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Appropriateness Criteria

Variant 1: Newly diagnosed. Clinical stage I-IIA (early stage) breast cancer at presentation. Evaluation for locoregional disease (includes invasive ductal carcinoma [IDC], or invasive lobular carcinoma [ILC], or not otherwise specified [NOS]).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 3 1 13
References Study Quality
22 (15486214) 3
25 (25086999) 2
114 (16500539) 4
113 (30131246) 3
112 (17574805) 3
111 (16442946) 3
110 (25119022) Good
109 (28221238) 4
108 (7602346) 4
107 (11015105) 4
106 (24596363) 2
105 (24780784) 4
104 (29641226) 3
26 (23826951) 3
Digital breast tomosynthesis diagnostic Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 2 0 0 0 0 1 4 9
References Study Quality
37 (28130619) 3
36 (26711795) 1
34 (26492903) 4
33 (29927337) 4
32 (28516226) Good
31 (27920631) 4
30 (22941162) 3
29 (30466027) 3
28 (28055247) 2
27 (27411945) 3
26 (23826951) 3
25 (25086999) 2
24 (30964425) 3
23 (26376882) 2
22 (15486214) 3
Mammography diagnostic Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 2 0 0 0 0 0 3 11
References Study Quality
37 (28130619) 3
36 (26711795) 1
34 (26492903) 4
33 (29927337) 4
32 (28516226) Good
31 (27920631) 4
30 (22941162) 3
29 (30466027) 3
28 (28055247) 2
27 (27411945) 3
26 (23826951) 3
25 (25086999) 2
24 (30964425) 3
23 (26376882) 2
22 (15486214) 3
MRI breast without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 1 7 7 0
References Study Quality
85 (24395846) 4
84 (28053631) 4
83 (30617471) 4
82 (32863709) 4
80 (30046588) 4
78 (24034548) 4
77 (21460377) 4
76 (29388904) 4
75 (26639066) 4
73 (26853509) 2
72 (32828998) 4
70 (20159292) 1
69 (34643778) 3
68 (24848838) 4
67 (28712698) 4
66 (26387498) 3
64 (24817517) 3
63 (31361209) 4
61 (22446897) 4
59 (27566960) 4
58 (19805685) Inadequate
56 (33120285) 4
55 (21751044) 4
23 (26376882) 2
16 (31660801) 3
86 (34611701) 3
87 (35471109) 3
US axilla May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 9 5 3 0 0
References Study Quality
103 (22227922) 3
100 (21597359) Good
99 (22972506) 2
98 (23436877) 2
97 (31562691) 2
96 (16632729) 4
95 (18955508) 3
94 (24859939) 2
93 (23664535) 3
92 (24455284) 3
91 (23515655) 3
89 (28898379) 1
88 (35550807) 4
36 (26711795) 1
Mammography with IV contrast May be appropriate Strong ☢☢ 0.1-1mSv 5 5 0 0 1 0 10 6 0 0 0
References Study Quality
16 (31660801) 3
54 (33178931) 3
53 (28654337) 2
52 (24986697) 3
51 (32000448) 3
49 (23220903) 1
48 (24048724) 1
47 (33650905) 4
28 (28055247) 2
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 1 0 1 0 0 0 0
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
CT chest abdomen pelvis with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 3 0 0 0 0 0 0
References Study Quality
20 (22751517) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 8 6 2 0 0 0 0 0 0
References Study Quality
21 (-3196411) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 2 0 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 5 4 0 1 0 0 0 0
References Study Quality
45 (24866608) 3
44 (31339353) 4
43 (2910416) 4
42 (24108553) 4
41 (21935602) 4
40 (27058014) 3
39 (26115367) 1
38 (26477029) 2
Variant 2: Newly diagnosed. Clinical stage I-IIA (early stage) breast cancer at presentation. Evaluation for distant disease (includes IDC, or ILC, or NOS).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US axilla Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 1 0 0 0 0 0
US breast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 1 0 0 0 0 0 0 0
Mammography diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 14 1 1 0 0 0 0 0 0
Mammography with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 1 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
Bone scan whole body Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 4 1 1 0 2 0 0 0
References Study Quality
127 (14672401) 4
126 (-3195169) 4
125 (32950408) 3
124 (1174812) 4
123 (28194227) 4
122 (27083181) 4
117 (20498394) 4
CT chest abdomen pelvis with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 4 2 1 3 1 0 0 0
References Study Quality
132 (30797241) 3
131 (28596258) 4
130 (31236598) 4
129 (30443868) 4
128 (-3195171) 4
126 (-3195169) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 6 4 2 1 2 1 0 0 0
References Study Quality
21 (-3196411) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 3 0 2 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 3 2 1 2 1 1 0 0
References Study Quality
13 (33651022) Inadequate
137 (31063423) 4
136 (23243198) 3
135 (31907750) 4
134 (32886897) 4
133 (34416711) 4
130 (31236598) 4
129 (30443868) 4
128 (-3195171) 4
