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Appropriateness Criteria

Variant 1: Suspected or initial diagnosis of gestational trophoblastic disease (GTD).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 1 6 5 2
References Study Quality
34 (26735221) 4
33 (19200936) 4
35 (28591340) 4
US pelvis transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 4 3 3 2 3
References Study Quality
32 (23416812) 3
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 1 2 1 11
References Study Quality
22 (17201012) 3
23 (27696434) 2
9 (19369669) 4
21 (16273594) 3
28 (24907943) 4
29 (23848045) 4
30 (26060553) 4
31 (24379071) 4
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 1 0 1 7 3 1 1 0
References Study Quality
19 (16816073) 4
36 (28287945) 4
20 (-3131525) 4
37 (23999759) 4
MRI head without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 9 4 0 0 2 0 0 1 0
References Study Quality
43 (26896825) 4
37 (23999759) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 10 4 1 0 0 0 0 1 0
References Study Quality
43 (26896825) 4
37 (23999759) 4
MRI pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 1 10 3 0 0 0 0 0 0
References Study Quality
44 (25126425) 4
45 (22085657) 4
46 (28189211) 3
MRI pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 2 10 2 0 0 0 0 0 0
References Study Quality
44 (25126425) 4
45 (22085657) 4
46 (28189211) 3
CT abdomen and pelvis with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 2 11 1 0 0 0 0 0 0
References Study Quality
43 (26896825) 4
37 (23999759) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 4 0 1 2 1 0 0 0
References Study Quality
43 (26896825) 4
37 (23999759) 4
CT chest with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 1 8 5 0 0 0 0 0 0
References Study Quality
19 (16816073) 4
36 (28287945) 4
20 (-3131525) 4
38 (26270122) 4
39 (3016626) 3
40 (19480243) 3
41 (19019416) 4
42 (17765466) 3
37 (23999759) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 2 10 2 0 0 0 0 0 0
References Study Quality
19 (16816073) 4
36 (28287945) 4
20 (-3131525) 4
38 (26270122) 4
39 (3016626) 3
40 (19480243) 3
41 (19019416) 4
42 (17765466) 3
37 (23999759) 4
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 5 1 1 3 2 0 0 0
References Study Quality
19 (16816073) 4
36 (28287945) 4
20 (-3131525) 4
38 (26270122) 4
39 (3016626) 3
40 (19480243) 3
41 (19019416) 4
42 (17765466) 3
37 (23999759) 4
CT head with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 4 10 0 0 0 0 0 0 0
References Study Quality
43 (26896825) 4
37 (23999759) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 2 1 3 0 0 0 0
References Study Quality
43 (26896825) 4
37 (23999759) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 5 1 1 2 0 1 0 0
References Study Quality
43 (26896825) 4
37 (23999759) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 3 11 0 0 0 0 0 0 0
References Study Quality
43 (26896825) 4
37 (23999759) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 6 0 0 2 0 0 0 0
References Study Quality
47 (26868372) 4
Variant 2: Staging and risk assessment: suspected or established diagnosis of gestational trophoblastic neoplasia (GTN).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler pelvis Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 1 4 7 2
References Study Quality
34 (26735221) 4
56 (22374461) 3
57 (22262502) 3
58 (23759086) 3
59 (26257463) 2
US pelvis transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 5 7 1
References Study Quality
32 (23416812) 3
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 1 2 3 9
References Study Quality
44 (25126425) 4
15 (23159816) 4
37 (23999759) 4
45 (22085657) 4
51 (22696814) 4
52 (21738043) 4
53 (25396428) 3
54 (9808132) 4
55 (22807194) 4
Radiography chest Usually appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 8 8 0 0 1 1 1 1 3 4 5
References Study Quality
6 (26092638) 4
7 (25341573) 4
36 (28287945) 4
20 (-3131525) 4
38 (26270122) 4
39 (3016626) 3
60 (22730711) 4
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 3 0 7 4 0
References Study Quality
44 (25126425) 4
14 (26775357) 4
15 (23159816) 4
17 (27424358) 2
46 (28189211) 3
52 (21738043) 4
61 (16546459) 4
65 (27001388) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 6 1 5 1 2
References Study Quality
6 (26092638) 4
36 (28287945) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 5 1 6 1 2
References Study Quality
7 (25341573) 4
19 (16816073) 4
36 (28287945) 4
20 (-3131525) 4
38 (26270122) 4
39 (3016626) 3
40 (19480243) 3
41 (19019416) 4
42 (17765466) 3
37 (23999759) 4
60 (22730711) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 4 6 2 2 0
References Study Quality
6 (26092638) 4
12 (25118474) 4
16 (23803756) 4
61 (16546459) 4
62 (20795342) 4
MRI pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 0 2 1 6 3 1 1 0
References Study Quality
44 (25126425) 4
14 (26775357) 4
15 (23159816) 4
17 (27424358) 2
46 (28189211) 3
52 (21738043) 4
61 (16546459) 4
65 (27001388) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 8 1 2 2 0
References Study Quality
7 (25341573) 4
19 (16816073) 4
36 (28287945) 4
20 (-3131525) 4
38 (26270122) 4
39 (3016626) 3
40 (19480243) 3
41 (19019416) 4
42 (17765466) 3
37 (23999759) 4
60 (22730711) 4
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 1 2 10 2 1 0 0
References Study Quality
6 (26092638) 4
12 (25118474) 4
16 (23803756) 4
43 (26896825) 4
37 (23999759) 4
61 (16546459) 4
62 (20795342) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 1 9 0 3 0 0
References Study Quality
67 (17218850) 4
47 (26868372) 4
66 (16220307) 3
68 (23314259) 3
69 (16356798) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 0 5 3 0 5 0 1 0 0
References Study Quality
6 (26092638) 4
12 (25118474) 4
16 (23803756) 4
61 (16546459) 4
62 (20795342) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 2 3 2 0 0 0 0
