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Major Blunt Trauma
Variant: 1
Adult. Major blunt trauma. Hemodynamically unstable. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography trauma series | Usually Appropriate | ☢☢☢ |
| CT whole body with IV contrast | May Be Appropriate | ☢☢☢☢ |
| MRI abdomen and pelvis without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen and pelvis without IV contrast | Usually Not Appropriate | O |
| CT whole body without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 2
Adult. Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography trauma series | Usually Appropriate | ☢☢☢ |
| CT whole body with IV contrast | Usually Appropriate | ☢☢☢☢ |
| MRI abdomen and pelvis without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen and pelvis without IV contrast | Usually Not Appropriate | O |
| CT whole body without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 3
Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography trauma series | Usually Appropriate | ☢☢☢ |
| CT maxillofacial without IV contrast | Usually Appropriate | ☢☢ |
| CT head without IV contrast | Usually Appropriate | ☢☢☢ |
| CTA head and neck with IV contrast | Usually Appropriate | ☢☢☢ |
| CT whole body with IV contrast | Usually Appropriate | ☢☢☢☢ |
| CT whole body without IV contrast | May Be Appropriate | ☢☢☢☢ |
| MRI head without IV contrast abbreviated | Usually Not Appropriate | O |
| CT maxillofacial with IV contrast | Usually Not Appropriate | ☢☢ |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT maxillofacial without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
Variant: 4
Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography trauma series | Usually Appropriate | ☢☢☢ |
| Radiography extremity area of interest | Usually Appropriate | Varies |
| CT whole body with IV contrast | Usually Appropriate | ☢☢☢☢ |
| CTA extremity area of interest with IV contrast | May Be Appropriate | Varies |
| US duplex Doppler extremity area of interest | Usually Not Appropriate | O |
| CT whole body without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT extremity area of interest with IV contrast | Usually Not Appropriate | Varies |
| CT extremity area of interest without and with IV contrast | Usually Not Appropriate | Varies |
| CT extremity area of interest without IV contrast | Usually Not Appropriate | Varies |
Variant: 5
Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography trauma series | Usually Appropriate | ☢☢☢ |
| CT abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢ |
| CT whole body with IV contrast | Usually Appropriate | ☢☢☢☢ |
| CTA abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢☢ |
| CT abdomen and pelvis without IV contrast | May Be Appropriate | ☢☢☢ |
| CT whole body without IV contrast | May Be Appropriate | ☢☢☢☢ |
| US abdomen | Usually Not Appropriate | O |
| MRI abdomen and pelvis without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen and pelvis without IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 6
Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography trauma series | Usually Appropriate | ☢☢☢ |
| CT abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢ |
| CT whole body with IV contrast | Usually Appropriate | ☢☢☢☢ |
| CT pelvis with bladder contrast (CT cystography) | May Be Appropriate (Disagreement) | ☢☢☢☢ |
| CTA abdomen and pelvis with IV contrast | May Be Appropriate | ☢☢☢☢ |
| US abdomen and pelvis | Usually Not Appropriate | O |
| Fluoroscopy cystography | Usually Not Appropriate | ☢☢☢ |
| Fluoroscopy retrograde urethrography | Usually Not Appropriate | ☢☢☢ |
| Radiography intravenous urography | Usually Not Appropriate | ☢☢☢ |
| MRI abdomen and pelvis without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen and pelvis without IV contrast | Usually Not Appropriate | O |
| MRU without and with IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT whole body without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTU without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 7
Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| Radiography trauma series | Usually Appropriate | ☢☢☢ |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| CTA chest with IV contrast | Usually Appropriate | ☢☢☢ |
| CT whole body with IV contrast | Usually Appropriate | ☢☢☢☢ |
| CT whole body without IV contrast | May Be Appropriate | ☢☢☢☢ |
| US chest | Usually Not Appropriate | O |
| MRI chest without and with IV contrast | Usually Not Appropriate | O |
| MRI chest without IV contrast | Usually Not Appropriate | O |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without IV contrast | Usually Not Appropriate | ☢☢☢ |
Variant: 8
Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US pregnant uterus | Usually Appropriate | O |
| Radiography trauma series | Usually Appropriate | ☢☢☢ |
| CT abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢ |
| CTA chest with IV contrast | May Be Appropriate (Disagreement) | ☢☢☢ |
| CT whole body with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CTA abdomen and pelvis with IV contrast | May Be Appropriate | ☢☢☢☢ |
| US abdomen and pelvis | Usually Not Appropriate | O |
| US pelvis | Usually Not Appropriate | O |
| MRI abdomen and pelvis without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen and pelvis without IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT whole body without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Panel Members
James T. Lee, MDa; Marc A. Camacho, MD, MSb; Deborah B. Diercks, MD, MScc; Sanjeeva P. Kalva, MDd; Mahammed Z. Khan Suheb, MDe; Faisal Khosa, MD, MBAf; Angela Lumba-Brown, MDg; Samuel Mandell, MDh; Thomas Ptak, MD, PhD, MPHi; Clint W. Sliker, MDj; Edwin F. Donnelly, MD, PhDk.
