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Ataxia-Child
Variant: 1
Child. Acute ataxia, no history of recent trauma. Initial imaging.
| Procedure | Appropriateness Category | Peds Relative Radiation Level |
| MRI head without and with IV contrast | Usually Appropriate | O |
| MRI head without IV contrast | Usually Appropriate | O |
| CT head without IV contrast | Usually Appropriate | ☢☢☢ |
| MRA head and neck without IV contrast | May Be Appropriate | O |
| MRA head without IV contrast | May Be Appropriate | O |
| MRA neck with IV contrast | May Be Appropriate | O |
| MRA neck without IV contrast | May Be Appropriate | O |
| MRI complete spine without and with IV contrast | May Be Appropriate | O |
| MRI complete spine without IV contrast | May Be Appropriate | O |
| CTA head and neck with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CTA head with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CTA neck with IV contrast | May Be Appropriate | ☢☢☢ |
| MR spectroscopy head without IV contrast | Usually Not Appropriate | O |
| MRI chest abdomen pelvis without and with IV contrast | Usually Not Appropriate | O |
| MRI chest abdomen pelvis without IV contrast | Usually Not Appropriate | O |
| MRV head and neck without IV contrast | Usually Not Appropriate | O |
| MRV head with IV contrast | Usually Not Appropriate | O |
| MRV head without and with IV contrast | Usually Not Appropriate | O |
| MRV head without IV contrast | Usually Not Appropriate | O |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTV head with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| MIBG scan | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢☢ |
| CT chest abdomen pelvis without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 2
Child. Acute ataxia, history of recent trauma. Initial imaging.
| Procedure | Appropriateness Category | Peds Relative Radiation Level |
| MRI head without IV contrast | Usually Appropriate | O |
| CT head without IV contrast | Usually Appropriate | ☢☢☢ |
| MRA head and neck without IV contrast | May Be Appropriate | O |
| MRA head without IV contrast | May Be Appropriate | O |
| MRA neck with IV contrast | May Be Appropriate | O |
| MRA neck without IV contrast | May Be Appropriate | O |
| CTA head and neck with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CTA head with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CTA neck with IV contrast | May Be Appropriate | ☢☢☢ |
| MR spectroscopy head without IV contrast | Usually Not Appropriate | O |
| MRI complete spine without and with IV contrast | Usually Not Appropriate | O |
| MRI complete spine without IV contrast | Usually Not Appropriate | O |
| MRI head without and with IV contrast | Usually Not Appropriate | O |
| MRV head and neck without IV contrast | Usually Not Appropriate | O |
| MRV head with IV contrast | Usually Not Appropriate | O |
| MRV head without and with IV contrast | Usually Not Appropriate | O |
| MRV head without IV contrast | Usually Not Appropriate | O |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTV head with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 3
Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
| Procedure | Appropriateness Category | Peds Relative Radiation Level |
| MRI head without IV contrast | Usually Appropriate | O |
| MR spectroscopy head without IV contrast | May Be Appropriate | O |
| MRI head without and with IV contrast | May Be Appropriate | O |
| MRA head and neck without IV contrast | Usually Not Appropriate | O |
| MRA head without IV contrast | Usually Not Appropriate | O |
| MRA neck with IV contrast | Usually Not Appropriate | O |
| MRA neck without IV contrast | Usually Not Appropriate | O |
| MRI complete spine without and with IV contrast | Usually Not Appropriate | O |
| MRI complete spine without IV contrast | Usually Not Appropriate | O |
| MRV head and neck without IV contrast | Usually Not Appropriate | O |
| MRV head with IV contrast | Usually Not Appropriate | O |
| MRV head without and with IV contrast | Usually Not Appropriate | O |
| MRV head without IV contrast | Usually Not Appropriate | O |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT head without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CTA head and neck with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTA head with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTA neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CTV head with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 4
Child. Chronic progressive ataxia. Initial imaging.
| Procedure | Appropriateness Category | Peds Relative Radiation Level |
| MRI head without and with IV contrast | Usually Appropriate | O |
| MRI head without IV contrast | Usually Appropriate | O |
| MRI complete spine without and with IV contrast | May Be Appropriate | O |
| MRI complete spine without IV contrast | May Be Appropriate | O |
| CT head without IV contrast | May Be Appropriate | ☢☢☢ |
| MR spectroscopy head without IV contrast | Usually Not Appropriate | O |
| MRA head and neck without IV contrast | Usually Not Appropriate | O |
| MRA head without IV contrast | Usually Not Appropriate | O |
| MRA neck with IV contrast | Usually Not Appropriate | O |
| MRA neck without IV contrast | Usually Not Appropriate | O |
| MRV head and neck without IV contrast | Usually Not Appropriate | O |
| MRV head with IV contrast | Usually Not Appropriate | O |
| MRV head without and with IV contrast | Usually Not Appropriate | O |
| MRV head without IV contrast | Usually Not Appropriate | O |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTA head and neck with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTA head with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTA neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CTV head with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 5
Child. Chronic nonprogressive ataxia. Initial imaging.
