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Appropriateness Criteria

Variant 1: Clinically suspected prostate cancer. No prior biopsy (biopsy naïve). Initial diagnosis. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI-targeted biopsy prostate Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 1 7 5
References Study Quality
64 (27305918) 3
63 (28165653) 3
62 (27500389) 3
61 (27574821) 1
60 (25862143) 2
59 (32925739) 2
58 (30527787) 2
57 (30522912) 3
56 (24262102) 2
55 (25869459) 4
30 (31204311) Good
28 (31022301) Good
26 (32130814) 3
25 (30470502) 1
24 (30477981) 1
23 (29552975) 2
TRUS-guided biopsy prostate Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 3 0 3 3 5
References Study Quality
72 (27864107) 2
71 (21632511) 3
70 (19154461) 3
69 (22110983) 4
68 (2659827) 4
18 (26481576) 4
MRI pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 1 0 0 0 0 1 5 7
References Study Quality
49 (26215604) M
48 (30667329) 3
47 (27439401) 3
46 (26395278) 2
45 (27488931) 3
44 (28336078) Good
43 (30268722) 2
42 (29341356) 2
41 (28570099) 2
40 (27101772) 3
39 (28196723) Good
MRI pelvis without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 2 4 1 6 0
References Study Quality
54 (30240296) Good
53 (26900904) 3
52 (27133703) 2
51 (26427566) 4
50 (22623539) 4
TRUS prostate Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 4 3 0 0 0 0 0 0
References Study Quality
67 (15247717) 3
66 (30534650) 3
65 (22595778) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 1 0 1 0 0 1 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 2 0 0 1 0 0 0
MRI whole body without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 0 1 1 0 0 0 0
MRI whole body without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 1 0 1 0 0 0 0
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 0 0 0 0 0 0 1
Choline PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 2 0 0 0 0 1 0 0
Choline PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 2 0 0 0 0 1 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 4 1 0 0 0 1 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 0 1 0 0 0 0
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 3 0 0 1 0 0 0 0
Fluciclovine PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 2 1 1 0 0 1 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 9 4 0 0 0 0 1 0 0
CT chest abdomen pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 0 0 0 0 1 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 3 0 0 0 0 1 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 0 1 0 0 0 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 0 0 0 1 0 0 0
Fluciclovine PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 9 3 0 1 0 0 1 0 0
Fluoride PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 0 0 0 0 1 0 0
PSMA PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 8 2 2 1 0 0 0 0 1
Variant 2: Clinically suspected prostate cancer. Negative TRUS-guided biopsy. Initial diagnosis. 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-targeted biopsy prostate Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 2 5 7
References Study Quality
61 (27574821) 1
60 (25862143) 2
59 (32925739) 2
58 (30527787) 2
57 (30522912) 3
56 (24262102) 2
55 (25869459) 4
30 (31204311) Good
28 (31022301) Good
26 (32130814) 3
25 (30470502) 1
24 (30477981) 1
23 (29552975) 2
TRUS-guided biopsy prostate Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 0 7 4 1
References Study Quality
77 (22416859) 3
76 (24094934) 4
75 (11992052) 4
74 (23452046) 3
73 (7514690) 3
MRI pelvis without and with IV contrast Usually appropriate Moderate O 0 mSv O 0 mSv [ped] 9 9 0 1 0 0 0 0 0 4 9
References Study Quality
49 (26215604) M
45 (27488931) 3
44 (28336078) Good
40 (27101772) 3
29 (22743165) 4
MRI pelvis without IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 0 6 2 5 0
References Study Quality
54 (30240296) Good
53 (26900904) 3
52 (27133703) 2
51 (26427566) 4
50 (22623539) 4
49 (26215604) M
45 (27488931) 3
44 (28336078) Good
40 (27101772) 3
29 (22743165) 4
TRUS prostate Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 9 2 1 0 1 0 0 1 0
References Study Quality
66 (30534650) 3
65 (22595778) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 4 2 0 0 0 0 1 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 2 0 0 1 0 0 0
