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Appropriateness Criteria

Variant 1: Pancreatic ductal adenocarcinoma. Initial staging pretreatment.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
11 (21436084) 2
33 (22687378) M
36 (21693662) 2
40 (21929674) 4
CT abdomen with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
29 (22954001) 4
33 (22687378) M
34 (18726967) 3
36 (21693662) 2
35 (14527907) 3
38 (24272022) M
37 (20635101) 3
US abdomen endoscopic May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
41 (24018593) M
42 (12115306) 3
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
11 (21436084) 2
33 (22687378) M
40 (21929674) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
48 (22510123) 3
44 (24721105) 3
47 (23496023) 4
49 (23922481) M
46 (22699202) 3
43 (20492008) 3
45 (24928186) 3
US abdomen transabdominal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
29 (22954001) 4
33 (22687378) M
34 (18726967) 3
36 (21693662) 2
35 (14527907) 3
38 (24272022) M
37 (20635101) 3
CT abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
29 (22954001) 4
33 (22687378) M
34 (18726967) 3
36 (21693662) 2
35 (14527907) 3
38 (24272022) M
37 (20635101) 3
Variant 2: Pancreatic ductal adenocarcinoma. Follow-up post-neoadjuvant therapy. Evaluate resectability for borderline resectable tumor.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
52 (25599322) 2
51 (21768431) 3
50 (23287712) 2
MRI abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
US abdomen endoscopic Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
US abdomen transabdominal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
52 (25599322) 2
51 (21768431) 3
50 (23287712) 2
CT abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
52 (25599322) 2
51 (21768431) 3
50 (23287712) 2
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.