Summary of Literature Review
Introduction/Background
Special Imaging Considerations
Initial Imaging Definition
Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant. More than one procedure can be considered usually appropriate in the initial imaging evaluation when:
- There are procedures that are equivalent alternatives (i.e., only one procedure will be ordered to provide the clinical information to effectively manage the patient’s care)
OR
- There are complementary procedures (i.e., more than one procedure is ordered as a set or simultaneously wherein each procedure provides unique clinical information to effectively manage the patient’s care).
Discussion of Procedures by Variant
Variant 1: Adult. Major blunt trauma. Hemodynamically unstable. Initial imaging.
Variant 1: Adult. Major blunt trauma. Hemodynamically unstable. Initial imaging.
A. CT whole body with IV contrast
A. CT whole body with IV contrast
Variant 1: Adult. Major blunt trauma. Hemodynamically unstable. Initial imaging.
B. CT whole body without IV contrast
B. CT whole body without IV contrast
Variant 1: Adult. Major blunt trauma. Hemodynamically unstable. Initial imaging.
C. MRI abdomen and pelvis without and with IV contrast
C. MRI abdomen and pelvis without and with IV contrast
Variant 1: Adult. Major blunt trauma. Hemodynamically unstable. Initial imaging.
D. MRI abdomen and pelvis without IV contrast
D. MRI abdomen and pelvis without IV contrast
Variant 1: Adult. Major blunt trauma. Hemodynamically unstable. Initial imaging.
E. Radiography trauma series
E. Radiography trauma series
Variant 2: Adult. Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging.
Variant 2: Adult. Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging.
A. CT whole body with IV contrast
A. CT whole body with IV contrast
Variant 2: Adult. Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging.
B. CT whole body without IV contrast
B. CT whole body without IV contrast
Variant 2: Adult. Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging.
C. MRI abdomen and pelvis without and with IV contrast
C. MRI abdomen and pelvis without and with IV contrast
Variant 2: Adult. Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging.
D. MRI abdomen and pelvis without IV contrast
D. MRI abdomen and pelvis without IV contrast
Variant 2: Adult. Major blunt trauma. Hemodynamically stable. Not otherwise specified. Initial imaging.
E. Radiography trauma series
E. Radiography trauma series
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
A. CT head with IV contrast
A. CT head with IV contrast
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
B. CT head without and with IV contrast
B. CT head without and with IV contrast
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
C. CT head without IV contrast
C. CT head without IV contrast
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
D. CT maxillofacial with IV contrast
D. CT maxillofacial with IV contrast
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
E. CT maxillofacial without and with IV contrast
E. CT maxillofacial without and with IV contrast
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
F. CT maxillofacial without IV contrast
F. CT maxillofacial without IV contrast
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
G. CT whole body with IV contrast
G. CT whole body with IV contrast
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
H. CT whole body without IV contrast
H. CT whole body without IV contrast
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
I. CTA head and neck with IV contrast
I. CTA head and neck with IV contrast
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
J. MRI head without IV contrast abbreviated
J. MRI head without IV contrast abbreviated
Variant 3: Adult. Major blunt trauma. Hemodynamically stable. Suspected facial injury. Initial imaging.