MRI whole body without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 1 0 1 0 0 0 0
MRI whole body without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 1 0 1 0 0 0 0
Bone scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 3 0 0 1 0 0 0 1
Choline PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 2 0 0 0 0 1 0 0
Choline PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 2 0 0 0 0 1 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 5 1 0 0 0 1 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 0 1 0 0 0 0
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 3 0 0 1 0 0 0 0
Fluciclovine PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 2 1 1 0 0 1 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 9 4 0 0 0 0 1 0 0
CT chest abdomen pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 0 0 0 0 1 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 3 0 0 0 0 1 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 0 0 0 1 0 0 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 0 0 0 1 0 0 0
Fluciclovine PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 9 3 0 1 0 0 1 0 0
Fluoride PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 0 1 0 0 1 0 0
PSMA PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 8 2 1 1 0 1 0 0 1
Variant 3: Clinically established low-risk prostate cancer. Active surveillance.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI-targeted biopsy prostate Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 0 1 9 2
References Study Quality
92 (26920465) 3
91 (26699628) 1
90 (27236496) 3
89 (30017404) 3
88 (29339663) 3
87 (31479660) 3
86 (30577395) 3
85 (29645347) 3
84 (30179620) 3
83 (26482887) 2
82 (31825297) 3
81 (30487646) Inadequate
59 (32925739) 2
58 (30527787) 2
57 (30522912) 3
56 (24262102) 2
55 (25869459) 4
TRUS-guided biopsy prostate Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 2 2 2 2 3 3
References Study Quality
92 (26920465) 3
91 (26699628) 1
82 (31825297) 3
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 1 0 0 0 0 0 11 2
References Study Quality
84 (30179620) 3
83 (26482887) 2
82 (31825297) 3
81 (30487646) Inadequate
MRI pelvis without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 0 0 1 2 5 4 1
References Study Quality
84 (30179620) 3
83 (26482887) 2
82 (31825297) 3
81 (30487646) Inadequate
TRUS prostate Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 8 2 1 1 1 0 0 1 0
References Study Quality
94 (27117443) 4
93 (22920360) 2
67 (15247717) 3
65 (22595778) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 2 0 0 1 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 2 0 0 0 0 1 0
MRI whole body without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 4 2 0 1 0 0 0 0
MRI whole body without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 7 5 1 0 1 0 0 0 0
Bone scan whole body Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 3 3 0 0 0 0 0 1
References Study Quality
80 (28958581) Good
79 (29043431) 2
78 (28317247) 3
Choline PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 3 0 0 0 1 1 0 0
Choline PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 3 0 0 0 1 1 0 0
CT abdomen and pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 5 1 0 0 0 1 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 4 0 0 1 0 0 0 0
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 2 0 0 1 0 0 0 0
Fluciclovine PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 9 2 1 0 0 1 1 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 3 0 0 0 0 1 0 0
CT chest abdomen pelvis with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 0 0 0 0 1 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 3 0 0 0 0 1 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 0 0 1 0 0 0 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 0 0 0 1 0 0 0
Fluciclovine PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 9 2 1 0 0 1 1 0 0
Fluoride PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 3 1 0 0 0 0 1 0
PSMA PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv 1 1 7 4 0 1 1 0 0 0 0
