoxyglucose Positron Emission Tomography breast dedicated on a patient with the following characteristics: supplemental breast cancer screening. Average-risk females with nondense breasts. | usually not appropriate | expert consensus | usually appropriate | may be appropriate (disagreement) | may be appropriate | usually not appropriate | D |
Consider the appropriateness of providing a Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography skull base to mid-thigh on a patient with the following characteristics: renal cell carcinoma. No contraindication to either iodinated Computed Tomography contrast or gadolinium-based Magnetic Resonance intravenous contrast. Staging. | usually not appropriate | strong | may be appropriate | usually appropriate | may be appropriate (disagreement) | usually not appropriate | D |
Evaluate the appropriateness of carrying out a Ultrasound echocardiography transesophageal on a patient with the following characteristics: suspected hypertrophic cardiomyopathy. Ischemic cardiomyopathy already excluded. Initial imaging. | usually not appropriate | expert consensus | usually appropriate | may be appropriate | may be appropriate (disagreement) | usually not appropriate | D |
Appraise the appropriateness of delivering a Computed Tomography abdomen and pelvis with Intravenous contrast on a patient with the following characteristics: suspected acute pyelonephritis. History of renal stones or renal obstruction. Initial imaging. | usually appropriate | limited | usually not appropriate | may be appropriate | usually appropriate | may be appropriate (disagreement) | C |
Assess how appropriate it would be to perform a Magnetic Resonance Imaging cervical spine without and with Intravenous contrast on a patient with the following characteristics: cervicogenic headache and new or increasing nontraumatic cervical or neck pain. No neurologic deficit. Initial imaging. | usually not appropriate | limited | usually not appropriate | may be appropriate | may be appropriate (disagreement) | usually appropriate | A |
Consider the appropriateness of undertaking a Computed Tomography temporal bone without Intravenous contrast on a patient with the following characteristics: multiple different middle cranial nerve palsies (CN V-VII). Initial imaging. | usually not appropriate | limited | usually appropriate | may be appropriate (disagreement) | may be appropriate | usually not appropriate | D |
Consider the appropriateness of undertaking a Magnetic Resonance Angiography coronary arteries without Intravenous contrast on a patient with the following characteristics: suspected large-vessel vasculitis (LVV). Initial imaging. | usually not appropriate | expert consensus | usually not appropriate | usually appropriate | may be appropriate | may be appropriate (disagreement) | A |
Investigate the appropriateness of performing a Computed Tomography pelvis with bladder contrast Computed Tomography cystography) on a patient with the following characteristics: recurrent lower urinary tract infections in a female. Complicated, or patients who are nonresponders to conventional therapy, develop frequent reinfections or relapses, or have known underlying risk factors. | may be appropriate | limited | usually appropriate | may be appropriate (disagreement) | may be appropriate | usually not appropriate | C |
Scrutinize the appropriateness of providing a Computed Tomography pelvis without and with Intravenous contrast on a patient with the following characteristics: first trimester vaginal bleeding. Positive urine or serum pregnancy test. | usually not appropriate | limited | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | D |
Consider the appropriateness of providing a Magnetic Resonance Imaging breast without Intravenous contrast abbreviated on a patient with the following characteristics: supplemental breast cancer screening. Intermediate-risk females with nondense breasts. | usually not appropriate | expert consensus | may be appropriate | usually not appropriate | may be appropriate (disagreement) | usually appropriate | B |
Review the appropriateness of conducting a Ultrasound intravascular iliac veins on a patient with the following characteristics: varicose veins. Initial diagnosis. | usually not appropriate | expert consensus | usually appropriate | may be appropriate (disagreement) | usually not appropriate | may be appropriate | C |
Appraise the appropriateness of delivering a Magnetic Resonance Imaging head perfusion with Intravenous contrast on a patient with the following characteristics: child. Clinical presentation suggestive of acute stroke, not a candidate for emergent intervention. Initial imaging. | may be appropriate | limited | may be appropriate | usually appropriate | may be appropriate (disagreement) | usually not appropriate | A |
