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Appropriateness Criteria

Variant 1: Initial local staging of pretreatment cervical cancer; assessment of local tumor extension (T staging) for any clinically visible lesion.
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 Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 1 4 6
References Study Quality
29 (25794993) 3
28 (30503642) 3
27 (21479769) 3
26 (28726120) Good
25 (18936313) 2
24 (27012496) 3
22 (30799568) 3
21 (30903231) 4
20 (7784021) 2
19 (8331236) 2
18 (1362678) 1
12 (32415584) 3
11 (14529663) 4
FDG-PET/MRI skull base to mid-thigh Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 1 0 0 0 4 0 5 1 1
References Study Quality
17 (20580064) 3
16 (19604567) 2
15 (33482909) 3
14 (28840302) 3
US pelvis transvaginal May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 9 0 0 0 0
References Study Quality
32 (23022593) 2
31 (30028181) 3
30 (32096793) Good
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 3 5 1 1 1
References Study Quality
29 (25794993) 3
28 (30503642) 3
27 (21479769) 3
22 (30799568) 3
21 (30903231) 4
CT pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 3 2 0 5 0 1 0 0
References Study Quality
12 (32415584) 3
11 (14529663) 4
10 (17179104) 2
9 (32551909) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 0 0 0 5 0 4 1 1
References Study Quality
9 (32551909) 4
12 (32415584) 3
US pelvis transabdominal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 7 3 1 0 0 0 0 1 0
CT pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 2 2 0 0 0 1 0 0
References Study Quality
13 (12117194) 4
CT pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 0 1 0 0 1 0 0
Variant 2: Initial systemic staging of pretreatment cervical cancer; assessment of lymph node and distant metastases (N/M 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] 8 8 0 0 0 0 0 0 5 5 1
References Study Quality
12 (32415584) 3
36 (20298252) M
CT abdomen and pelvis with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 0 1 0 4 4 2
References Study Quality
36 (20298252) M
35 (27357415) 4
34 (30739082) 3
33 (29185901) 2
12 (32415584) 3
CT chest with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 0 10 1 0
References Study Quality
33 (29185901) 2
FDG-PET/MRI skull base to mid-thigh Usually appropriate Limited ☢☢☢ 1-10 mSv 8 8 0 0 0 0 1 0 4 5 1
References Study Quality
17 (20580064) 3
16 (19604567) 2
14 (28840302) 3
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 1 0 0 1 4 6
References Study Quality
38 (27178725) 3
37 (-3195133) 4
36 (20298252) M
35 (27357415) 4
34 (30739082) 3
33 (29185901) 2
12 (32415584) 3
MRI abdomen without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 2 6 3 0 0
References Study Quality
12 (32415584) 3
36 (20298252) M
MRI abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 8 1 0 1 0
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 5 2 2 1 0
References Study Quality
39 (32636272) 4
40 (18201753) 3
CT chest without IV contrast May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 1 8 0 1 0 0
References Study Quality
33 (29185901) 2
US abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 5 4 1 1 1 0 0 0 0
US pelvis transabdominal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 7 3 1 0 0 1 0 0 0
US pelvis transvaginal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 7 3 1 0 0 0 0 0 1
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 6 2 1 0 2 0 1 0 0
References Study Quality
41 (7557610) 2
42 (16556457) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 2 1 0 0 0 0 0
References Study Quality
13 (12117194) 4
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 2 3 0 3 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 7 1 3 0 0 0 0 0 0
Variant 3: Initial treatment response assessment of cervical cancer after chemoradiation.
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 Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 0 0 1 8 2
References Study Quality
66 (31079257) 3
65 (26919800) 4
64 (32621877) 3
63 (32424659) 3
62 (33788707) Good
61 (28301309) 3
60 (26622060) 3
59 (30149749) Good
58 (30712019) 3
57 (32701045) 3
56 (26671305) 3
55 (16425027) 4
54 (26849153) 4
52 (29159572) 2
14 (28840302) 3
MRI pelvis without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 3 5 1 0
References Study Quality
66 (31079257) 3
64 (32621877) 3
63 (32424659) 3
62 (33788707) Good
59 (30149749) Good
58 (30712019) 3
57 (32701045) 3
FDG-PET/MRI skull base to mid-thigh Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 0 0 2 1 3 5 0
References Study Quality
53 (32798280) 3
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 1 3 6 1
References Study Quality
52 (29159572) 2
51 (31328452) Good
50 (30207790) Good
48 (31414206) 3
47 (27276204) 3
46 (29470614) 3
45 (30069578) 3
44 (29559287) 3
43 (24407578) 4
MRI abdomen without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 4 3 1 1 0
References Study Quality
37 (-3195133) 4
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 0 2 4 3 1 1 0 0
References Study Quality
37 (-3195133) 4
CT abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 2 2 5 0 0
References Study Quality
37 (-3195133) 4
CT chest with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 3 2 2 1 3 0 0
References Study Quality
37 (-3195133) 4
US abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 5 1 0 0 0 0 0 0
US pelvis transabdominal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 7 4 0 0 0 0 1 0 0
US pelvis transvaginal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 3 2 0 3 0 0 0 1
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 6 3 3 0 0 0 0 0 0
References Study Quality
37 (-3195133) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 1 3 2 2 0 1 0 0
References Study Quality
37 (-3195133) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 2 3 1 2 0 0 0 0
References Study Quality
37 (-3195133) 4
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 1 4 0 3 0 1 0 0
References Study Quality
37 (-3195133) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 3 3 1 1 0 1 0 0
References Study Quality
37 (-3195133) 4
Variant 4: Surveillance of treated cervical cancer in asymptomatic patients.