126 (-3195169) 4
Variant 3: Newly diagnosed. Clinical stage IIB-III (late stage) breast cancer at presentation. Evaluation for locoregional disease (includes IDC, or ILC, or NOS).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US axilla Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 3 5 5 2 2
References Study Quality
36 (26711795) 1
126 (-3195169) 4
103 (22227922) 3
100 (21597359) Good
99 (22972506) 2
98 (23436877) 2
97 (31562691) 2
96 (16632729) 4
95 (18955508) 3
94 (24859939) 2
93 (23664535) 3
92 (24455284) 3
91 (23515655) 3
89 (28898379) 1
88 (35550807) 4
140 (20807849) 4
141 (24008555) Good
US breast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 2 0 0 0 0 2 3 9
References Study Quality
22 (15486214) 3
25 (25086999) 2
114 (16500539) 4
113 (30131246) 3
112 (17574805) 3
111 (16442946) 3
110 (25119022) Good
109 (28221238) 4
108 (7602346) 4
107 (11015105) 4
106 (24596363) 2
105 (24780784) 4
104 (29641226) 3
26 (23826951) 3
Digital breast tomosynthesis diagnostic Usually appropriate Strong ☢☢ 0.1-1mSv 8 8 0 2 0 0 0 0 3 5 6
References Study Quality
24 (30964425) 3
29 (30466027) 3
23 (26376882) 2
28 (28055247) 2
46 (28861372) 3
36 (26711795) 1
34 (26492903) 4
33 (29927337) 4
32 (28516226) Good
31 (27920631) 4
30 (22941162) 3
27 (27411945) 3
26 (23826951) 3
25 (25086999) 2
22 (15486214) 3
126 (-3195169) 4
Mammography diagnostic Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 2 0 0 0 0 2 3 9
References Study Quality
126 (-3195169) 4
46 (28861372) 3
36 (26711795) 1
34 (26492903) 4
33 (29927337) 4
32 (28516226) Good
31 (27920631) 4
30 (22941162) 3
29 (30466027) 3
28 (28055247) 2
27 (27411945) 3
26 (23826951) 3
25 (25086999) 2
24 (30964425) 3
23 (26376882) 2
22 (15486214) 3
MRI breast without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 3 12 2
References Study Quality
85 (24395846) 4
84 (28053631) 4
83 (30617471) 4
82 (32863709) 4
80 (30046588) 4
78 (24034548) 4
77 (21460377) 4
76 (29388904) 4
75 (26639066) 4
73 (26853509) 2
72 (32828998) 4
70 (20159292) 1
69 (34643778) 3
68 (24848838) 4
67 (28712698) 4
66 (26387498) 3
64 (24817517) 3
63 (31361209) 4
61 (22446897) 4
59 (27566960) 4
58 (19805685) Inadequate
56 (33120285) 4
55 (21751044) 4
23 (26376882) 2
16 (31660801) 3
FDG-PET/CT skull base to mid-thigh Usually appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 0 2 9 5 0
References Study Quality
15 (33894709) Good
14 (30292261) Inadequate
13 (33651022) Inadequate
126 (-3195169) 4
139 (28456837) 2
138 (21880576) 3
2 (25381395) 4
Mammography with IV contrast May be appropriate Strong ☢☢ 0.1-1mSv 5 5 1 0 0 0 9 7 0 0 0
References Study Quality
54 (33178931) 3
53 (28654337) 2
52 (24986697) 3
51 (32000448) 3
49 (23220903) 1
48 (24048724) 1
47 (33650905) 4
28 (28055247) 2
16 (31660801) 3
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 1 0 0 0 0 0 0
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
CT chest abdomen pelvis with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 4 6 0 0 1 0 0 0
References Study Quality
20 (22751517) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 4 6 0 0 1 0 0 0
References Study Quality
20 (22751517) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 0 0 0 0 0 0 0
Variant 4: Newly diagnosed. Clinical stage IIB-III (late stage) breast cancer at presentation. Evaluation for distant disease. IDC or ILC that is ER+/HER2-.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Bone scan whole body Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 1 1 6 3 3
References Study Quality
146 (23287962) 4
145 (22342788) 4
144 (28786907) 3
143 (15254062) 4
124 (1174812) 4
123 (28194227) 4
122 (27083181) 4
117 (20498394) 4
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 0 2 6 2 4
References Study Quality
17 (22006539) 3
126 (-3195169) 4
132 (30797241) 3
145 (22342788) 4
147 (27642105) 4
148 (27551013) 4
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 6 9 2
References Study Quality
41 (21935602) 4
162 (-3111285) 4
161 (21765193) 4
160 (20516453) 3
159 (29313949) 4
158 (17653852) 4
157 (27129866) 2
156 (21070439) 4
155 (25214641) 2
154 (18632831) 3
153 (18436392) 2
152 (18695254) 3
151 (23640467) 3
150 (19164229) 4
149 (19645022) 3
139 (28456837) 2
138 (21880576) 3
137 (31063423) 4
136 (23243198) 3
126 (-3195169) 4
US axilla Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 1 0 0 0 0
US breast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 1 0 0 0 0 0 0 0
Mammography diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 0 0 0 0 0 0 0 0
Mammography with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 1 0 0 0
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 13 2 2 0 0 0 0 0 0
