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Appropriateness Criteria

Variant 1: Newly diagnosed esophageal cancer. Pretreatment clinical staging. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT chest and abdomen with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 1 0 1 0 3 4 2 5 2
References Study Quality
10 (29153370) 2
8 (28363659) 2
12 (26008856) 2
7 (20033712) 2
4 (6849089) 2
5 (1898802) 2
6 (18330935) Good
9 (-3194704) 4
11 (15181133) 2
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 1 0 0 2 0 4 5 6
References Study Quality
2 (29179897) 4
13 (20379789) 2
10 (29153370) 2
8 (28363659) 2
17 (24389439) 2
16 (21964582) 2
14 (19379906) 2
18 (19184245) 2
11 (15181133) 2
15 (15365078) Inadequate
MRI chest and abdomen without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 0 1 13 4 0 0 0 0
References Study Quality
21 (28799124) 2
20 (27767330) 2
22 (26315570) 2
FDG-PET/MRI skull base to mid-thigh May be appropriate Limited ☢☢☢ 1-10 mSv 4 4 0 0 1 9 7 0 1 0 0
References Study Quality
19 (24868109) 2
CT chest abdomen pelvis with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 4 7 3 2 0 0
References Study Quality
12 (26008856) 2
11 (15181133) 2
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 15 2 0 1 0 0 0 0 0
Fluoroscopy upper GI series Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 2 1 0 1 0 1 0 0
MRI chest and abdomen without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 6 3 5 1 1 2 0 0 0
References Study Quality
21 (28799124) 2
20 (27767330) 2
22 (26315570) 2
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 9 5 2 1 0 1 0 0 0
References Study Quality
12 (26008856) 2
11 (15181133) 2
CT chest abdomen pelvis without IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 3 0 1 0 1 0 0
References Study Quality
12 (26008856) 2
11 (15181133) 2
CT chest and abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 8 3 2 3 0 1 0 1 0
References Study Quality
10 (29153370) 2
8 (28363659) 2
12 (26008856) 2
7 (20033712) 2
4 (6849089) 2
5 (1898802) 2
6 (18330935) Good
9 (-3194704) 4
11 (15181133) 2
CT chest and abdomen without IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 6 5 1 2 2 0 1 1 0
References Study Quality
10 (29153370) 2
8 (28363659) 2
12 (26008856) 2
7 (20033712) 2
4 (6849089) 2
5 (1898802) 2
6 (18330935) Good
9 (-3194704) 4
11 (15181133) 2
Variant 2: Esophageal cancer. Imaging during treatment.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 0 0 3 5 4 5 0
References Study Quality
26 (30111193) 2
33 (29917073) 4
29 (19953708) 2
27 (29533721) 2
30 (25351460) 2
31 (23470576) 2
28 (21221582) 2
25 (16118165) 4
32 (21233607) 2
MRI chest and abdomen without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 2 0 10 6 0 0 0 0
References Study Quality
35 (30091709) 2
36 (27838148) 2
37 (30673335) 2
34 (27296409) 2
FDG-PET/MRI skull base to mid-thigh May be appropriate Expert Consensus ☢☢☢ 1-10 mSv 4 4 1 5 1 5 5 0 1 0 0
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 2 0 0 0 0 0 0 0
Fluoroscopy upper GI series Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 2 2 0 0 0 1 0 0
MRI chest and abdomen without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 5 5 5 1 0 1 0 0 1
References Study Quality
35 (30091709) 2
36 (27838148) 2
37 (30673335) 2
34 (27296409) 2
CT chest abdomen pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 8 4 3 0 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 9 4 3 1 0 1 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 6 1 0 0 1 1 0 0
CT chest and abdomen with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 3 3 2 6 4 4 1 1 0 0 0
References Study Quality
24 (23645329) 2
23 (21944048) 2
25 (16118165) 4
CT chest and abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 8 6 1 1 0 0 2 0 0
References Study Quality
24 (23645329) 2
23 (21944048) 2
25 (16118165) 4
CT chest and abdomen without IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 5 9 3 0 1 0 0 0 0
References Study Quality
24 (23645329) 2
23 (21944048) 2
25 (16118165) 4
Variant 3: Esophageal cancer. Posttreatment imaging. No suspected or known recurrence.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT chest and abdomen with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 1 0 0 0 2 5 3 5 2
References Study Quality
40 (24649807) 4
39 (19023632) 2
38 (15286962) 2
FDG-PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 2 0 7 6 2
References Study Quality
41 (29125331) 2
42 (25952733) 4
CT chest abdomen pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 0 0 5 3 1 7 1 0
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 2 0 0 0 0 0 0 0
Fluoroscopy upper GI series Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 2 2 0 0 1 0 0 0
MRI chest and abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 4 1 2 1 0 0 0 0
MRI chest and abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 4 3 0 0 0 0 0 1
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 9 5 2 0 1 1 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 4 1 1 0 1 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 9 6 1 0 0 1 1 0 0
CT chest and abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 6 9 1 1 1 0 0 0 0
References Study Quality
40 (24649807) 4
39 (19023632) 2
38 (15286962) 2
CT chest and abdomen without IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 4 11 2 1 0 0 0 0 0
References Study Quality
40 (24649807) 4
39 (19023632) 2
38 (15286962) 2
Variant 4: Esophageal cancer. Posttreatment imaging. Suspected or known recurrence.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT chest and abdomen with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 1 0 1 0 2 0 7 6 1
References Study Quality
43 (24435775) 2
FDG-PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 0 1 4 8 4
References Study Quality
42 (25952733) 4
43 (24435775) 2
CT chest abdomen pelvis with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 2 6 2 3 3 0
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 16 2 0 0 0 0 0 0 0
Fluoroscopy upper GI series Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 3 1 0 0 1 0 0 0
MRI chest and abdomen without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 8 3 3 2 1 0 0 0 1
MRI chest and abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 3 4 2 0 0 0 0 0
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 8 1 1 2 4 1 0 1 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 3 3 1 1 0 0 0 1
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 4 6 3 3 1 1 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 5 1 1 0 1 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 3 0 0 1 1 0 0
CT chest and abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 9 3 3 1 0 0 1 1 0
References Study Quality
43 (24435775) 2
CT chest and abdomen without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 2 2 4 9 3 1 0 1 0 0 0
References Study Quality
43 (24435775) 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.