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Standard Procedure List – AC Diagnostic Topics

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ACR Appropriateness Criteria - Procedure List for Diagnostic Imaging Topics Procedure Name* Modality CT abdomen and pelvis with IV contrast CT CT abdomen and pelvis without and with IV contrast CT CT abdomen and pelvis without IV contrast CT CT abdomen with IV contrast CT CT abdomen with IV contrast multiphase CT CT abdomen without and with IV contrast CT CT abdomen without IV contrast CT CT ankle and hindfoot with IV contrast CT CT ankle and hindfoot without and with IV contrast CT CT ankle and hindfoot without IV contrast CT CT ankle with IV contrast CT CT ankle without and with IV contrast CT CT ankle without IV contrast CT CT appendicular skeleton area of interest with IV contrast CT CT appendicular skeleton area of interest without and with IV contrast CT CT appendicular skeleton area of interest without IV contrast CT CT area of interest with IV contrast CT CT area of interest without and with IV contrast CT CT area of interest without IV contrast CT CT arm with IV contrast CT CT arm without and with IV contrast CT CT arm without IV contrast CT CT arthrography ankle CT CT arthrography ankle and hindfoot CT CT arthrography elbow CT CT arthrography hip CT CT arthrography knee CT CT arthrography shoulder CT CT arthrography wrist CT CT cervical and lumbar spine with IV contrast CT CT cervical and lumbar spine without and with IV contrast CT CT cervical and lumbar spine without IV contrast CT CT cervical and thoracic spine with IV contrast CT CT cervical and thoracic spine without and with IV contrast CT CT cervical and thoracic spine without IV contrast CT CT cervical spine with IV contrast CT CT cervical spine without and with IV contrast CT CT cervical spine without IV contrast CT CT chest abdomen pelvis with IV contrast CT CT chest abdomen pelvis without and with IV contrast CT CT chest abdomen pelvis without IV contrast CT CT chest and abdomen with IV contrast CT CT chest and abdomen without and with IV contrast CT Procedure Name* Modality CT chest and abdomen without IV contrast CT CT chest with IV contrast CT CT chest with IV contrast (including upper abdomen) CT CT chest with IV contrast (through the adrenal glands) CT CT chest without and with IV contrast CT CT chest without and with IV contrast (including upper abdomen) CT CT chest without and with IV contrast (through the adrenal glands) CT CT chest without IV contrast CT CT chest without IV contrast (including upper abdomen) CT CT chest without IV contrast (through the adrenal glands) CT CT chest without IV contrast screening CT CT colonography CT CT complete spine with IV contrast CT CT complete spine without and with IV contrast CT CT complete spine without IV contrast CT CT cone beam paranasal sinuses without IV contrast CT CT coronary calcium CT CT elbow with IV contrast CT CT elbow without and with IV contrast CT CT elbow without IV contrast CT CT enteroclysis CT CT enterography CT CT extremity area of interest with IV contrast CT CT extremity area of interest without and with IV contrast CT CT extremity area of interest without IV contrast CT CT extremity with IV contrast CT CT extremity without and with IV contrast CT CT extremity without IV contrast CT CT finger with IV contrast CT CT finger without and with IV contrast CT CT finger without IV contrast CT CT foot with IV contrast CT CT foot without and with IV contrast CT CT foot without IV contrast CT CT forearm with IV contrast CT CT forearm without and with IV contrast CT CT forearm without IV contrast CT CT hand with IV contrast CT CT hand without and with IV contrast CT CT hand without IV contrast CT CT head and neck with IV contrast CT CT head and neck without and with IV contrast CT CT head and neck without IV contrast CT CT head and orbits with IV contrast CT Procedure Name* Modality CT head and orbits without and with IV contrast CT CT head and orbits without IV contrast CT CT head and paranasal sinuses with IV contrast CT CT head and paranasal sinuses without and with IV contrast CT CT head and paranasal sinuses without IV contrast CT CT head cisternography CT CT head perfusion with IV contrast CT CT head with IV contrast CT CT head without and with IV contrast CT CT head without IV contrast CT CT heart function and morphology with IV contrast CT CT hip CT CT hip with IV contrast CT CT hip without and with IV contrast CT CT hip without IV contrast CT CT hips and spine with IV contrast CT CT hips and spine without and with IV contrast CT CT hips and spine without IV contrast CT CT hips with IV contrast CT CT hips without and with IV contrast CT CT hips without IV contrast CT CT knee with IV contrast CT CT knee without and with IV contrast CT CT knee without IV contrast CT CT leg with IV contrast CT CT leg without and with IV contrast