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Appropriateness Criteria

Variant 1: Prostate cancer follow-up. Status post radical prostatectomy. Clinical concern for residual or recurrent disease.
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 Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 2 3 5 5
References Study Quality
40 (28216327) 3
39 (23313568) M
38 (23521479) 2
37 (8501793) 3
36 (20205350) 2
35 (20106624) 3
34 (11418435) 2
33 (23377546) 2
32 (15064390) 3
31 (18226441) 1
30 (18430830) 2
29 (19921202) 4
28 (19948393) 4
10 (24978358) 3
8 (24434294) 3
6 (18825386) 3
Choline PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 1 0 1 2 0 5 7 0
References Study Quality
47 (30205893) 3
56 (29425221) 3
55 (30521498) 3
57 (25319322) 3
54 (22549847) 3
53 (17891394) 3
52 (20306038) 3
51 (19756592) 3
50 (19690023) 3
49 (23069923) 3
48 (22621862) 4
46 (23123372) 3
45 (23628493) M
44 (23486334) M
8 (24434294) 3
Fluciclovine PET/MRI skull base to mid-thigh Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 1 0 2 4 5 3 1
References Study Quality
78 (17204699) 2
77 (27694179) 4
76 (27694178) 4
75 (29970541) 3
74 (17926036) 3
73 (16315004) 3
72 (16865395) 3
71 (12679398) 1
70 (16832632) 3
84 (27557844) 3
DCFPyL PET/CT skull base to mid-thigh Usually appropriate Moderate ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 1 1 10 1 1
References Study Quality
92 (31676732) 3
91 (33981607) Good
90 (31201249) 4
89 (27908968) 3
Fluciclovine PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 3 2 6 3 2
References Study Quality
66 (31216198) 3
67 (30179618) 3
65 (30589673) 3
69 (33427655) 1
68 (33517323) 1
64 (27746282) 3
63 (25907118) M
62 (26960562) 3
61 (26053708) 2
60 (23591953) 3
59 (27091135) 2
PSMA PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 1 0 0 1 3 1 4 5 1
References Study Quality
84 (27557844) 3
87 (28408526) 4
86 (31283605) 2
85 (31375469) 2
83 (30920593) 2
82 (-3194111) 4
MRI-targeted biopsy prostatectomy bed May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 1 0 0 2 4 4 3 2 0
References Study Quality
10 (24978358) 3
TRUS-guided biopsy prostatectomy bed May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 11 1 1 0 0
References Study Quality
41 (17440730) 2
MRI abdomen and pelvis without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 4 12 0 0 0 0
MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 0 6 6 2 0 1 1 0
References Study Quality
40 (28216327) 3
39 (23313568) M
38 (23521479) 2
37 (8501793) 3
36 (20205350) 2
35 (20106624) 3
34 (11418435) 2
33 (23377546) 2
32 (15064390) 3
31 (18226441) 1
30 (18430830) 2
29 (19921202) 4
28 (19948393) 4
10 (24978358) 3
8 (24434294) 3
6 (18825386) 3
Bone scan whole body May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 12 2 1 0 0
References Study Quality
25 (23903557) M
24 (20483148) 4
23 (23707439) 4
22 (-3098847) 4
21 (9751361) 3
20 (12639656) 3
Choline PET/MRI skull base to mid-thigh May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 0 1 1 1 2 0 4 7 0
References Study Quality
58 (28803358) 2
CT abdomen and pelvis with IV contrast May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 9 3 0 1 0
References Study Quality
26 (22417806) 2
27 (14571410) 4
Fluoride PET/CT skull base to mid-thigh May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 1 1 7 1 1 0 4 1 0
TRUS prostatectomy bed Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 4 4 4 0 2 2 0 0 0
References Study Quality
19 (16602039) 2
42 (8819374) 3
43 (16546462) 2
Radiography skeletal survey Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 5 3 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 1 3 6 2 2 2 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 2 3 0 4 2 0 0 0
References Study Quality
26 (22417806) 2
27 (14571410) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 4 5 0 1 0 0 1 0
References Study Quality
26 (22417806) 2
27 (14571410) 4
CT chest abdomen pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 3 10 0 0 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 9 2 3 0 1 0 0 1 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 2 3 1 2 1 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 5 6 1 1 0 1 0 0
References Study Quality
81 (15950100) 4
80 (8638000) 3
79 (16000572) 3
Variant 2: Prostate cancer follow-up. Clinical concern for residual or recurrent disease after nonsurgical local and pelvic treatments.