Gauge the appropriateness of executing a Computed Tomography head without and with Intravenous contrast on a patient with the following characteristics: child. Nontraumatic intraparenchymal hemorrhage (hematoma) found on Computed Tomography or Magnetic Resonance Imaging Unknown etiology. Next imaging study. | usually not appropriate | limited | may be appropriate | usually appropriate | may be appropriate (disagreement) | usually not appropriate | D |
Assess how appropriate it would be to perform a Computed Tomography pelvis with Intravenous contrast on a patient with the following characteristics: man <40 years of age, transient or episodic hematospermia, and no other symptoms or signs of disease. | usually not appropriate | not specified | may be appropriate | usually not appropriate | may be appropriate (disagreement) | usually appropriate | B |
Consider the appropriateness of undertaking a Fluorodeoxyglucose Positron Emission Tomography breast dedicated on a patient with the following characteristics: supplemental breast cancer screening. High-risk females with dense breasts. | usually not appropriate | expert consensus | usually not appropriate | may be appropriate (disagreement) | usually appropriate | may be appropriate | A |
Probe the appropriateness of offering a Radiographic arthrography hand on a patient with the following characteristics: adult. Chronic hand pain. Radiographs normal or remarkable for nonspecific arthritis. Next imaging study. | usually not appropriate | expert consensus | usually not appropriate | may be appropriate (disagreement) | usually appropriate | may be appropriate | A |
Consider the appropriateness of undertaking a Bone scan hip on a patient with the following characteristics: routine follow-up of the asymptomatic patient after hip arthroplasty. | usually not appropriate | limited | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | D |
Assess how appropriate it would be to perform a Arteriography cervicocerebral on a patient with the following characteristics: headache with new onset or pattern during pregnancy or peripartum period. Initial imaging. | usually not appropriate | expert consensus | may be appropriate | may be appropriate (disagreement) | usually not appropriate | usually appropriate | C |
Evaluate the appropriateness of performing a Computed Tomography chest without Intravenous contrast on a patient with the following characteristics: acute respiratory illness in immunocompetent patients with negative physical examination, normal vital signs and no other risk factors. Initial imaging. | usually not appropriate | expert consensus | usually appropriate | may be appropriate | may be appropriate (disagreement) | usually not appropriate | D |
Evaluate the appropriateness of carrying out a Computed Tomography abdomen without Intravenous contrast on a patient with the following characteristics: indeterminate adrenal mass, less than 1 cm on initial imaging. No diagnostic benign imaging features. No history of malignancy. | usually not appropriate | limited | usually appropriate | usually not appropriate | may be appropriate (disagreement) | may be appropriate | B |
Review the appropriateness of conducting a Radiography abdomen and pelvis on a patient with the following characteristics: left lower quadrant pain. Suspected diverticulitis. Initial imaging. | usually not appropriate | expert consensus | usually not appropriate | usually appropriate | may be appropriate (disagreement) | may be appropriate | A |
Measure the appropriateness of undertaking a Computed Tomography head and orbits without and with Intravenous contrast on a patient with the following characteristics: child. Congenital or developmental abnormality leading to decreased visual acuity or vision loss. No leukocoria. Unilateral or bilateral. Initial imaging. | usually not appropriate | expert consensus | may be appropriate | may be appropriate (disagreement) | usually not appropriate | usually appropriate | C |
Analyze the appropriateness of providing a Magnetic Resonance Imaging head without and with Intravenous contrast on a patient with the following characteristics: carotid territory or vertebrobasilar TIA, initial screening survey. | usually appropriate | not specified | usually not appropriate | may be appropriate | may be appropriate (disagreement) | usually appropriate | D |