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 Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 1 0 6 3 0
References Study Quality
81 (27842663) Good
80 (32312283) 3
79 (28935271) 3
78 (30980126) 4
77 (33039422) 3
66 (31079257) 3
59 (30149749) Good
54 (26849153) 4
44 (29559287) 3
37 (-3195133) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 1 0 8 1 0
References Study Quality
37 (-3195133) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 2 0 7 1 0
References Study Quality
37 (-3195133) 4
FDG-PET/MRI skull base to mid-thigh Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 0 0 2 0 5 4 0
References Study Quality
76 (24804676) 2
75 (26551527) 3
73 (32034109) 3
53 (32798280) 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 0 3 6 1
References Study Quality
73 (32034109) 3
72 (33620285) 3
71 (24177043) Good
70 (24798933) Good
54 (26849153) 4
46 (29470614) 3
43 (24407578) 4
37 (-3195133) 4
5 (28372871) 4
MRI abdomen without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 2 1 1 2 3 2 0
References Study Quality
37 (-3195133) 4
MRI abdomen without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 2 3 2 1 2 0 0
References Study Quality
37 (-3195133) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 1 5 2 2 0 0
References Study Quality
37 (-3195133) 4
80 (32312283) 3
79 (28935271) 3
78 (30980126) 4
77 (33039422) 3
CT abdomen and pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 2 1 2 2 2 1 1 0 0
References Study Quality
37 (-3195133) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 4 3 1 2 0 0
References Study Quality
37 (-3195133) 4
US abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 4 1 1 0 0 0 0 0
References Study Quality
5 (28372871) 4
37 (-3195133) 4
US pelvis transabdominal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 3 2 0 0 0 1 0 0
References Study Quality
5 (28372871) 4
37 (-3195133) 4
US pelvis transvaginal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 6 4 1 0 0 0 0 0 0
References Study Quality
5 (28372871) 4
37 (-3195133) 4
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 5 3 3 0 1 0 0 0 0
References Study Quality
5 (28372871) 4
37 (-3195133) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 4 4 0 0 0 0 0 0
References Study Quality
37 (-3195133) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 2 4 0 0 0 0 0 0
References Study Quality
37 (-3195133) 4
Variant 5: Evaluation of known or suspected cervical cancer local recurrence or distant metastatic disease. Follow-up imaging.
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 Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 2 5 2 0
References Study Quality
37 (-3195133) 4
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 0 9 2 0
References Study Quality
37 (-3195133) 4
CT abdomen and pelvis with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 0 8 3 0
References Study Quality
37 (-3195133) 4
82 (24299154) Good
CT chest with IV contrast Usually appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 0 8 3 0
References Study Quality
37 (-3195133) 4
82 (24299154) Good
FDG-PET/MRI skull base to mid-thigh Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 0 0 2 1 3 4 1
References Study Quality
75 (26551527) 3
76 (24804676) 2
FDG-PET/CT skull base to mid-thigh Usually appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 2 5 4
References Study Quality
37 (-3195133) 4
47 (27276204) 3
54 (26849153) 4
82 (24299154) Good
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 0 7 1 2 0 0
References Study Quality
37 (-3195133) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 4 2 4 0 0
References Study Quality
37 (-3195133) 4
CT abdomen and pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 1 2 1 3 2 1 0 0
References Study Quality
37 (-3195133) 4
82 (24299154) Good
CT chest without IV contrast May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 3 2 3 3 0 0
References Study Quality
37 (-3195133) 4
82 (24299154) Good
CT abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 3 1 4 0 1 1 1 0 0
References Study Quality
37 (-3195133) 4
82 (24299154) Good
US abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 7 2 2 0 0 0 0 0 0
References Study Quality
5 (28372871) 4
37 (-3195133) 4
US pelvis transabdominal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 7 2 2 0 0 0 0 0 0
References Study Quality
5 (28372871) 4
37 (-3195133) 4
US pelvis transvaginal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 5 2 0 0 0 0 0 0
References Study Quality
5 (28372871) 4
37 (-3195133) 4
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 4 4 2 0 1 0 0 0 0
References Study Quality
5 (28372871) 4
37 (-3195133) 4
CT chest without and with IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 2 4 0 1 0 1 0 0
References Study Quality
37 (-3195133) 4
82 (24299154) Good
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.