K. Radiography trauma series
K. Radiography trauma series
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
A. CT extremity area of interest with IV contrast
A. CT extremity area of interest with IV contrast
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
B. CT extremity area of interest without and with IV contrast
B. CT extremity area of interest without and with IV contrast
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
C. CT extremity area of interest without IV contrast
C. CT extremity area of interest without IV contrast
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
D. CT whole body with IV contrast
D. CT whole body with IV contrast
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
E. CT whole body without IV contrast
E. CT whole body without IV contrast
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
F. CTA extremity area of interest with IV contrast
F. CTA extremity area of interest with IV contrast
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
G. Radiography extremity area of interest
G. Radiography extremity area of interest
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
H. Radiography trauma series
H. Radiography trauma series
Variant 4: Adult. Major blunt trauma. Hemodynamically stable. Suspected extremity trauma. Initial imaging.
I. US duplex Doppler extremity area of interest
I. US duplex Doppler extremity area of interest
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
D. CT whole body with IV contrast
D. CT whole body with IV contrast
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
E. CT whole body without IV contrast
E. CT whole body without IV contrast
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
F. CTA abdomen and pelvis with IV contrast
F. CTA abdomen and pelvis with IV contrast
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
G. MRI abdomen and pelvis without and with IV contrast
G. MRI abdomen and pelvis without and with IV contrast
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
H. MRI abdomen and pelvis without IV contrast
H. MRI abdomen and pelvis without IV contrast
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
I. Radiography trauma series
I. Radiography trauma series
Variant 5: Adult. Major blunt trauma. Hemodynamically stable. Suspected bowel or mesenteric trauma. Initial imaging.
J. US abdomen
J. US abdomen
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
D. CT Whole Body With IV Contrast
D. CT Whole Body With IV Contrast
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
E. CT Whole Body Without IV Contrast
E. CT Whole Body Without IV Contrast
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
F. CTA Abdomen And Pelvis With IV Contrast
F. CTA Abdomen And Pelvis With IV Contrast
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
G. CTU Without And With IV Contrast
G. CTU Without And With IV Contrast
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
H. CT Pelvis with Bladder Contrast (CT Cystography)
H. CT Pelvis with Bladder Contrast (CT Cystography)
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
I. Fluoroscopy Retrograde Urethrography
I. Fluoroscopy Retrograde Urethrography
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
J. Fluoroscopy Cystography
J. Fluoroscopy Cystography
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
K. MRI abdomen and pelvis without and with IV contrast
K. MRI abdomen and pelvis without and with IV contrast
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
L. MRI abdomen and pelvis without IV contrast
L. MRI abdomen and pelvis without IV contrast
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
M. MRU without and with IV contrast
M. MRU without and with IV contrast
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
N. Radiography intravenous urography
N. Radiography intravenous urography
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
O. Radiography trauma series
O. Radiography trauma series
Variant 6: Adult. Major blunt trauma. Hemodynamically stable. Suspected urinary system trauma. Initial imaging.
P. US abdomen and pelvis
P. US abdomen and pelvis
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
A. CT chest with IV contrast
A. CT chest with IV contrast
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
B. CT chest without and with IV contrast
B. CT chest without and with IV contrast
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
C. CT chest without IV contrast
C. CT chest without IV contrast
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
D. CT whole body with IV contrast
D. CT whole body with IV contrast
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
E. CT whole body without IV contrast
E. CT whole body without IV contrast
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
F. CTA chest with IV contrast
F. CTA chest with IV contrast
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
G. MRI chest without and with IV contrast
G. MRI chest without and with IV contrast
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
H. MRI chest without IV contrast
H. MRI chest without IV contrast
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
I. Radiography trauma series
I. Radiography trauma series
Variant 7: Adult. Major blunt trauma. Hemodynamically stable. Suspected chest trauma. Initial imaging.
J. US chest
J. US chest
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
D. CT whole body with IV contrast
D. CT whole body with IV contrast
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
E. CT whole body without IV contrast
E. CT whole body without IV contrast
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
F. CTA abdomen and pelvis with IV contrast
F. CTA abdomen and pelvis with IV contrast
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
G. CTA chest with IV contrast
G. CTA chest with IV contrast
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
H. MRI abdomen and pelvis without and with IV contrast
H. MRI abdomen and pelvis without and with IV contrast
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
I. MRI abdomen and pelvis without IV contrast
I. MRI abdomen and pelvis without IV contrast
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
J. Radiography trauma series
J. Radiography trauma series
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
K. US abdomen and pelvis
K. US abdomen and pelvis
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
L. US pelvis
L. US pelvis
Variant 8: Major blunt trauma. Hemodynamically stable. Pregnant patient. Initial imaging.