Examine the appropriateness of offering a Computed Tomography Angiography head with Intravenous contrast on a patient with the following characteristics: acute sinusitis with rapid progression or suspected invasive fungal sinusitis. Initial Imaging. | usually not appropriate | expert consensus | may be appropriate | usually appropriate | may be appropriate (disagreement) | usually not appropriate | D |
Investigate the appropriateness of performing a Single Photon Emission Computed Tomography or Single-photon Emission Computed Tomography / Computed Tomography Myocardial Perfusion Imaging rest and stress on a patient with the following characteristics: suspected cardiac injury following blunt trauma, hemodynamically unstable patient. | usually not appropriate | limited | usually appropriate | usually not appropriate | may be appropriate (disagreement) | may be appropriate | B |
Evaluate the appropriateness of performing a Magnetic Resonance Imaging spine area of interest without Intravenous contrast on a patient with the following characteristics: axial spondyloarthritis with spine ankylosis. Suspected fracture. Initial imaging. | usually appropriate | limited | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | C |
Weigh the appropriateness of administering a Magnetic Resonance arthrography shoulder on a patient with the following characteristics: chronic shoulder pain. History of prior rotator cuff repair. Suspect rotator cuff disorders or subacromial subdeltoid bursitis. Initial radiographs normal or inconclusive. Next imaging study. | usually appropriate | limited | usually appropriate | may be appropriate | may be appropriate (disagreement) | usually not appropriate | A |
Gauge the appropriateness of executing a Magnetic Resonance Imaging breast without Intravenous contrast on a patient with the following characteristics: adult of any age. Female or transfeminine. Evaluation of silicone breast implants. Asymptomatic. Initial imaging at 5 to 6 years after implant placement and follow-up imaging every 2 to 3 years after initial negative imaging. | usually appropriate | strong | usually not appropriate | may be appropriate | may be appropriate (disagreement) | usually appropriate | D |
Measure the appropriateness of undertaking a Ultrasound pelvis transrectal on a patient with the following characteristics: rectal cancer. Locoregional staging. Postneoadjuvant therapy. | may be appropriate (disagreement) | expert opinion | may be appropriate | may be appropriate (disagreement) | usually not appropriate | usually appropriate | B |
Gauge the appropriateness of executing a Anticoagulation alone on a patient with the following characteristics: iliofemoral DVT with persistent moderate symptoms at least 3 months after initial treatment with anticoagulation alone. | may be appropriate | limited | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | A |
Scrutinize the appropriateness of providing a Magnetic Resonance Angiography head without Intravenous contrast on a patient with the following characteristics: sudden onset severe headache that reaches maximal severity within one hour. Initial imaging. | usually not appropriate | limited | usually appropriate | may be appropriate | usually not appropriate | may be appropriate (disagreement) | C |
Examine the appropriateness of offering a Magnetic Resonance Imaging cervical spine without and with Intravenous contrast on a patient with the following characteristics: 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. | usually not appropriate | strong | usually appropriate | may be appropriate (disagreement) | usually not appropriate | may be appropriate | C |
Consider the appropriateness of undertaking a Fluoroscopy barium swallow modified on a patient with the following characteristics: oropharyngeal dysphagia with an attributable cause. Initial imaging. | usually appropriate | limited | usually appropriate | may be appropriate (disagreement) | may be appropriate | usually not appropriate | A |
Determine the appropriateness of administering a Computed Tomography chest without and with Intravenous contrast on a patient with the following characteristics: renal cell carcinoma. Contraindication only to iodinated Computed Tomography intravenous contrast. Staging. | usually not appropriate | strong | usually appropriate | may be appropriate (disagreement) | usually not appropriate | may be appropriate | C |
Analyze the appropriateness of providing a Ultrasound pelvis transvaginal on a patient with the following characteristics: abnormal uterine bleeding. Initial imaging. | usually appropriate | strong | usually appropriate | may be appropriate (disagreement) | may be appropriate | usually not appropriate | A |