References Study Quality
6 (26092638) 4
36 (28287945) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 1 8 4 0 1 0 0 0 0
References Study Quality
7 (25341573) 4
19 (16816073) 4
20 (-3131525) 4
38 (26270122) 4
39 (3016626) 3
40 (19480243) 3
41 (19019416) 4
42 (17765466) 3
37 (23999759) 4
60 (22730711) 4
CT head without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 1 8 0 0 4 1 0 0 0
References Study Quality
6 (26092638) 4
12 (25118474) 4
16 (23803756) 4
43 (26896825) 4
37 (23999759) 4
61 (16546459) 4
62 (20795342) 4
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 1 7 1 1 4 0 0 0 0
References Study Quality
6 (26092638) 4
12 (25118474) 4
16 (23803756) 4
43 (26896825) 4
37 (23999759) 4
61 (16546459) 4
62 (20795342) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 3 5 4 0 2 0 0 0 0
References Study Quality
6 (26092638) 4
36 (28287945) 4
Variant 3: Surveillance of GTN, including refractory, relapsed, or quiescent GTN.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler pelvis Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 0 3 8 2
References Study Quality
57 (22262502) 3
61 (16546459) 4
US pelvis transabdominal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 4 3 4 2
References Study Quality
32 (23416812) 3
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 1 10 2
References Study Quality
2 (22244665) 4
13 (20739008) 4
61 (16546459) 4
MRI head without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 0 10 3 1
References Study Quality
12 (25118474) 4
61 (16546459) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 4 1 2 6 2
References Study Quality
16 (23803756) 4
18 (20495216) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 3 2 3 5 2
References Study Quality
16 (23803756) 4
18 (20495216) 4
71 (16404359) 3
MRI head without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 5 2 0 3 2 2 0 0
References Study Quality
12 (25118474) 4
61 (16546459) 4
MRI pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 3 6 3 1 1
References Study Quality
44 (25126425) 4
16 (23803756) 4
17 (27424358) 2
45 (22085657) 4
61 (16546459) 4
24 (19552948) 4
MRI pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 1 0 1 0 8 2 1 1 0
References Study Quality
44 (25126425) 4
16 (23803756) 4
17 (27424358) 2
45 (22085657) 4
61 (16546459) 4
24 (19552948) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 0 9 1 3 1 0
References Study Quality
16 (23803756) 4
18 (20495216) 4
71 (16404359) 3
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 0 0 8 3 2 1 0
References Study Quality
6 (26092638) 4
CT head without and with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 1 3 2 6 2 1 0 0
References Study Quality
6 (26092638) 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 2 6 1 1 2 0 1 1 0
References Study Quality
16 (23803756) 4
18 (20495216) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 1 7 4 1 0 0
References Study Quality
67 (17218850) 4
10 (20673583) 4
66 (16220307) 3
69 (16356798) 4
72 (17165434) 4
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 3 3 1 5 4 1 2 0 0 1 0
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 5 1 0 4 1 0 1 0
References Study Quality
16 (23803756) 4
18 (20495216) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 2 6 2 1 1 1 0 1 0
References Study Quality
16 (23803756) 4
18 (20495216) 4
71 (16404359) 3
CT head without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 2 5 1 0 6 0 0 0 0
References Study Quality
6 (26092638) 4
Variant 4: Assessment of complications: GTD and GTN.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pelvis transvaginal Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 4 1 4 3 4
References Study Quality
44 (25126425) 4
61 (16546459) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 4 1 5 3 3
References Study Quality
16 (23803756) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 5 2 3 3 2
References Study Quality
44 (25126425) 4
45 (22085657) 4
US duplex Doppler pelvis May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 5 3 1 3 3
References Study Quality
44 (25126425) 4
US pelvis transabdominal May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 7 4 1 1 0
References Study Quality
32 (23416812) 3
37 (23999759) 4
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 0 1 2 7 3 0 1 0
References Study Quality
44 (25126425) 4
45 (22085657) 4
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 7 4 3 1 0
References Study Quality
16 (23803756) 4
MRI head without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 11 2 0 1 0
References Study Quality
16 (23803756) 4
MRI pelvis without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 2 8 4 2 0 0
References Study Quality
75 (29052024) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 7 4 0 1 0
References Study Quality
75 (29052024) 4
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 7 4 1 1 0
References Study Quality
16 (23803756) 4
CT chest without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 2 1 2 5 1 2 1 0
References Study Quality
44 (25126425) 4
45 (22085657) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 0 10 2 1 1 0
References Study Quality
44 (25126425) 4
45 (22085657) 4
CT head with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 2 0 7 3 4 0 0
References Study Quality
16 (23803756) 4
CT head without and with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 0 11 2 0 1 0
References Study Quality
16 (23803756) 4
CT head without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 0 1 6 6 0 1 0
References Study Quality
16 (23803756) 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 0 1 2 3 5 1 1 0
References Study Quality
16 (23803756) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 5 2 0 2 1 0 0 1
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.