Variant 1: Man <40 years of age, transient or episodic hematospermia, and no other symptoms or signs of disease.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	1	2	3	4	5	6	7	8	9
TRUS prostate	Usually not appropriate		O 0 mSv	O 0 mSv [ped]	3	n/a	0	0	0	0	0	0	0	0	0
Arteriography pelvis	Usually not appropriate		☢☢☢☢ 10-30 mSv		1	n/a	0	0	0	0	0	0	0	0	0
MRI pelvis without and with IV contrast	Usually not appropriate		O 0 mSv	O 0 mSv [ped]	3	n/a	0	0	0	0	0	0	0	0	0
MRI pelvis without IV contrast	Usually not appropriate		O 0 mSv	O 0 mSv [ped]	3	n/a	0	0	0	0	0	0	0	0	0
CT pelvis with IV contrast	Usually not appropriate		☢☢☢ 1-10 mSv	☢☢☢☢ 3-10 mSv [ped]	1	n/a	0	0	0	0	0	0	0	0	0
CT pelvis without IV contrast	Usually not appropriate		☢☢☢ 1-10 mSv	☢☢☢☢ 3-10 mSv [ped]	1	n/a	0	0	0	0	0	0	0	0	0
CT pelvis without and with IV contrast	Usually not appropriate		☢☢☢☢ 10-30 mSv	☢☢☢☢ 3-10 mSv [ped]	1	n/a	0	0	0	0	0	0	0	0	0

Variant 2: Man ≥40 years of age, or man of any age with persistent hematospermia, or hematospermia accompanied by associated symptoms or signs of disease.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	1	2	3	4	5	6	7	8	9
TRUS prostate	Usually appropriate		O 0 mSv	O 0 mSv [ped]	8	n/a	0	0	0	0	0	0	0	0	0
MRI pelvis without and with IV contrast	Usually appropriate		O 0 mSv	O 0 mSv [ped]	8	n/a	0	0	0	0	0	0	0	0	0
MRI pelvis without IV contrast	Usually appropriate		O 0 mSv	O 0 mSv [ped]	7	n/a	0	0	0	0	0	0	0	0	0
Arteriography pelvis	Usually not appropriate		☢☢☢☢ 10-30 mSv		2	n/a	0	0	0	0	0	0	0	0	0
CT pelvis with IV contrast	Usually not appropriate		☢☢☢ 1-10 mSv	☢☢☢☢ 3-10 mSv [ped]	2	n/a	0	0	0	0	0	0	0	0	0
CT pelvis without IV contrast	Usually not appropriate		☢☢☢ 1-10 mSv	☢☢☢☢ 3-10 mSv [ped]	1	n/a	0	0	0	0	0	0	0	0	0
CT pelvis without and with IV contrast	Usually not appropriate		☢☢☢☢ 10-30 mSv	☢☢☢☢ 3-10 mSv [ped]	1	n/a	0	0	0	0	0	0	0	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.

Appropriateness Criteria

Variant 1: Man <40 years of age, transient or episodic hematospermia, and no other symptoms or signs of disease.

Variant 2: Man ≥40 years of age, or man of any age with persistent hematospermia, or hematospermia accompanied by associated symptoms or signs of disease.