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Appropriateness Criteria

Variant 1: Adult. Newly diagnosed squamous cell anal cancer. Locoregional assessment at initial staging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 1 11 0 1
References Study Quality
18 (19365694) 3
19 (36932225) 4
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 0 2 5 5 2
References Study Quality
17 (37592085) Good
16 (24672298) Good
15 (29759568) Good
14 (28972796) Good
13 (25652048) Good
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 3 3 4 2 0
References Study Quality
19 (36932225) 4
23 (28874205) 3
22 (29134349) 3
21 (32540336) 3
20 (22294527) 3
CT pelvis with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 9 1 3 0 0
References Study Quality
14 (28972796) Good
13 (25652048) Good
12 (22592047) 3
11 (20832181) 3
FDG-PET/MRI whole body May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 1 4 7 1 1 0 0
US pelvis transrectal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 5 5 1 2 0 0 0 0
References Study Quality
24 (28152518) 3
18 (19365694) 3
19 (36932225) 4
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 3 3 1 1 0 0 1 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 4 4 1 0 0 1 0 0
Variant 2: Adult. Squamous cell anal cancer. Assessment for metastatic disease at initial staging or 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 Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 1 1 6 6
References Study Quality
13 (25652048) Good
10 (31753232) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 0 0 0 1 1 5 5 2
References Study Quality
10 (31753232) 4
CT chest without IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 3 1 6 3 0
References Study Quality
10 (31753232) 4
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 0 2 5 7 0
References Study Quality
13 (25652048) Good
14 (28972796) Good
26 (22208962) 3
17 (37592085) Good
MRI abdomen and pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 8 6 1 0 0
References Study Quality
27 (33153555) 4
CT abdomen and pelvis without IV contrast May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 2 1 3 4 3 2 0 0 0
References Study Quality
13 (25652048) Good
MRI abdomen and pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 0 2 8 4 1 0 0 0 0
References Study Quality
27 (33153555) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 2 11 2 0 0 0 0 0 0
References Study Quality
10 (31753232) 4
FDG-PET/MRI whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 0 5 0 4 1 1 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 5 7 1 0 0 0 0 0
References Study Quality
13 (25652048) Good
Variant 3: Adult. Squamous cell anal cancer. Posttreatment locoregional assessment.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 1 3 5 4 0
References Study Quality
24 (28152518) 3
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 1 1 7 4 1
References Study Quality
29 (35274187) 4
28 (33539412) 3
17 (37592085) Good
14 (28972796) Good
13 (25652048) Good
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 7 6 0 0 0
References Study Quality
31 (37462820) 3
30 (27090113) 3
29 (35274187) 4
24 (28152518) 3
19 (36932225) 4
CT pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 7 7 1 0 0 0
FDG-PET/MRI whole body May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 6 0 8 0 0 0 0
US pelvis transrectal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 1 7 1 2 1 0 0 0
References Study Quality
24 (28152518) 3
32 (25585077) 3
CT pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 5 4 3 1 0 0 0 0
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 3 3 0 1 1 1 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.