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Appropriateness Criteria

Variant 1: Adult. Local staging of pancreatic neuroendocrine tumor.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 0 2 1 4 6
References Study Quality
22 (33064623) 4
21 (25048189) 4
18 (23436873) 4
19 (29140113) 4
20 (34647178) 4
17 (28355596) 4
10 (33978449) 4
2 (29594467) 4
9 (30376977) 4
6 (22915400) 4
DOTATATE PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 1 0 0 0 2 4 5 1 1
References Study Quality
26 (20395323) 4
25 (31856076) 4
1 (36737523) 4
17 (28355596) 4
23 (26742109) 4
24 (29025982) 4
CT abdomen and pelvis without and with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 1 0 0 0 1 5 6 1 0
US abdomen endoscopic May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 0 2 9 2 0 0
References Study Quality
7 (34175209) 4
9 (30376977) 4
MRI abdomen without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 3 2 1 0 0 1 5 1 1
References Study Quality
9 (30376977) 4
27 (28092495) 4
31 (26850565) 4
18 (23436873) 4
5 (32346794) 4
28 (28619284) 4
33 (26280127) 4
19 (29140113) 4
10 (33978449) 4
20 (34647178) 4
29 (23728305) 2
32 (30182253) 3
21 (25048189) 4
MRI abdomen without and with IV contrast with MRCP May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 1 1 0 0 0 2 5 4
References Study Quality
33 (26280127) 4
32 (30182253) 3
31 (26850565) 4
30 (26022520) 4
29 (23728305) 2
28 (28619284) 4
18 (23436873) 4
27 (28092495) 4
19 (29140113) 4
10 (33978449) 4
20 (34647178) 4
13 (28480609) 2
9 (30376977) 4
21 (25048189) 4
5 (32346794) 4
6 (22915400) 4
MRI abdomen without IV contrast with MRCP May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 1 1 1 5 4 2 0 0 0
FDG-PET/CT skull base to mid-thigh May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 1 2 1 8 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 1 3 4 1 1 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 4 5 2 0 2 0 0 0
Variant 2: Adult. Staging of pancreatic neuroendocrine tumor. Evaluation for metastatic disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen and pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 1 0 6 5 0
References Study Quality
39 (35550803) 4
38 (29470627) 4
36 (23533288) 2
25 (31856076) 4
34 (20010089) 4
37 (28902795) 4
9 (30376977) 4
1 (36737523) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 0 0 3 8 2
References Study Quality
17 (28355596) 4
34 (20010089) 4
DOTATATE PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢ 1-10 mSv 8 8 0 0 0 0 0 0 3 5 6
References Study Quality
26 (20395323) 4
25 (31856076) 4
1 (36737523) 4
17 (28355596) 4
23 (26742109) 4
24 (29025982) 4
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 2 3 3 0 4
References Study Quality
35 (-3197520) 4
25 (31856076) 4
1 (36737523) 4
8 (32675783) 4
17 (28355596) 4
23 (26742109) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 1 1 2 7 1 1 0 0
References Study Quality
36 (23533288) 2
40 (27345612) 2
41 (21474918) 4
CT abdomen and pelvis without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 1 0 0 0 4 6 3 0 0
CT chest abdomen pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 1 0 0 1 8 2 1 1 0
References Study Quality
35 (-3197520) 4
25 (31856076) 4
1 (36737523) 4
8 (32675783) 4
17 (28355596) 4
23 (26742109) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 0 0 13 0 0 0 0
US abdomen endoscopic Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 4 2 1 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 1 6 1 1 1 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 9 0 0 0 0 0 0
Variant 3: Adult. Pancreatic neuroendocrine tumor. Imaging after surgical resection, no suspected or known recurrence. Surveillance.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 0 0 4 4 5
References Study Quality
9 (30376977) 4
35 (-3197520) 4
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 0 0 0 0 3 9 1 0
References Study Quality
35 (-3197520) 4
MRI abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 0 0 0 0 0 8 4 0
References Study Quality
1 (36737523) 4
9 (30376977) 4
43 (23192781) 4
MRI abdomen and pelvis without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 2 0 0 7 5 0 0 0 0
DOTATATE PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢ 1-10 mSv 5 5 2 0 0 2 8 1 1 0 0
References Study Quality
17 (28355596) 4
23 (26742109) 4
24 (29025982) 4
25 (31856076) 4
35 (-3197520) 4
42 (34985313) 4
1 (36737523) 4
CT abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 1 1 0 0 2 8 1 1 0
CT chest abdomen pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 1 0 3 1 6 3 0 0 0
References Study Quality
35 (-3197520) 4
US abdomen endoscopic Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 5 2 0 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 3 3 3 1 1 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 5 2 3 0 2 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 2 4 3 0 0 0 0 0
Variant 4: Adult. Pancreatic neuroendocrine tumor. Follow-up imaging after treatment. Liver dominant disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 3 4 5
References Study Quality
40 (27345612) 2
39 (35550803) 4
36 (23533288) 2
25 (31856076) 4
37 (28902795) 4
38 (29470627) 4
9 (30376977) 4
1 (36737523) 4