Inspect the appropriateness of conducting a Computed Tomography cervical spine without and with Intravenous contrast on a patient with the following characteristics: chronic cervical or neck pain. Initial imaging. | usually not appropriate | expert consensus | usually not appropriate | may be appropriate | usually appropriate | may be appropriate (disagreement) | A |
Review the appropriateness of conducting a Computed Tomography paranasal sinuses without and with Intravenous contrast on a patient with the following characteristics: child. Uncomplicated acute sinusitis. Initial imaging. | usually not appropriate | expert consensus | usually appropriate | may be appropriate | may be appropriate (disagreement) | usually not appropriate | D |
Judge the appropriateness of administering a Fluoroscopy contrast enema on a patient with the following characteristics: left lower quadrant pain. Suspected diverticulitis. Initial imaging. | usually not appropriate | limited | usually not appropriate | usually appropriate | may be appropriate | may be appropriate (disagreement) | A |
Analyze the appropriateness of providing a Computed Tomography chest abdomen pelvis without Intravenous contrast on a patient with the following characteristics: suspected or confirmed sepsis. No specific symptoms suggestive of origin, or symptoms cannot be assessed. Normal or equivocal or nonspecific chest radiograph. Next imaging study. | may be appropriate (disagreement) | expert opinion | usually appropriate | usually not appropriate | may be appropriate (disagreement) | may be appropriate | C |
Measure the appropriateness of undertaking a Magnetic Resonance Venography head without and with Intravenous contrast on a patient with the following characteristics: adult. Asymptomatic cervical bruit. Initial imaging. | usually not appropriate | expert consensus | usually appropriate | usually not appropriate | may be appropriate (disagreement) | may be appropriate | B |
Investigate the appropriateness of performing a Radiography paranasal sinuses on a patient with the following characteristics: suspected CSF leak. Initial Imaging. | usually not appropriate | expert consensus | usually appropriate | usually not appropriate | may be appropriate (disagreement) | may be appropriate | B |
Evaluate the appropriateness of carrying out a Hysterectomy on a patient with the following characteristics: reproductive age patient with uterine fibroids desiring pregnancy and experiencing reproductive dysfunction. Initial therapy. | usually not appropriate | expert consensus | usually appropriate | may be appropriate | usually not appropriate | may be appropriate (disagreement) | C |
Assess how appropriate it would be to perform a Computed Tomography abdomen and pelvis without Intravenous contrast on a patient with the following characteristics: child. Atypical or recurrent febrile urinary tract infections. Initial imaging. | usually not appropriate | expert consensus | usually appropriate | usually not appropriate | may be appropriate (disagreement) | may be appropriate | B |
Investigate the appropriateness of performing a Sestamibi MBI on a patient with the following characteristics: adult female. Postsurgical excision for breast cancer. Positive margins. Asymptomatic. Initial imaging. | usually not appropriate | expert consensus | usually not appropriate | may be appropriate (disagreement) | usually appropriate | may be appropriate | A |
Probe the appropriateness of offering a Computed Tomography chest and abdomen without Intravenous contrast on a patient with the following characteristics: esophageal cancer. Imaging during treatment. | usually not appropriate | strong | usually appropriate | may be appropriate (disagreement) | may be appropriate | usually not appropriate | D |
Assess how appropriate it would be to perform a Computed Tomography Angiography neck with Intravenous contrast on a patient with the following characteristics: known high-flow vascular malformation (AVM/AVF). Surveillance monitoring. | usually not appropriate | expert consensus | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | D |
Determine the appropriateness of executing a Computed Tomography cervical spine with Intravenous contrast on a patient with the following characteristics: age greater than or equal to 16 years. Acute cervical spine injury detected on radiographs. Treatment planning for mechanically unstable spine. | usually not appropriate | expert consensus | may be appropriate | usually appropriate | may be appropriate (disagreement) | usually not appropriate | D |
Judge the appropriateness of administering a Computed Tomography Urography without and with Intravenous contrast on a patient with the following characteristics: adult. Nonmuscle invasive bladder cancer. Pretreatment staging. | usually appropriate | strong | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | C |