References Study Quality
21 (-3196411) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 3 0 1 0 0 0 0
References Study Quality
17 (22006539) 3
132 (30797241) 3
147 (27642105) 4
148 (27551013) 4
Variant 5: Newly diagnosed. Clinical stage IIB-III (late stage) breast cancer at presentation. Evaluation for distant disease. IDC or ILC that is HER2+ or triple negative (ER, PR, and HER2-).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Bone scan whole body Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 2 2 3 3 4
References Study Quality
146 (23287962) 4
145 (22342788) 4
144 (28786907) 3
143 (15254062) 4
124 (1174812) 4
123 (28194227) 4
122 (27083181) 4
117 (20498394) 4
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 1 0 1 4 2 7
References Study Quality
148 (27551013) 4
147 (27642105) 4
145 (22342788) 4
132 (30797241) 3
126 (-3195169) 4
17 (22006539) 3
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 1 0 1 3 4 6
References Study Quality
126 (-3195169) 4
162 (-3111285) 4
161 (21765193) 4
160 (20516453) 3
159 (29313949) 4
158 (17653852) 4
157 (27129866) 2
156 (21070439) 4
155 (25214641) 2
154 (18632831) 3
153 (18436392) 2
152 (18695254) 3
151 (23640467) 3
150 (19164229) 4
149 (19645022) 3
139 (28456837) 2
138 (21880576) 3
137 (31063423) 4
136 (23243198) 3
41 (21935602) 4
US axilla Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 1 0 0 1 0 0 0 0
US breast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 0 0 0 0 0 0 0 0
Mammography diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 0 0 0 0 0 0 0 0
Mammography with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 2 3 2 2 2 0 0 0
References Study Quality
126 (-3195169) 4
165 (28301662) 4
164 (17577662) 4
163 (15254054) 4
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 13 1 1 0 1 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 14 2 1 0 0 0 0 0 0
References Study Quality
21 (-3196411) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 3 1 1 0 0 0 0
References Study Quality
17 (22006539) 3
132 (30797241) 3
147 (27642105) 4
148 (27551013) 4
Variant 6: Surveillance. Regardless of clinical stage of breast cancer at time of original presentation. Evaluation for local recurrence in patient with history of BCT.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Digital breast tomosynthesis diagnostic Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 2 0 0 0 0 5 9
References Study Quality
184 (29748762) 3
183 (26893205) 4
182 (34003059) 4
181 (32966113) 3
180 (30207076) 4
179 (23860534) 4
178 (27810132) 4
177 (28341031) 4
176 (27422453) 4
175 (22766990) 4
174 (22692036) 3
173 (-3195175) 4
172 (-3195173) 4
Digital breast tomosynthesis screening Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 1 0 0 0 0 1 2 2 11
References Study Quality
172 (-3195173) 4
173 (-3195175) 4
174 (22692036) 3
175 (22766990) 4
176 (27422453) 4
177 (28341031) 4
178 (27810132) 4
179 (23860534) 4
180 (30207076) 4
Mammography diagnostic Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 5 12
References Study Quality
184 (29748762) 3
183 (26893205) 4
182 (34003059) 4
180 (30207076) 4
179 (23860534) 4
178 (27810132) 4
177 (28341031) 4
176 (27422453) 4
175 (22766990) 4
174 (22692036) 3
173 (-3195175) 4
172 (-3195173) 4
Mammography screening Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 1 16
References Study Quality
172 (-3195173) 4
173 (-3195175) 4
174 (22692036) 3
175 (22766990) 4
176 (27422453) 4
177 (28341031) 4
178 (27810132) 4
179 (23860534) 4
180 (30207076) 4
Mammography with IV contrast May be appropriate Limited ☢☢ 0.1-1mSv 5 5 0 1 0 1 10 4 1 0 0
References Study Quality
185 (31453765) 2
MRI breast without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 1 0 0 2 5 2 5 0 1
References Study Quality
196 (32303988) Inadequate
195 (29435556) 3
193 (26322264) 3
192 (26744477) 3
191 (24635678) 3
190 (26142951) 3
189 (22474203) 1
188 (31161975) 4
186 (29371086) 4
US breast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 4 5 0 0 1 0 0 1
References Study Quality
197 (23695431) 3
198 (24959654) 4
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
Variant 7: Surveillance. Regardless of clinical stage of breast cancer at time of original presentation. Evaluation for local recurrence in patient with history of mastectomy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI breast without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 0 3 1 9 0 2 0 0
US breast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 3 1 0 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 14 1 1 0 0 0 0 0 0
Digital breast tomosynthesis screening Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 1 0 0 0 0 0 0 0
