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Appropriateness Criteria

Variant 1: Nonmuscle invasive bladder cancer no symptoms or risk factors. Post-treatment surveillance.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pelvis (bladder) Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
32 (21655537) 2
33 (18096730) 2
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 0 0 0 0 0 0 0 0 0
Radiography intravenous urography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 7 4 3 0 0 1 1 0 0
References Study Quality
29 (26760195) 2
30 (24072383) 2
27 (30922688) 2
28 (31012814) 2
25 (29727910) Inadequate
26 (29206594) Good
24 (28987698) Good
MRI abdomen and pelvis without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 10 2 2 0 1 0 1 0 0
References Study Quality
29 (26760195) 2
30 (24072383) 2
27 (30922688) 2
28 (31012814) 2
25 (29727910) Inadequate
26 (29206594) Good
24 (28987698) Good
MRU without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 3 5 1 0 0 1 1 0
References Study Quality
31 (20152273) 3
20 (10367843) 4
19 (10992362) 3
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 4 4 0 0 0 2 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 4 2 0 2 0 0 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 8 4 2 0 0 0 2 0 0
CTU without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 4 7 5 1 0 0 0 0 0
References Study Quality
23 (23680310) 3
20 (10367843) 4
19 (10992362) 3
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
Variant 2: Nonmuscle invasive bladder cancer with symptoms or risk factors. Post-treatment surveillance.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRU without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 1 11 5 0
References Study Quality
40 (20171676) 2
CTU without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 1 0 0 0 0 2 4 7 2
References Study Quality
38 (25341140) 1
Radiography chest May be appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 1 1 3 10 2 0 0 0 0
References Study Quality
29 (26760195) 2
30 (24072383) 2
27 (30922688) 2
28 (31012814) 2
25 (29727910) Inadequate
26 (29206594) Good
24 (28987698) Good
CT abdomen and pelvis with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 1 3 9 1 1 1 0 0
US pelvis (bladder) Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
32 (21655537) 2
33 (18096730) 2
Radiography intravenous urography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 2 2 3 8 3 3 0 0 0 0 0
References Study Quality
29 (26760195) 2
30 (24072383) 2
27 (30922688) 2
28 (31012814) 2
25 (29727910) Inadequate
26 (29206594) Good
24 (28987698) Good
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 7 1 1 0 0 0 0 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT chest without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 6 7 2 1 1 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
Variant 3: Muscle-invasive bladder cancer with or without cystectomy. Post-treatment surveillance.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest Usually appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 0 0 0 0 0
Fluoroscopy abdomen loopogram Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv 8 8 0 0 0 0 0 0 0 0 0
MRI abdomen and pelvis without and with IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 2 3 4 5 1
References Study Quality
62 (19396568) 3
63 (19914691) 3
61 (29381380) Good
MRU without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 5 4 5
References Study Quality
40 (20171676) 2
CT abdomen and pelvis with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 1 2 4 3 4
CTU without and with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 1 0 2 4 9
References Study Quality
38 (25341140) 1
MRI abdomen and pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 3 1 3 5 3 1 1 0
References Study Quality
62 (19396568) 3
63 (19914691) 3
61 (29381380) Good
CT chest with IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 0 0 0 0 0 0
CT chest without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 0 0 0 0 0 0
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 1 5 2 0 6 0 1 0
FDG-PET/CT skull base to mid-thigh May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 0 0 0 0 0 0
References Study Quality
54 (17475965) 3
50 (19652070) 2
51 (20151968) 2
56 (22448033) 4
60 (16741302) 2
55 (27565154) 2
58 (30001845) 2
52 (28753817) 2
53 (29847834) Good
57 (28674853) 2
59 (28532260) 3
US pelvis (bladder) Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
References Study Quality
43 (24462548) 3
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
References Study Quality
64 (21512076) 3
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 4 3 7 0 0 0 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 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.