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Hydronephrosis on Prior Imaging-Unknown Cause
Variant: 1
Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRU without and with IV contrast | Usually Appropriate | O |
| MAG3 renal scan | Usually Appropriate | ☢☢☢ |
| CTU without and with IV contrast | Usually Appropriate | ☢☢☢☢ |
| US color Doppler kidneys and bladder retroperitoneal | May Be Appropriate | O |
| MRU without IV contrast | May Be Appropriate | O |
| CT abdomen and pelvis with IV contrast | May Be Appropriate (Disagreement) | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | May Be Appropriate | ☢☢☢ |
| DTPA renal scan | May Be Appropriate (Disagreement) | ☢☢☢ |
| US abdomen | Usually Not Appropriate | O |
| Fluoroscopy voiding cystourethrography | Usually Not Appropriate | ☢☢ |
| Fluoroscopy antegrade pyelography | Usually Not Appropriate | ☢☢☢ |
| Radiography abdomen and pelvis | 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 |
| MRI abdomen without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen without IV contrast | Usually Not Appropriate | O |
| CT abdomen with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT abdomen without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 2
Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRU without and with IV contrast | Usually Appropriate | O |
| MAG3 renal scan | Usually Appropriate | ☢☢☢ |
| MRU without IV contrast | May Be Appropriate | O |
| CT abdomen and pelvis with IV contrast | May Be Appropriate (Disagreement) | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | May Be Appropriate | ☢☢☢ |
| DTPA renal scan | May Be Appropriate (Disagreement) | ☢☢☢ |
| CTU without and with IV contrast | May Be Appropriate (Disagreement) | ☢☢☢☢ |
| US abdomen | Usually Not Appropriate | O |
| US color Doppler kidneys and bladder retroperitoneal | Usually Not Appropriate | O |
| Fluoroscopy voiding cystourethrography | Usually Not Appropriate | ☢☢ |
| Fluoroscopy antegrade pyelography | Usually Not Appropriate | ☢☢☢ |
| Radiography abdomen and pelvis | 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 |
| MRI abdomen without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen without IV contrast | Usually Not Appropriate | O |
| CT abdomen with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT abdomen without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 3
Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US color Doppler kidneys and bladder retroperitoneal | Usually Appropriate | O |
| MRU without and with IV contrast | Usually Appropriate | O |
| MAG3 renal scan | Usually Appropriate | ☢☢☢ |
| CTU without and with IV contrast | Usually Appropriate | ☢☢☢☢ |
| US abdomen | May Be Appropriate (Disagreement) | O |
| MRI abdomen and pelvis without and with IV contrast | May Be Appropriate | O |
| MRI abdomen and pelvis without IV contrast | May Be Appropriate | O |
| MRU without IV contrast | May Be Appropriate | O |
| CT abdomen and pelvis with IV contrast | May Be Appropriate | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | May Be Appropriate | ☢☢☢ |
| DTPA renal scan | May Be Appropriate | ☢☢☢ |
| Fluoroscopy voiding cystourethrography | Usually Not Appropriate | ☢☢ |
| Fluoroscopy antegrade pyelography | Usually Not Appropriate | ☢☢☢ |
| Radiography abdomen and pelvis | Usually Not Appropriate | ☢☢☢ |
| Radiography intravenous urography | Usually Not Appropriate | ☢☢☢ |
| MRI abdomen without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen without IV contrast | Usually Not Appropriate | O |
| CT abdomen with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT abdomen without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 4
Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US color Doppler kidneys and bladder retroperitoneal | Usually Appropriate | O |
| US abdomen | May Be Appropriate | O |
| MRI abdomen and pelvis without IV contrast | May Be Appropriate (Disagreement) | O |
| MRU without IV contrast | May Be Appropriate | O |
| Fluoroscopy voiding cystourethrography | Usually Not Appropriate | ☢☢ |
| Fluoroscopy antegrade pyelography | Usually Not Appropriate | ☢☢☢ |
| Radiography abdomen and pelvis | Usually Not Appropriate | ☢☢☢ |
| Radiography intravenous urography | Usually Not Appropriate | ☢☢☢ |
| MRI abdomen and pelvis without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen without IV contrast | Usually Not Appropriate | O |
| MRU without and with IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen without IV contrast | Usually Not Appropriate | ☢☢☢ |
| DTPA renal scan | Usually Not Appropriate | ☢☢☢ |
| MAG3 renal scan | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT abdomen without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTU without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 5
Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US color Doppler kidneys and bladder retroperitoneal | Usually Appropriate | O |
| MRU without IV contrast | Usually Appropriate | O |
| US abdomen | May Be Appropriate | O |
| MRI abdomen and pelvis without IV contrast | May Be Appropriate | O |
| CT abdomen and pelvis without IV contrast | May Be Appropriate | ☢☢☢ |
| Fluoroscopy voiding cystourethrography | Usually Not Appropriate | ☢☢ |
| Fluoroscopy antegrade pyelography | Usually Not Appropriate | ☢☢☢ |
| Radiography abdomen and pelvis | Usually Not Appropriate | ☢☢☢ |
