Table 2

Appropriateness Categories and Scores

ScoreCategoryDescription
1, 2, or 3Rarely appropriateRarely an appropriate option for management of patients in this population due to the lack of a clear benefit/risk advantage; rarely an effective option for individual care plans; exceptions should have documentation of the clinical reasons for proceeding with this care option (i.e., procedure is not generally acceptable and is not generally reasonable for the indication).
4, 5, or 6May be appropriateAt times an appropriate option for management of patients in this population due to variable evidence or agreement regarding the benefit/risk ratio, potential benefit based on practice experience in the absence of evidence, and/or variability in the population; effectiveness for individual care must be determined by a patient's physician in consultation with the patient based on additional clinical variables and judgment along with patient preferences (i.e., procedure may be acceptable and may be reasonable for the indication).
7, 8, or 9AppropriateAn appropriate option for management of patients in this population due to benefits generally outweighing risks; effective option for individual care plans although not always necessary, depending on physician judgment and patient-specific preferences (i.e., procedure is generally acceptable and is generally reasonable for the indication).

The rating scale is composed of discreet integers from 1 to 9. The available knowledge base of evidence for rating each scenario varies from extensive to limited or none. Each member of a rating panel considers the available evidence, which may be limited, unclear, or even conflicting, and using their expertise and experience, determines their individual rating for each modality in the scenario. The modified Delphi technique is robust as a methodology for handling differences in interpretation of the evidence-based and varied expertise among the rating panel members. Imaging procedures for a clinical scenario with a rating in the maybe appropriate category may indicate the need for additional evidence to move the rating into either the rarely appropriate or appropriate rating ranges.