| Procedure | Appropriateness Category | Peds Relative Radiation Level |
| MRI head without IV contrast | Usually Appropriate | O |
| MRI complete spine without IV contrast | May Be Appropriate | O |
| CT head without IV contrast | May Be Appropriate | ☢☢☢ |
| MR spectroscopy head without IV contrast | Usually Not Appropriate | O |
| MRA head and neck without IV contrast | Usually Not Appropriate | O |
| MRA head without IV contrast | Usually Not Appropriate | O |
| MRA neck with IV contrast | Usually Not Appropriate | O |
| MRA neck without IV contrast | Usually Not Appropriate | O |
| MRI complete spine without and with IV contrast | Usually Not Appropriate | O |
| MRI head without and with IV contrast | Usually Not Appropriate | O |
| MRV head and neck without IV contrast | Usually Not Appropriate | O |
| MRV head with IV contrast | Usually Not Appropriate | O |
| MRV head without and with IV contrast | Usually Not Appropriate | O |
| MRV head without IV contrast | Usually Not Appropriate | O |
| CT head with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTA head and neck with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTA head with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTA neck with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CTV head with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT complete spine without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Panel Members
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: Child. Acute ataxia, no history of recent trauma. Initial imaging.
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
A. CT Head
A. CT Head
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
B. CT Complete Spine
B. CT Complete Spine
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
C. CTA Head and Neck
C. CTA Head and Neck
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
D. CTA Head
D. CTA Head
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
E. CTA Neck
E. CTA Neck
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
F. CTV Head
F. CTV Head
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
G. MRI Head
G. MRI Head
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
H. MRI Complete Spine
H. MRI Complete Spine
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
I. MR Spectroscopy Head
I. MR Spectroscopy Head
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
J. MRA Head and Neck
J. MRA Head and Neck
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
K. MRA Head
K. MRA Head
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
L. MRA Neck
L. MRA Neck
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
M. MRV Head and Neck
M. MRV Head and Neck
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
N. MRV Head
N. MRV Head
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
O. MIBG Scan
O. MIBG Scan
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
P. CT Chest, Abdomen, and Pelvis
P. CT Chest, Abdomen, and Pelvis
Variant 1: Child. Acute ataxia, no history of recent trauma. Initial imaging.
Q. MRI Chest, Abdomen, and Pelvis
Q. MRI Chest, Abdomen, and Pelvis
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
A. CT Head
A. CT Head
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
B. CT Complete Spine
B. CT Complete Spine
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
C. CTA Head and Neck
C. CTA Head and Neck
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
D. CTA Head
D. CTA Head
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
E. CTA Neck
E. CTA Neck
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
F. CTV Head
F. CTV Head
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
G. MRI Head
G. MRI Head
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
H. MR Spectroscopy Head
H. MR Spectroscopy Head
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
I. MRA Head and Neck
I. MRA Head and Neck
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
J. MRA Head
J. MRA Head
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
K. MRA Neck
K. MRA Neck
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
L. MRI Complete Spine
L. MRI Complete Spine
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
M. MRV Head and Neck
M. MRV Head and Neck
Variant 2: Child. Acute ataxia, history of recent trauma. Initial imaging.
N. MRV Head
N. MRV Head
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
A. CT Head
A. CT Head
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
B. CT Complete Spine
B. CT Complete Spine
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
C. CTA Head and Neck
C. CTA Head and Neck
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
D. CTA Head
D. CTA Head
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
E. CTA Neck
E. CTA Neck
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
F. CTV Head
F. CTV Head
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
G. MRI Head
G. MRI Head
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
H. MRI Complete Spine
H. MRI Complete Spine
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
I. MR Spectroscopy Head
I. MR Spectroscopy Head
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
J. MRA Head and Neck
J. MRA Head and Neck
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
K. MRA Head
K. MRA Head
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
L. MRA Neck
L. MRA Neck
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
M. MRV Head and Neck
M. MRV Head and Neck
Variant 3: Child. Recurrent ataxia with interval normal neurology examination. Initial imaging.
N. MRV Head
N. MRV Head
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
A. CT Head
A. CT Head
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
B. CT Complete Spine
B. CT Complete Spine
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
C. CTA Head and Neck
C. CTA Head and Neck
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
D. CTA Head
D. CTA Head
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
E. CTA Neck
E. CTA Neck
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
F. CTV Head
F. CTV Head
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
G. MRI Head
G. MRI Head
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
H. MRI Complete Spine
H. MRI Complete Spine
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
I. MR Spectroscopy Head
I. MR Spectroscopy Head
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
J. MRA Head and Neck
J. MRA Head and Neck
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
K. MRA Head
K. MRA Head
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
L. MRA Neck
L. MRA Neck
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
M. MRV Head and Neck
M. MRV Head and Neck
Variant 4: Child. Chronic progressive ataxia. Initial imaging.
N. MRV Head
N. MRV Head
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
A. CT Head
A. CT Head
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
B. CT Complete Spine
B. CT Complete Spine
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
C. CTA Head and Neck
C. CTA Head and Neck
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
D. CTA Head
D. CTA Head
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
E. CTA Neck
E. CTA Neck
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
F. CTV Head
F. CTV Head
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
G. MRI Head
G. MRI Head
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
H. MRI Complete Spine
H. MRI Complete Spine
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
I. MR Spectroscopy Head
I. MR Spectroscopy Head
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
J. MRA Head and Neck
J. MRA Head and Neck
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
K. MRA Head
K. MRA Head
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
L. MRA Neck
L. MRA Neck
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
M. MRV Head and Neck
M. MRV Head and Neck
Variant 5: Child. Chronic nonprogressive ataxia. Initial imaging.
N. MRV Head
N. MRV Head
Summary of Recommendations
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.
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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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.