| Radiography intravenous urography | Usually Not Appropriate | ☢☢☢ |
| MRI abdomen and pelvis without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen without and with IV contrast | Usually Not Appropriate | O |
| MRI abdomen without IV contrast | Usually Not Appropriate | O |
| MRU without and with IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen without IV contrast | Usually Not Appropriate | ☢☢☢ |
| DTPA renal scan | Usually Not Appropriate | ☢☢☢ |
| MAG3 renal scan | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT abdomen without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CTU without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Panel Members
Pat Whitworth III, MDa; Kelsey G. Courtney, MDb; Aytekin Oto, MDc; Brian C. Allen, MDd; Oguz Akin, MDe; Samantha J. Barker, MDf; Twyla B. Bartel, DO, MBAg; Catherine DuBeau, MDh; Marielia Gerena, MDi; Kate H. Kraft, MD, MHPEj; Susie Q. Lew, MDk; Lori Mankowski Gettle, MD, MBAl; Baris Turkbey, MDm; Jennifer W. Uyeda, MDn; Paul Nikolaidis, MDo.
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. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
D. CT abdomen with IV contrast
D. CT abdomen with IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
E. CT abdomen without and with IV contrast
E. CT abdomen without and with IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
F. CT abdomen without IV contrast
F. CT abdomen without IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
G. CTU without and with IV contrast
G. CTU without and with IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
H. DTPA renal scan
H. DTPA renal scan
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
I. Fluoroscopy antegrade pyelography
I. Fluoroscopy antegrade pyelography
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
J. Fluoroscopy voiding cystourethrography
J. Fluoroscopy voiding cystourethrography
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
K. MAG3 renal scan
K. MAG3 renal scan
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
L. MRI abdomen and pelvis without and with IV contrast
L. MRI abdomen and pelvis without and with IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
M. MRI abdomen and pelvis without IV contrast
M. MRI abdomen and pelvis without IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
N. MRI abdomen without and with IV contrast
N. MRI abdomen without and with IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
O. MRI abdomen without IV contrast
O. MRI abdomen without IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
P. MRU without and with IV contrast
P. MRU without and with IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
Q. MRU without IV contrast
Q. MRU without IV contrast
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
R. Radiography abdomen and pelvis
R. Radiography abdomen and pelvis
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
S. Radiography intravenous urography
S. Radiography intravenous urography
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
T. US abdomen
T. US abdomen
Variant 1: Adult. Asymptomatic unilateral hydronephrosis with unknown cause. Initial imaging.
U. US color Doppler kidneys and bladder retroperitoneal
U. US color Doppler kidneys and bladder retroperitoneal
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
D. CT abdomen with IV contrast
D. CT abdomen with IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
E. CT abdomen without and with IV contrast
E. CT abdomen without and with IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
F. CT abdomen without IV contrast
F. CT abdomen without IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
G. CTU without and with IV contrast
G. CTU without and with IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
H. DTPA renal scan
H. DTPA renal scan
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
I. Fluoroscopy antegrade pyelography
I. Fluoroscopy antegrade pyelography
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
J. Fluoroscopy voiding cystourethrography
J. Fluoroscopy voiding cystourethrography
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
K. MAG3 renal scan
K. MAG3 renal scan
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
L. MRI abdomen and pelvis without and with IV contrast
L. MRI abdomen and pelvis without and with IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
M. MRI abdomen and pelvis without IV contrast
M. MRI abdomen and pelvis without IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
N. MRI abdomen without and with IV contrast
N. MRI abdomen without and with IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
O. MRI abdomen without IV contrast
O. MRI abdomen without IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
P. MRU without and with IV contrast
P. MRU without and with IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
Q. MRU without IV contrast
Q. MRU without IV contrast
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
R. Radiography abdomen and pelvis
R. Radiography abdomen and pelvis
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
S. Radiography intravenous urography
S. Radiography intravenous urography
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
T. US abdomen
T. US abdomen
Variant 2: Adult. Asymptomatic bilateral hydronephrosis or asymptomatic hydronephrosis in a solitary kidney with unknown cause. Initial imaging.