CT abdomen and pelvis without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 1 0 0 1 0 2 2 6 2
References Study Quality
17 (28355596) 4
34 (20010089) 4
36 (23533288) 2
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 0 0 0 1 2 9 1 0
References Study Quality
35 (-3197520) 4
17 (28355596) 4
CT chest abdomen pelvis without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 1 0 0 0 2 2 7 2 0
References Study Quality
35 (-3197520) 4
17 (28355596) 4
MRI abdomen and pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 1 1 0 4 6 1 0 0
References Study Quality
36 (23533288) 2
40 (27345612) 2
41 (21474918) 4
MRI abdomen without and with IV contrast with MRCP May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 1 1 1 0 0 6 3 1
References Study Quality
40 (27345612) 2
39 (35550803) 4
36 (23533288) 2
25 (31856076) 4
37 (28902795) 4
38 (29470627) 4
9 (30376977) 4
1 (36737523) 4
MRI abdomen without IV contrast with MRCP May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 2 0 1 1 4 5 1 0 0
References Study Quality
36 (23533288) 2
40 (27345612) 2
41 (21474918) 4
CT abdomen and pelvis with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 0 0 0 1 1 2 6 2
References Study Quality
17 (28355596) 4
34 (20010089) 4
36 (23533288) 2
DOTATATE PET/CT skull base to mid-thigh May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 2 0 0 1 2 7 2 0 0
References Study Quality
42 (34985313) 4
35 (-3197520) 4
17 (28355596) 4
23 (26742109) 4
24 (29025982) 4
25 (31856076) 4
1 (36737523) 4
US abdomen endoscopic Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 0 0 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 2 10 0 0 0 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 2 10 1 1 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] 3 3 2 1 5 5 1 0 0 0 0
Variant 5: Adult. Pancreatic neuroendocrine tumor. Follow-up imaging after treatment. Non-liver dominant disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen and pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 1 2 7 3 0
References Study Quality
43 (23192781) 4
CT abdomen and pelvis with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 0 0 3 8 2
DOTATATE PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 1 0 1 1 3 3 3 2
References Study Quality
24 (29025982) 4
8 (32675783) 4
1 (36737523) 4
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 1 2 1 2 4 3
References Study Quality
35 (-3197520) 4
MRI abdomen and pelvis without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 1 0 2 10 1 0 0 0
MRI abdomen without and with IV contrast with MRCP May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 2 0 7 1 3 0 0
References Study Quality
43 (23192781) 4
MRI abdomen without IV contrast with MRCP May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 1 2 3 7 1 0 0 0
References Study Quality
36 (23533288) 2
40 (27345612) 2
CT abdomen and pelvis without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 1 0 0 0 3 9 1 0 0
CT chest abdomen pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 0 1 0 1 3 7 2 0 0
References Study Quality
35 (-3197520) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 3 2 4 2 1 0 1 0
References Study Quality
42 (34985313) 4
US abdomen endoscopic Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 1 0 1 1 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 4 9 0 0 0 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 4 8 0 0 0 0 0 0
Variant 6: Adult. Pancreatic neuroendocrine tumor. Follow-up imaging of untreated disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 1 1 7 2 2
References Study Quality
38 (29470627) 4
33 (26280127) 4
31 (26850565) 4
27 (28092495) 4
29 (23728305) 2
32 (30182253) 3
5 (32346794) 4
19 (29140113) 4
10 (33978449) 4
20 (34647178) 4
13 (28480609) 2
9 (30376977) 4
21 (25048189) 4
MRI abdomen without and with IV contrast with MRCP Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 1 0 0 1 0 2 3 3 4
References Study Quality
38 (29470627) 4
32 (30182253) 3
31 (26850565) 4
27 (28092495) 4
29 (23728305) 2
21 (25048189) 4
5 (32346794) 4
19 (29140113) 4
10 (33978449) 4
20 (34647178) 4
13 (28480609) 2
9 (30376977) 4
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 1 0 1 1 5 6
References Study Quality
32 (30182253) 3
31 (26850565) 4
30 (26022520) 4
20 (34647178) 4
29 (23728305) 2
21 (25048189) 4
18 (23436873) 4
5 (32346794) 4
10 (33978449) 4
2 (29594467) 4
13 (28480609) 2
9 (30376977) 4
CT abdomen and pelvis without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 7 0 0 1 1 3 1 3 4 1
References Study Quality
2 (29594467) 4
9 (30376977) 4
18 (23436873) 4
MRI abdomen and pelvis without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 0 1 0 8 5 0 0 0 0
MRI abdomen without IV contrast with MRCP May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 1 1 1 4 6 1 0 0 0
DOTATATE PET/CT skull base to mid-thigh May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 1 2 0 1 7 2 1 0 0
References Study Quality
1 (36737523) 4
US abdomen endoscopic Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 3 5 1 0 3 1 1 0 0
References Study Quality
9 (30376977) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 4 8 0 1 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 3 2 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.