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Appropriateness Criteria

Variant 1: Male. Less than 40 years of age. Transient hematospermia. No associated signs or symptoms of disease. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
TRUS prostate Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 0 1 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
US scrotum Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 6 2 2 1 0 0 0 0 0
References Study Quality
25 (17437771) 4
1 (11912400) 2
22 (27520544) 2
20 (35483126) 4
19 (35633853) 3
10 (37051970) 4
2 (27054210) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 0 1 0 0 0 1 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
MRI abdomen and pelvis without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 0 1 0 0 0 1 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
MRI pelvis without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 7 2 2 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
MRI pelvis without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 9 1 1 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
MRU without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 0 0 0 1 0 1 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
MRU without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 0 1 0 0 0 1 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
CT abdomen and pelvis with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 2 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 2 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
CT pelvis with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 1 0 0 1 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
CT pelvis without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 1 1 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
Fluciclovine PET/MRI skull base to mid-thigh Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 11 1 0 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 9 1 2 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
CT pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 1 0 0 1 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
CTA abdomen and pelvis with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 11 0 1 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
CTA abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 11 0 1 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
CTA pelvis with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 11 0 1 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
CTU without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 0 1 0 1 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
Fluciclovine PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 11 1 0 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
PSMA PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 11 1 0 0 0 0 0 0 0
References Study Quality
21 (16802198) 4
24 (32704074) 3
23 (29048208) 2
22 (27520544) 2
8 (34183196) 4
3 (32577619) 4
2 (27054210) 4
Variant 2: Male. Greater than or equal to 40 years of age with hematospermia; or male of any age with persistent or recurrent hematospermia or hematospermia accompanied by associated signs or symptoms of disease. Initial imaging.
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] 7 7 0 0 0 1 3 0 5 1 2
References Study Quality
17 (33694277) 3
13 (33955038) 4
5 (30903016) 4
3 (32577619) 4
TRUS prostate May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 2 5 1 0 0
References Study Quality
36 (27819756) 3
35 (28332431) 4
34 (33773582) 2
33 (29735816) 2
27 (29184797) 4
22 (27520544) 2
13 (33955038) 4
8 (34183196) 4
7 (27652230) 4
6 (28382905) 4
5 (30903016) 4
US scrotum May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 2 6 1 0 0
References Study Quality
25 (17437771) 4
1 (11912400) 2
22 (27520544) 2
20 (35483126) 4
19 (35633853) 3
10 (37051970) 4
2 (27054210) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 7 3 1 0 0
References Study Quality
17 (33694277) 3
13 (33955038) 4
5 (30903016) 4
3 (32577619) 4
MRU without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 0 8 2 0 0 0
References Study Quality
31 (38040458) 4
MRU without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 0 1 5 3 2 0 0 0
References Study Quality
31 (38040458) 4
CT abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 1 2 6 2 0 1 0 0
References Study Quality
29 (30924591) 4
30 (31897685) 4
CT pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 2 5 3 1 1 0 0
References Study Quality
30 (31897685) 4
29 (30924591) 4
CT pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 2 1 2 5 2 0 0 0 0
References Study Quality
30 (31897685) 4
29 (30924591) 4
CT abdomen and pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 3 1 1 4 2 0 1 0 0
References Study Quality
29 (30924591) 4
30 (31897685) 4
CT pelvis without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 0 8 3 0 0 0 0
References Study Quality
30 (31897685) 4
29 (30924591) 4
CTU without and with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 0 1 1 4 1 4 1 0 0
References Study Quality
31 (38040458) 4
30 (31897685) 4
29 (30924591) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 1 4 3 0 0 0 0 0
References Study Quality
17 (33694277) 3
13 (33955038) 4
5 (30903016) 4
3 (32577619) 4
MRI abdomen and pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 2 3 3 0 0 0 0 0
References Study Quality
5 (30903016) 4
13 (33955038) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 1 4 5 0 0 0 0 0
References Study Quality
30 (31897685) 4
29 (30924591) 4
Fluciclovine PET/MRI skull base to mid-thigh Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 8 2 2 0 0 0 0 0 0
References Study Quality
20 (35483126) 4
15 (36241064) 4
10 (37051970) 4
CTA abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 2 2 7 0 0 0 0 0 0
CTA abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 3 0 5 2 1 0 1 0 0
CTA pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 3 3 3 1 5 2 0 0 0 0 0
Fluciclovine PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 1 1 8 2 2 0 0 0 0 0 0
References Study Quality
32 (37236742) 4
20 (35483126) 4
15 (36241064) 4
10 (37051970) 4
PSMA PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv 1 1 9 3 0 0 0 0 0 0 0
References Study Quality
32 (37236742) 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.