U. US color Doppler kidneys and bladder retroperitoneal
U. US color Doppler kidneys and bladder retroperitoneal
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
D. CT abdomen with IV contrast
D. CT abdomen with IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
E. CT abdomen without and with IV contrast
E. CT abdomen without and with IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
F. CT abdomen without IV contrast
F. CT abdomen without IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
G. CTU without and with IV contrast
G. CTU without and with IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
H. DTPA renal scan
H. DTPA renal scan
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
I. Fluoroscopy antegrade pyelography
I. Fluoroscopy antegrade pyelography
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
J. Fluoroscopy voiding cystourethrography
J. Fluoroscopy voiding cystourethrography
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
K. MAG3 renal scan
K. MAG3 renal scan
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
L. MRI abdomen and pelvis without and with IV contrast
L. MRI abdomen and pelvis without and with IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
M. MRI abdomen and pelvis without IV contrast
M. MRI abdomen and pelvis without IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
N. MRI abdomen without and with IV contrast
N. MRI abdomen without and with IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
O. MRI abdomen without IV contrast
O. MRI abdomen without IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
P. MRU without and with IV contrast
P. MRU without and with IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
Q. MRU without IV contrast
Q. MRU without IV contrast
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
R. Radiography abdomen and pelvis
R. Radiography abdomen and pelvis
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
S. Radiography intravenous urography
S. Radiography intravenous urography
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
T. US abdomen
T. US abdomen
Variant 3: Adult. Symptomatic hydronephrosis with unknown cause. Initial imaging.
U. US color Doppler kidneys and bladder retroperitoneal
U. US color Doppler kidneys and bladder retroperitoneal
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
D. CT abdomen with IV contrast
D. CT abdomen with IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
E. CT abdomen without and with IV contrast
E. CT abdomen without and with IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
F. CT abdomen without IV contrast
F. CT abdomen without IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
G. CTU without and with IV contrast
G. CTU without and with IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
H. DTPA renal scan
H. DTPA renal scan
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
I. Fluoroscopy antegrade pyelography
I. Fluoroscopy antegrade pyelography
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
J. Fluoroscopy voiding cystourethrography
J. Fluoroscopy voiding cystourethrography
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
K. MAG3 renal scan
K. MAG3 renal scan
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
L. MRI abdomen and pelvis without and with IV contrast
L. MRI abdomen and pelvis without and with IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
M. MRI abdomen and pelvis without IV contrast
M. MRI abdomen and pelvis without IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
N. MRI abdomen without and with IV contrast
N. MRI abdomen without and with IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
O. MRI abdomen without IV contrast
O. MRI abdomen without IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
P. MRU without and with IV contrast
P. MRU without and with IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
Q. MRU without IV contrast
Q. MRU without IV contrast
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
R. Radiography abdomen and pelvis
R. Radiography abdomen and pelvis
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
S. Radiography intravenous urography
S. Radiography intravenous urography
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
T. US abdomen
T. US abdomen
Variant 4: Adult. Asymptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
U. US color Doppler kidneys and bladder retroperitoneal
U. US color Doppler kidneys and bladder retroperitoneal
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. 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. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
D. CT abdomen with IV contrast
D. CT abdomen with IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
E. CT abdomen without and with IV contrast
E. CT abdomen without and with IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
F. CT abdomen without IV contrast
F. CT abdomen without IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
G. CTU without and with IV contrast
G. CTU without and with IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
H. DTPA renal scan
H. DTPA renal scan
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
I. Fluoroscopy antegrade pyelography
I. Fluoroscopy antegrade pyelography
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
J. Fluoroscopy voiding cystourethrography
J. Fluoroscopy voiding cystourethrography
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
K. MAG3 renal scan
K. MAG3 renal scan
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
L. MRI abdomen and pelvis without and with IV contrast
L. MRI abdomen and pelvis without and with IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
M. MRI abdomen and pelvis without IV contrast
M. MRI abdomen and pelvis without IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
N. MRI abdomen without and with IV contrast
N. MRI abdomen without and with IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
O. MRI abdomen without IV contrast
O. MRI abdomen without IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
P. MRU without and with IV contrast
P. MRU without and with IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
Q. MRU without IV contrast
Q. MRU without IV contrast
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
R. Radiography abdomen and pelvis
R. Radiography abdomen and pelvis
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
S. Radiography intravenous urography
S. Radiography intravenous urography
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
T. US abdomen
T. US abdomen
Variant 5: Adult. Symptomatic hydronephrosis in a pregnant patient with unknown cause. Initial imaging.
U. US color Doppler kidneys and bladder retroperitoneal
U. US color Doppler kidneys and bladder retroperitoneal
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
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.” |
||
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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.