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Appropriateness Criteria

Variant 1: Initial staging of pretreatment ovarian cancer.
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 Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 1 0 1 2 1 13
References Study Quality
59 (23994535) 2
55 (26607779) 2
69 (24725017) 2
68 (14730048) 4
5 (20858663) 3
52 (7676985) 3
43 (1947112) 3
58 (12794595) 2
39 (18519739) 2
40 (20683405) 2
60 (18704437) 3
61 (17233859) 3
63 (20981128) 4
62 (19098191) 3
64 (17264334) 3
65 (3336709) 3
66 (2917315) 3
67 (3258096) 3
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 1 0 1 5 3 8
References Study Quality
70 (19955956) 4
71 (21193598) 2
72 (11222208) 4
73 (11566689) 4
MRI abdomen and pelvis without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 3 2 9 4 1 0
References Study Quality
75 (22302265) 3
76 (10831697) 1
8 (17433597) Inadequate
6 (10992033) 4
7 (12432104) 4
31 (19620444) 2
78 (18485169) 3
44 (8428108) 2
77 (17157627) 4
74 (10644099) 3
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 3 3 5 7 1 0 0 0
References Study Quality
75 (22302265) 3
76 (10831697) 1
8 (17433597) Inadequate
6 (10992033) 4
7 (12432104) 4
31 (19620444) 2
78 (18485169) 3
44 (8428108) 2
77 (17157627) 4
74 (10644099) 3
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 5 1 11 1 1 0 0 0
References Study Quality
59 (23994535) 2
55 (26607779) 2
69 (24725017) 2
68 (14730048) 4
5 (20858663) 3
52 (7676985) 3
43 (1947112) 3
58 (12794595) 2
39 (18519739) 2
40 (20683405) 2
60 (18704437) 3
61 (17233859) 3
63 (20981128) 4
62 (19098191) 3
64 (17264334) 3
65 (3336709) 3
66 (2917315) 3
67 (3258096) 3
CT chest abdomen pelvis without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 3 4 9 2 0 0 0 0
References Study Quality
70 (19955956) 4
71 (21193598) 2
72 (11222208) 4
73 (11566689) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 2 4 11 2 0 0
References Study Quality
82 (24463640) 3
81 (26350201) 2
83 (14684544) 2
33 (11418411) 3
80 (12034950) 2
79 (17625380) 3
US abdomen and pelvis transabdominal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 3 4 3 1 1 0 0 0
US pelvis transvaginal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 4 6 1 1 1 0 0 0
References Study Quality
80 (12034950) 2
Fluoroscopy contrast enema Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 2 1 0 0 0 0 1
Radiography intravenous urography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 1 0 1 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 5 7 4 1 1 0 0 0
References Study Quality
59 (23994535) 2
55 (26607779) 2
69 (24725017) 2
68 (14730048) 4
52 (7676985) 3
58 (12794595) 2
39 (18519739) 2
60 (18704437) 3
61 (17233859) 3
63 (20981128) 4
62 (19098191) 3
64 (17264334) 3
65 (3336709) 3
66 (2917315) 3
67 (3258096) 3
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 4 8 3 1 0 0 1 0
References Study Quality
70 (19955956) 4
71 (21193598) 2
72 (11222208) 4
73 (11566689) 4
Variant 2: Extent of disease in suspected or known recurrence of ovarian cancer.
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 Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 1 0 1 3 3 10
References Study Quality
59 (23994535) 2
86 (18418592) 3
87 (26745811) 3
5 (20858663) 3
52 (7676985) 3
43 (1947112) 3
58 (12794595) 2
CT chest abdomen pelvis with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 1 0 0 4 4 9
References Study Quality
59 (23994535) 2
86 (18418592) 3
87 (26745811) 3
5 (20858663) 3
52 (7676985) 3
43 (1947112) 3
58 (12794595) 2
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 1 0 0 1 2 2 2 8 2
References Study Quality
88 (18378417) Good
82 (24463640) 3
10 (21415197) 4
89 (17404789) 2
86 (18418592) 3
87 (26745811) 3
34 (18827492) 3
19 (16515575) 3
91 (17208284) 3
90 (11373212) 3
MRI abdomen and pelvis without and with IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 6 6 0 0 1 5 3 8 2 0 0
References Study Quality
88 (18378417) Good
14 (7480729) 3
MRI abdomen and pelvis without IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 4 4 1 3 3 8 2 2 0 0 0
References Study Quality
88 (18378417) Good
14 (7480729) 3
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 5 2 8 3 1 0 0 0
References Study Quality
59 (23994535) 2
86 (18418592) 3
87 (26745811) 3
5 (20858663) 3
52 (7676985) 3
43 (1947112) 3
58 (12794595) 2
CT chest abdomen pelvis without IV contrast May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 4 2 9 2 1 0 0 0
References Study Quality
59 (23994535) 2
86 (18418592) 3
87 (26745811) 3
5 (20858663) 3
52 (7676985) 3
43 (1947112) 3
58 (12794595) 2
US abdomen and pelvis transabdominal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 1 3 13 1 0 1 0 0 0
US pelvis transvaginal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 5 10 1 1 1 0 0 0
References Study Quality
95 (22858859) 4
Fluoroscopy contrast enema Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 3 1 0 0 0 0 1
Radiography intravenous urography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 0 2 0 1 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 5 8 3 1 1 0 0 0
References Study Quality
59 (23994535) 2
86 (18418592) 3
87 (26745811) 3
5 (20858663) 3
52 (7676985) 3
43 (1947112) 3
58 (12794595) 2
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 4 8 3 1 1 0 0 0
References Study Quality
59 (23994535) 2
86 (18418592) 3
87 (26745811) 3
5 (20858663) 3
52 (7676985) 3
43 (1947112) 3
58 (12794595) 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.