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 Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 1 1 6 3 4
References Study Quality
118 (27663393) 3
116 (27527896) 2
117 (29317377) 3
120 (31361529) 2
119 (30730409) 3
115 (17707266) 3
114 (19161194) 3
113 (15134982) 2
112 (19130116) 3
111 (17881141) 2
110 (20551184) 2
109 (15972335) 3
108 (15375223) 2
107 (21785087) 3
39 (23313568) M
38 (23521479) 2
Choline PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢ 1-10 mSv 8 8 0 1 0 1 3 0 3 8 0
References Study Quality
44 (23486334) M
45 (23628493) M
124 (27597240) 3
125 (28126302) 3
Fluciclovine PET/MRI skull base to mid-thigh Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv 7 7 0 0 0 1 5 0 6 3 1
DCFPyL PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 0 0 0 1 0 1 10 1 1
References Study Quality
92 (31676732) 3
89 (27908968) 3
Fluciclovine PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 4 2 5 4 1
References Study Quality
127 (29685521) 1
128 (30954940) 1
126 (24991547) 3
64 (27746282) 3
63 (25907118) M
PSMA PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 1 0 0 0 3 2 4 5 1
References Study Quality
82 (-3194111) 4
129 (32531840) 3
MRI-targeted biopsy prostate May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 2 5 6 0 0
TRUS-guided biopsy prostate May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 1 7 4 1 0
References Study Quality
123 (10974448) 1
122 (-3098926) 4
MRI abdomen and pelvis without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 11 4 1 0 0
MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 4 4 0 0 6 5 3 0 1 1 0
References Study Quality
120 (31361529) 2
119 (30730409) 3
118 (27663393) 3
117 (29317377) 3
116 (27527896) 2
115 (17707266) 3
114 (19161194) 3
113 (15134982) 2
112 (19130116) 3
111 (17881141) 2
110 (20551184) 2
109 (15972335) 3
108 (15375223) 2
107 (21785087) 3
39 (23313568) M
38 (23521479) 2
Bone scan whole body May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 0 13 3 0 0 0
References Study Quality
3 (23806388) 3
5 (-3102557) 4
20 (12639656) 3
23 (23707439) 4
Choline PET/MRI skull base to mid-thigh May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 0 0 3 1 2 1 3 6 0
CT abdomen and pelvis with IV contrast May be appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 12 1 2 0 0
References Study Quality
26 (22417806) 2
27 (14571410) 4
Fluoride PET/CT skull base to mid-thigh May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 0 0 9 1 1 0 3 2 0
TRUS prostate Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 4 6 1 0 0 0 0 0
References Study Quality
93 (10664674) 4
121 (7690016) 3
Radiography skeletal survey Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 8 4 4 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 2 4 2 4 1 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Moderate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 2 4 1 3 2 0 0 0
References Study Quality
26 (22417806) 2
27 (14571410) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 4 3 6 0 1 1 0 1 0
References Study Quality
26 (22417806) 2
27 (14571410) 4
CT chest abdomen pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 10 0 0 0 1 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 6 4 4 1 1 0 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 4 2 1 4 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 1 6 4 2 2 0 1 0 0
Variant 3: Metastatic prostate cancer treated by systemic therapy (androgen deprivation therapy [ADT], chemotherapy, immunotherapy). Follow-up.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Bone scan whole body Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 3 5 5 3
References Study Quality
134 (26956538) 4
Choline PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 0 1 2 5 3 5 0
References Study Quality
139 (26768648) 2
138 (25808631) 3
137 (25504434) 1
136 (26323576) 3
44 (23486334) M
45 (23628493) M
Choline PET/MRI skull base to mid-thigh Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv 7 7 0 0 1 1 2 3 4 5 0
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 1 0 3 4 5 2
References Study Quality
27 (14571410) 4
135 (28473088) 4
Fluciclovine PET/MRI skull base to mid-thigh Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 0 0 4 2 5 5 0
References Study Quality
146 (33052718) 2
140 (31127357) Good
78 (17204699) 2
77 (27694179) 4
76 (27694178) 4
74 (17926036) 3
73 (16315004) 3
72 (16865395) 3
71 (12679398) 1
70 (16832632) 3
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 2 3 3 5 2 1
References Study Quality
27 (14571410) 4
135 (28473088) 4
DCFPyL PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 1 0 0 1 4 1 3 6 0
References Study Quality
156 (33452039) 4
155 (31451492) 3
Fluciclovine PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 1 4 7 4 0
References Study Quality
145 (31343613) 3
144 (33237350) 4
143 (26278491) 4
142 (24943499) 4
PSMA PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv 7 7 1 0 0 0 1 3 5 6 0
References Study Quality
153 (28758969) 3
154 (32481743) 3
MRI abdomen and pelvis without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 3 6 4 1 0
MRI abdomen and pelvis without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 1 5 5 2 1 0 1
MRI pelvis without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 0 2 3 4 5 2 0 0 0
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 1 6 1 5 2 0 0 0
References Study Quality
27 (14571410) 4
135 (28473088) 4
CT chest abdomen pelvis without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 3 5 3 3 2 0 0 0
References Study Quality
27 (14571410) 4
135 (28473088) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 1 5 6 1 1 1
References Study Quality
79 (16000572) 3
80 (8638000) 3
152 (12031380) 3
151 (15867215) 3
150 (20975102) 3
149 (10492189) 3
148 (27383216) M
147 (27694167) 4
Fluoride PET/CT whole body May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 3 2 3 2 2 4 0
References Study Quality
140 (31127357) Good
141 (30877561) Good
MRI-targeted biopsy prostatectomy bed Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 3 6 2 2 0 0 0 0
TRUS prostatectomy bed Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 4 5 0 1 0 0 0 0
TRUS-guided biopsy prostatectomy bed Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 3 4 7 0 2 0 0 0 0
Radiography skeletal survey Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 5 5 5 1 0 0 0 0 0
MRI pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 2 3 5 1 4 1 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 3 9 0 0 1 0 0 0
References Study Quality
27 (14571410) 4
135 (28473088) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 2 10 0 0 1 0 0 0
References Study Quality
27 (14571410) 4
135 (28473088) 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.