Weigh the appropriateness of administering a Magnetic Resonance Imaging chest without and with Intravenous contrast on a patient with the following characteristics: chronic dyspnea. Suspected chronic obstructive pulmonary disease (COPD). Initial imaging. | usually not appropriate | moderate | may be appropriate | usually appropriate | may be appropriate (disagreement) | usually not appropriate | D |
Determine the appropriateness of executing a Magnetic Resonance Imaging head and internal auditory canal with Intravenous contrast on a patient with the following characteristics: nonpulsatile tinnitus, unilateral; no hearing loss, and no neurologic deficit, and no trauma. Initial imaging. | usually not appropriate | expert consensus | usually not appropriate | may be appropriate | may be appropriate (disagreement) | usually appropriate | A |
Investigate the appropriateness of performing a Computed Tomography cervical spine without and with Intravenous contrast on a patient with the following characteristics: age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Follow-up imaging on patient with no unstable injury demonstrated initially, but kept in collar for neck pain. No new neurologic symptoms. Includes whiplash associated disorders. | usually not appropriate | expert consensus | usually appropriate | usually not appropriate | may be appropriate (disagreement) | may be appropriate | B |
Probe the appropriateness of offering a Computed Tomography chest abdomen pelvis without and with Intravenous contrast on a patient with the following characteristics: newly diagnosed. Clinical stage I-IIA (early stage) breast cancer at presentation. Evaluation for locoregional disease (includes invasive ductal carcinoma [IDC], or invasive lobular carcinoma [ILC], or not otherwise specified [NOS]). | usually not appropriate | limited | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | D |
Judge the appropriateness of administering a Magnetic Resonance Imaging head and internal auditory canal without Intravenous contrast on a patient with the following characteristics: acquired conductive hearing loss secondary to cholesteatoma or neoplasm with suspected intracranial or inner ear extension. Surgical planning. | may be appropriate | limited | may be appropriate | usually not appropriate | may be appropriate (disagreement) | usually appropriate | A |
Weigh the appropriateness of administering a Computed Tomography head with Intravenous contrast on a patient with the following characteristics: subacute or chronic head trauma with unexplained cognitive or neurologic deficit(s). Initial imaging. | usually not appropriate | limited | usually not appropriate | usually appropriate | may be appropriate (disagreement) | may be appropriate | A |
Evaluate the appropriateness of carrying out a Magnetic Resonance Imaging abdomen and pelvis without Intravenous contrast on a patient with the following characteristics: gross hematuria. Initial imaging. | may be appropriate | limited | may be appropriate | usually appropriate | may be appropriate (disagreement) | usually not appropriate | A |
Gauge the appropriateness of executing a Single Photon Emission Computed Tomography or Single-photon Emission Computed Tomography / Computed Tomography brain perfusion ictal and interictal on a patient with the following characteristics: known seizure disorder. Surgical candidate or surgical planning. | may be appropriate | limited | usually not appropriate | usually appropriate | may be appropriate (disagreement) | may be appropriate | D |
Inspect the appropriateness of conducting a Ultrasound pelvis transabdominal on a patient with the following characteristics: postpartum hemorrhage. Late (greater than 24 hours to 6 weeks) after vaginal delivery. Initial imaging. | usually appropriate | limited | usually appropriate | may be appropriate (disagreement) | usually not appropriate | may be appropriate | A |
Probe the appropriateness of offering a Computed Tomography sacroiliac joints with Intravenous contrast on a patient with the following characteristics: inflammatory back pain. Suspected axial spondyloarthritis. Additional imaging following radiographs. Next imaging study. | usually not appropriate | strong | usually appropriate | usually not appropriate | may be appropriate (disagreement) | may be appropriate | B |
Appraise the appropriateness of delivering a Radiography area of interest repeat in 10-14 days on a patient with the following characteristics: adult. Positive stress fracture on radiographs, excluding vertebrae. Need for determining extent (ie, for surgical planning, return to activity) or associated complication (ie, osteonecrosis or delayed healing). Next imaging study. | may be appropriate | expert consensus | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | A |