Mammography diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 14 2 0 0 0 0 0 0 0
Mammography screening Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 16 1 0 0 0 0 0 0 0
Mammography with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 1 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 4 0 0 1 0 0 0
References Study Quality
172 (-3195173) 4
173 (-3195175) 4
200 (-3195384) 4
Variant 8: Suspected local recurrence of breast cancer based on symptoms, physical examination, or laboratory value in patient with history of BCT. Regardless of clinical stage at time of original presentation.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 1 1 0 1 4 2 7
References Study Quality
207 (28473077) 4
208 (30392596) 4
Digital breast tomosynthesis diagnostic Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 1 0 0 0 0 0 2 4 9
References Study Quality
202 (23345348) 2
Mammography diagnostic Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 1 0 0 0 0 0 3 2 10
References Study Quality
202 (23345348) 2
Mammography with IV contrast May be appropriate Limited ☢☢ 0.1-1mSv 5 5 0 1 0 1 12 2 1 0 0
References Study Quality
203 (30240292) 2
MRI breast without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 3 1 1 9 2 0 0 0
References Study Quality
204 (23046046) 3
205 (28754486) 3
206 (32108973) 4
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 1 2 0 0 0 0 0
Variant 9: Suspected local recurrence of breast cancer based on symptoms, physical examination, or laboratory value in patient with history of mastectomy. Regardless of clinical stage at time of original presentation.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 6 2 9
References Study Quality
207 (28473077) 4
208 (30392596) 4
Digital breast tomosynthesis diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 12 0 1 0 2 1 0 0 0
Mammography diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 11 0 2 0 2 1 0 0 0
Mammography with IV contrast Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 12 0 1 1 2 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 2 3 4 0 1 1 0 0
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 14 1 0 0 0 1 0 0 0
Variant 10: Surveillance. Regardless of clinical stage of breast cancer at time of original presentation. Evaluation for distant metastatic disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US axilla Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 1 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 0 1 0 0 0 0 0 0
Mammography diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 15 0 1 0 0 0 0 0 0
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 11 1 3 1 0 0 0 0 0
References Study Quality
126 (-3195169) 4
128 (-3195171) 4
209 (23601761) 4
210 (26314782) 4
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 0 0 0 0 0
Bone scan whole body Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 3 0 0 1 0 0 0
References Study Quality
126 (-3195169) 4
128 (-3195171) 4
209 (23601761) 4
210 (26314782) 4
CT chest abdomen pelvis with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 4 0 0 1 0 0 0
References Study Quality
126 (-3195169) 4
128 (-3195171) 4
209 (23601761) 4
210 (26314782) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 0 4 0 0 1 0 0 0
References Study Quality
126 (-3195169) 4
128 (-3195171) 4
209 (23601761) 4
210 (26314782) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 0 3 0 0 1 0 0 0
References Study Quality
126 (-3195169) 4
128 (-3195171) 4
209 (23601761) 4
210 (26314782) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 0 4 0 0 1 0 0 0
References Study Quality
126 (-3195169) 4
128 (-3195171) 4
209 (23601761) 4
210 (26314782) 4
Variant 11: Suspected distant recurrence of breast cancer based on symptoms, physical examination, or laboratory value. Regardless of clinical stage at time of original presentation.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 2 7 4 4
References Study Quality
164 (17577662) 4
165 (28301662) 4
Bone scan whole body Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 1 0 2 2 1 9
References Study Quality
126 (-3195169) 4
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 1 2 2 1 9
References Study Quality
172 (-3195173) 4
FDG-PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 1 0 2 3 3 6
References Study Quality
126 (-3195169) 4
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 1 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 1 1 0 0 0 0 0 0
References Study Quality
21 (-3196411) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 0 0 1 0 0 0 0
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.