M. US pregnant uterus
M. US pregnant uterus
Summary of Highlights
Supporting Documents
The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.
For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.
Safety Considerations in Pregnant Patients
Imaging of the pregnant patient can be challenging, particularly with respect to minimizing radiation exposure and risk. For further information and guidance, see the following ACR documents:
· ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI)
· ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation
· ACR-ACOG-AIUM-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetrical Ultrasound
· ACR Manual on Contrast Media
· ACR Manual on MR Safety
Gender Equality and Inclusivity Clause
The ACR acknowledges the limitations in applying inclusive language when citing research studies that predates the use of the current understanding of language inclusive of diversity in sex, intersex, gender, and gender-diverse people. The data variables regarding sex and gender used in the cited literature will not be changed. However, this guideline will use the terminology and definitions as proposed by the National Institutes of Health.
Appropriateness Category Names and Definitions
|
Appropriateness Category Name |
Appropriateness Rating |
Appropriateness Category Definition |
|
Usually Appropriate |
7, 8, or 9 |
The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients. |
|
May Be Appropriate |
4, 5, or 6 |
The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal. |
|
May Be Appropriate (Disagreement) |
5 |
The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned. |
|
Usually Not Appropriate |
1, 2, or 3 |
The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable. |
Relative Radiation Level Information
Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria® Radiation Dose Assessment Introduction document.
|
Relative Radiation Level Designations |
||
|
Relative Radiation Level* |
Adult Effective Dose Estimate Range |
Pediatric Effective Dose Estimate Range |
|
O |
0 mSv |
0 mSv |
|
☢ |
<0.1 mSv |
<0.03 mSv |
|
☢☢ |
0.1-1 mSv |
0.03-0.3 mSv |
|
☢☢☢ |
1-10 mSv |
0.3-3 mSv |
|
☢☢☢☢ |
10-30 mSv |
3-10 mSv |
|
☢☢☢☢☢ |
30-100 mSv |
10-30 mSv |
|
*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.” |
||
References
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| 2. | Lee JT, Sobieh A, Bonne S, et al. ACR Appropriateness Criteria® Penetrating Torso Trauma. J Am Coll Radiol 2024;21:S448-S63. | |
| 3. | Shih RY, Burns J, Ajam AA, et al. ACR Appropriateness Criteria® Head Trauma: 2021 Update. J Am Coll Radiol 2021;18:S13-S36. | |
| 4. | Akoglu H, Celik OF, Celik A, Ergelen R, Onur O, Denizbasi A. Diagnostic accuracy of the Extended Focused Abdominal Sonography for Trauma (E-FAST) performed by emergency physicians compared to CT. American Journal of Emergency Medicine. 36(6):1014-1017, 2018 Jun.Am J Emerg Med. 36(6):1014-1017, 2018 Jun. | |
| 5. | Hassankhani A, Freeman CW, Banks J, et al. ACR Appropriateness Criteria® Acute Spinal Trauma: 2024 Update. J Am Coll Radiol 2025;22:S48-S66. | |
| 6. | Osterwalder J, Mathis G, Hoffmann B. New Perspectives for Modern Trauma Management - Lessons Learned from 25 Years FAST and 15 Years E-FAST. [Review]. Ultraschall Med. 40(5):560-583, 2019 Oct. | |
| 7. | Kozar RA, Crandall M, Shanmuganathan K, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg 2018;85:1119-22. | |
| 8. | Tsutsumi Y, Fukuma S, Tsuchiya A, et al. Computed tomography during initial management and mortality among hemodynamically unstable blunt trauma patients: a nationwide retrospective cohort study. Scand J Trauma Resusc Emerg Med. 25(1):74, 2017 Jul 19. | |
| 9. | Huber-Wagner S, Biberthaler P, Haberle S, et al. Whole-body CT in haemodynamically unstable severely injured patients--a retrospective, multicentre study. PLoS ONE. 8(7):e68880, 2013. | |
| 10. | American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=164+&releaseId=2. | |
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Disclaimer
The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.