Evaluate the appropriateness of performing a Computed Tomography abdomen and pelvis with Intravenous contrast on a patient with the following characteristics: ovarian cancer screening. Postmenopausal. Average risk. | usually not appropriate | limited | usually appropriate | may be appropriate | usually not appropriate | may be appropriate (disagreement) | C |
Analyze the appropriateness of providing a Magnetic Resonance Imaging fetal without and with Intravenous contrast on a patient with the following characteristics: second and third trimester screening for fetal anomaly. Low-risk pregnancy. Initial imaging. | usually not appropriate | expert consensus | usually not appropriate | may be appropriate (disagreement) | usually appropriate | may be appropriate | A |
Assess how appropriate it would be to perform a Computed Tomography Angiography head with Intravenous contrast on a patient with the following characteristics: child. Clinical presentation suggestive of acute stroke, known or suspected high-flow vascular anomaly. Initial imaging. | usually appropriate | expert consensus | usually appropriate | usually not appropriate | may be appropriate | may be appropriate (disagreement) | A |
Survey the appropriateness of delivering a Magnetic Resonance Imaging fetal without Intravenous contrast on a patient with the following characteristics: multiple gestations. Monochorionic twins. Second trimester anatomy examination. Follow-up imaging. | may be appropriate | expert consensus | usually appropriate | may be appropriate (disagreement) | may be appropriate | usually not appropriate | C |
Judge the appropriateness of administering a Ultrasound shoulder on a patient with the following characteristics: traumatic shoulder pain. Radiographs normal. Physical examination and history consistent with dislocation event or instability. Next imaging study. | usually not appropriate | limited | may be appropriate | may be appropriate (disagreement) | usually appropriate | usually not appropriate | D |
Examine the appropriateness of offering a Computed Tomography shoulder without and with Intravenous contrast on a patient with the following characteristics: traumatic shoulder pain. Radiographs already performed. Neuropathic syndrome (excluding plexopathy). Next imaging study. | usually not appropriate | expert consensus | may be appropriate | usually not appropriate | usually appropriate | may be appropriate (disagreement) | B |
Analyze the appropriateness of providing a Magnetic Resonance Venography head with Intravenous contrast on a patient with the following characteristics: headache with features of intracranial hypertension (eg, papilledema, pulsatile tinnitus, visual symptoms worse on Valsalva). Initial imaging. | may be appropriate | limited | usually appropriate | may be appropriate | usually not appropriate | may be appropriate (disagreement) | B |
Examine the appropriateness of offering a Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography skull base to mid-thigh on a patient with the following characteristics: suspected or initial diagnosis of gestational trophoblastic disease (GTD). | usually not appropriate | limited | usually appropriate | usually not appropriate | may be appropriate | may be appropriate (disagreement) | B |
Measure the appropriateness of undertaking a Magnetic Resonance Imaging breast without Intravenous contrast on a patient with the following characteristics: supplemental breast cancer screening. Average-risk females with nondense breasts. | usually not appropriate | expert consensus | usually appropriate | may be appropriate (disagreement) | may be appropriate | usually not appropriate | D |
Appraise the appropriateness of delivering a Magnetic Resonance Imaging pelvis without Intravenous contrast on a patient with the following characteristics: clinically established low-risk prostate cancer. Active surveillance. | usually appropriate | limited | may be appropriate | usually not appropriate | usually appropriate | may be appropriate (disagreement) | C |
Weigh the appropriateness of administering a Ultrasound echocardiography transthoracic resting on a patient with the following characteristics: suspected pulmonary embolism. Low or intermediate pretest probability with a negative D-dimer. Initial Imaging. | usually not appropriate | limited | usually not appropriate | usually appropriate | may be appropriate | may be appropriate (disagreement) | A |
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