CT CT leg without IV contrast CT CT lower extremity area of interest (not pelvis or hip) without IV CT contrast CT lower extremity area of interest (not pelvis or hip) with IV contrast CT CT lower extremity area of interest (not pelvis or hip) without and with CT IV contrast CT lower extremity area of interest with IV contrast CT CT lower extremity area of interest without and with IV contrast CT CT lower extremity area of interest without IV contrast CT CT lower extremity with IV contrast CT CT lower extremity without and with IV contrast CT CT lower extremity without IV contrast CT CT lumbar spine with IV contrast CT CT lumbar spine without and with IV contrast CT CT lumbar spine without IV contrast CT CT lumbosacral spine with IV contrast CT CT lumbosacral spine without and with IV contrast CT CT lumbosacral spine without IV contrast CT Procedure Name* Modality CT maxillofacial with IV contrast CT CT maxillofacial without and with IV contrast CT CT maxillofacial without IV contrast CT CT myelography cervical and lumbar spine CT CT myelography cervical and thoracic spine CT CT myelography cervical spine CT CT myelography complete spine CT CT myelography lumbar spine CT CT myelography spine area of interest CT CT myelography thoracic and lumbar spine CT CT myelography thoracic spine CT CT neck and chest with IV contrast CT CT neck and chest without and with IV contrast CT CT neck and chest without IV contrast CT CT neck with IV contrast CT CT neck with parotid sialography CT CT neck without and with IV contrast CT CT neck without IV contrast CT CT orbits with IV contrast CT CT orbits without and with IV contrast CT CT orbits without IV contrast CT CT paranasal sinuses and orbits with IV contrast CT CT paranasal sinuses and orbits without and with IV contrast CT CT paranasal sinuses and orbits without IV contrast CT CT paranasal sinuses with IV contrast CT CT paranasal sinuses without and with IV contrast CT CT paranasal sinuses without IV contrast CT CT pelvis and hips with IV contrast CT CT pelvis and hips without and with IV contrast CT CT pelvis and hips without IV contrast CT CT pelvis with bladder contrast (CT cystography) CT CT pelvis with IV contrast CT CT pelvis without and with IV contrast CT CT pelvis without IV contrast CT CT sacroiliac joints and cervical and lumbar spine with IV contrast CT CT sacroiliac joints and cervical and lumbar spine without and with IV CT contrast CT sacroiliac joints and cervical and lumbar spine without IV contrast CT CT sacroiliac joints and cervical and thoracic spine with IV contrast CT CT sacroiliac joints and cervical and thoracic spine without and with IV CT contrast CT sacroiliac joints and cervical and thoracic spine without IV contrast CT Procedure Name* Modality CT sacroiliac joints and cervical spine with IV contrast CT CT sacroiliac joints and cervical spine without and with IV contrast CT CT sacroiliac joints and cervical spine without IV contrast CT CT sacroiliac joints and complete spine with IV contrast CT CT sacroiliac joints and complete spine without and with IV contrast CT CT sacroiliac joints and complete spine without IV contrast CT CT sacroiliac joints and lumbar spine with IV contrast CT CT sacroiliac joints and lumbar spine without and with IV contrast CT CT sacroiliac joints and lumbar spine without IV contrast CT CT sacroiliac joints and sacrum with IV contrast CT CT sacroiliac joints and sacrum without and with IV contrast CT CT sacroiliac joints and sacrum without IV contrast CT CT sacroiliac joints and spine area of interest with IV contrast CT CT sacroiliac joints and spine area of interest without and with IV CT contrast CT sacroiliac joints and spine area of interest without IV contrast CT CT sacroiliac joints and thoracic and lumbar spine with IV contrast CT CT sacroiliac joints and thoracic and lumbar spine without and with IV CT contrast CT sacroiliac joints and thoracic and lumbar spine without IV contrast CT CT sacroiliac joints and thoracic spine with IV contrast CT CT sacroiliac joints and thoracic spine without and with IV contrast CT CT sacroiliac joints and thoracic spine without IV contrast CT CT sacroiliac joints with IV contrast CT CT sacroiliac joints without and with IV contrast CT CT sacroiliac joints without IV contrast CT CT sacrum with IV contrast CT CT sacrum without and with IV contrast CT CT sacrum without IV contrast CT CT sella with IV contrast CT CT sella without and with IV contrast CT CT sella without IV contrast CT CT shoulder with IV contrast CT CT shoulder without and with IV contrast CT CT shoulder without IV contrast CT CT spine area of interest with IV contrast CT CT spine area of interest without and with IV contrast CT CT spine area of interest without IV contrast CT CT spine hot area with IV contrast CT Procedure Name* Modality CT spine hot area without
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