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Appropriateness Criteria

Variant 1: Superficial soft tissue mass. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US area of interest Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 2 2 2 7
References Study Quality
17 (24848846) 3
19 (24848826) 4
18 (33058264) 2
16 (31900511) 2
15 (35412355) 4
14 (28987653) 3
13 (30928084) 4
12 (32438440) 4
9 (29846498) 4
Radiography area of interest Usually appropriate Limited Varies Varies 9 9 1 0 1 0 0 0 0 1 11
References Study Quality
11 (27726739) 4
10 (18566812) 4
9 (29846498) 4
US area of interest with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 2 0 0 0 0 1 0 0
References Study Quality
22 (22411306) 4
21 (27959625) 2
20 (25454097) 2
Image-guided biopsy area of interest Usually not appropriate Limited Varies Varies 1 1 10 1 1 1 0 0 1 0 0
References Study Quality
23 (23971442) 4
24 (29752328) 4
Image-guided fine needle aspiration area of interest Usually not appropriate Limited Varies Varies 1 1 10 1 1 0 1 0 1 0 0
References Study Quality
23 (23971442) 4
24 (29752328) 4
MRI area of interest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 2 1 3 1 1 0 0 0
MRI area of interest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 2 0 2 1 1 0 0 0
FDG-PET/CT area of interest Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 1 1 0 0 0 0 1 0
CT area of interest with IV contrast Usually not appropriate Expert Consensus Varies Varies 2 2 7 4 2 0 0 1 0 0 0
CT area of interest without and with IV contrast Usually not appropriate Expert Consensus Varies Varies 2 2 7 2 2 0 1 1 1 0 0
CT area of interest without IV contrast Usually not appropriate Expert Consensus Varies Varies 2 2 6 4 2 0 0 0 1 0 0
Variant 2: Nonsuperficial (deep) soft tissue mass. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography area of interest Usually appropriate Limited Varies Varies 9 9 1 0 0 0 0 0 2 1 10
References Study Quality
11 (27726739) 4
25 (23673552) 4
26 (35236592) 4
9 (29846498) 4
US area of interest May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 10 2 0 0 0
References Study Quality
13 (30928084) 4
27 (19414084) 3
28 (32591891) 2
CT area of interest with IV contrast May be appropriate Limited Varies Varies 5 5 0 1 2 1 6 3 0 0 0
References Study Quality
11 (27726739) 4
29 (25344599) 4
30 (20489097) 4
31 (33299004) 4
CT area of interest without and with IV contrast May be appropriate Limited Varies Varies 5 5 0 1 0 1 8 3 0 0 0
References Study Quality
11 (27726739) 4
29 (25344599) 4
30 (20489097) 4
31 (33299004) 4
CT area of interest without IV contrast May be appropriate Limited Varies Varies 5 5 0 2 0 0 8 3 0 0 0
References Study Quality
11 (27726739) 4
29 (25344599) 4
30 (20489097) 4
31 (33299004) 4
US area of interest with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 0 3 1 2 0 1 0 0
References Study Quality
27 (19414084) 3
Image-guided biopsy area of interest Usually not appropriate Limited Varies Varies 1 1 12 1 0 0 0 0 1 0 0
References Study Quality
23 (23971442) 4
24 (29752328) 4
Image-guided fine needle aspiration area of interest Usually not appropriate Limited Varies Varies 1 1 12 0 0 1 0 0 1 0 0
References Study Quality
23 (23971442) 4
24 (29752328) 4
MRI area of interest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 3 1 2 1 0 0 0 1
MRI area of interest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 0 0 3 0 0 0 0
FDG-PET/CT area of interest Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 11 2 0 0 0 0 1 0 0
Variant 3: Soft tissue mass. Nondiagnostic radiograph and noncontrast enhanced ultrasound. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI area of interest without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 0 2 0 11
References Study Quality
42 (33814107) 4
41 (28655433) 4
40 (31834812) 2
39 (32885297) 2
38 (30949892) 4
37 (32649224) 2
36 (32379793) 2
35 (30663160) 2
34 (33542870) 2
33 (15459325) 1
11 (27726739) 4
3 (33852362) 4
MRI area of interest without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 4 4 3 1 0
References Study Quality
42 (33814107) 4
41 (28655433) 4
40 (31834812) 2
39 (32885297) 2
38 (30949892) 4
37 (32649224) 2
36 (32379793) 2
35 (30663160) 2
34 (33542870) 2
33 (15459325) 1
11 (27726739) 4
3 (33852362) 4
CT area of interest with IV contrast May be appropriate Moderate Varies Varies 5 5 0 0 0 0 7 1 2 1 2
References Study Quality
32 (8988217) 2
29 (25344599) 4
30 (20489097) 4
31 (33299004) 4
CT area of interest without and with IV contrast May be appropriate Moderate Varies Varies 5 5 0 0 0 0 8 5 0 0 0
References Study Quality
32 (8988217) 2
31 (33299004) 4
US area of interest with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 6 2 3 1 0 1 1 0 0
References Study Quality
16 (31900511) 2
28 (32591891) 2
Image-guided biopsy area of interest Usually not appropriate Limited Varies Varies 1 1 10 1 1 0 0 0 1 0 0
References Study Quality
23 (23971442) 4
24 (29752328) 4
Image-guided fine needle aspiration area of interest Usually not appropriate Limited Varies Varies 1 1 10 1 1 0 0 0 1 0 0
References Study Quality
23 (23971442) 4
24 (29752328) 4
FDG-PET/CT area of interest Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 5 5 1 0 1 0 1 0 0
References Study Quality
47 (26990930) 2
45 (32711449) 2
46 (20660389) 3
43 (19636577) 3
48 (26053718) 3
44 (18756363) 3
CT area of interest without IV contrast Usually not appropriate Moderate Varies Varies 2 2 6 1 4 1 1 0 0 0 0
References Study Quality
32 (8988217) 2
Variant 4: Soft tissue mass. Nondiagnostic radiograph and noncontrast enhanced ultrasound. MRI contraindicated. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT area of interest with IV contrast Usually appropriate Strong Varies Varies 9 9 0 1 0 0 0 1 0 2 9
References Study Quality
49 (21249370) 3
52 (24834889) 4
51 (26025120) 3
53 (25340586) 3
29 (25344599) 4
54 (25819070) 2
50 (30919651) 4
CT area of interest without and with IV contrast May be appropriate Limited Varies Varies 5 5 0 0 0 1 11 0 1 0 0
References Study Quality
31 (33299004) 4
US area of interest with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 6 0 5 2 0 0 1 0 0
Image-guided biopsy area of interest Usually not appropriate Limited Varies Varies 1 1 8 0 3 0 1 2 0 0 0
References Study Quality
29 (25344599) 4
24 (29752328) 4
Image-guided fine needle aspiration area of interest Usually not appropriate Limited Varies Varies 1 1 7 3 2 0 0 0 1 0 0
References Study Quality
29 (25344599) 4
24 (29752328) 4
FDG-PET/CT area of interest Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 5 5 1 1 0 0 1 0 0
References Study Quality
47 (26990930) 2
45 (32711449) 2
46 (20660389) 3
43 (19636577) 3
48 (26053718) 3
44 (18756363) 3
CT area of interest without IV contrast Usually not appropriate Limited Varies Varies 3 3 5 1 2 2 2 1 1 0 0
References Study Quality
29 (25344599) 4
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.