Variant 4: Clinically established intermediate-risk prostate cancer. Staging or surveillance.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI-targeted biopsy prostate Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 1 8 4 0
References Study Quality
112 (30759371) 3
111 (31909690) 4
110 (26181182) 3
109 (21115873) 4
MRI abdomen and pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 0 3 6 3 0
References Study Quality
20 (23271765) 4
113 (27043655) 3
112 (30759371) 3
111 (31909690) 4
110 (26181182) 3
109 (21115873) 4
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 2 1 7 3
References Study Quality
49 (26215604) M
115 (22109291) 3
114 (15197809) 3
112 (30759371) 3
111 (31909690) 4
110 (26181182) 3
109 (21115873) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 1 5 2 5 0
References Study Quality
20 (23271765) 4
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 1 3 8 0
References Study Quality
20 (23271765) 4
Fluciclovine PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 0 0 1 4 1 7 0 0
References Study Quality
106 (32347780) 2
105 (29294158) 2
104 (27817158) 2
103 (28986510) 3
102 (29147764) 2
98 (31358294) Good
PSMA PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 0 2 9 1 1
References Study Quality
19 (30226456) 2
123 (31562225) 3
122 (29794224) 3
121 (26682756) 2
120 (30120038) 2
119 (32209449) 2
118 (29678358) Good
117 (28957842) 2
TRUS-guided biopsy prostate May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 1 7 1 2 1 1
References Study Quality
111 (31909690) 4
110 (26181182) 3
109 (21115873) 4
MRI abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 6 6 1 0 0
References Study Quality
113 (27043655) 3
112 (30759371) 3
111 (31909690) 4
110 (26181182) 3
109 (21115873) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 2 4 2 1 3
References Study Quality
49 (26215604) M
115 (22109291) 3
114 (15197809) 3
112 (30759371) 3
111 (31909690) 4
110 (26181182) 3
109 (21115873) 4
MRI whole body without and with IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 1 0 3 5 2 1 0
References Study Quality
49 (26215604) M
117 (28957842) 2
116 (28216327) 3
115 (22109291) 3
114 (15197809) 3
112 (30759371) 3
111 (31909690) 4
110 (26181182) 3
109 (21115873) 4
108 (30382380) 3
96 (30519933) 2
MRI whole body without IV contrast May be appropriate (Disagreement) Expert Opinion O 0 mSv O 0 mSv [ped] 5 5 0 1 1 0 9 0 2 0 0
References Study Quality
49 (26215604) M
96 (30519933) 2
117 (28957842) 2
116 (28216327) 3
115 (22109291) 3
114 (15197809) 3
112 (30759371) 3
111 (31909690) 4
110 (26181182) 3
109 (21115873) 4
108 (30382380) 3
Bone scan whole body May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 0 3 4 2 2 2
References Study Quality
80 (28958581) Good
97 (30972933) 4
96 (30519933) 2
95 (31127357) Good
79 (29043431) 2
78 (28317247) 3
20 (23271765) 4
Choline PET/CT skull base to mid-thigh May be appropriate Strong ☢☢☢ 1-10 mSv 6 6 0 0 0 1 4 7 1 0 0
References Study Quality
100 (30448957) 3
99 (25649494) 3
98 (31358294) Good
96 (30519933) 2
Choline PET/MRI skull base to mid-thigh May be appropriate Strong ☢☢☢ 1-10 mSv 5 5 0 0 0 1 6 4 2 0 0
References Study Quality
101 (29323548) 2
100 (30448957) 3
99 (25649494) 3
98 (31358294) Good
96 (30519933) 2
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 1 1 0 5 6 1 0 0
References Study Quality
20 (23271765) 4
Fluciclovine PET/MRI skull base to mid-thigh May be appropriate Strong ☢☢☢ 1-10 mSv 6 6 0 0 0 2 3 4 4 0 0
References Study Quality
106 (32347780) 2
105 (29294158) 2
103 (28986510) 3
102 (29147764) 2
98 (31358294) Good
CT abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 9 1 0 0 1 0 2 0 0
CT chest abdomen pelvis without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 5 6 1 0 0
References Study Quality
20 (23271765) 4
Fluoride PET/CT whole body May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 2 0 0 4 6 1 0 0
References Study Quality
108 (30382380) 3
107 (30877561) Good
79 (29043431) 2
20 (23271765) 4
TRUS prostate Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 2 1 0 2 0 0 1 0
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 7 3 2 1 0 1 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 11 0 0 0 1 0 1 0 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 2 1 0 1 0 0 0
Variant 5: Clinically established high-risk prostate cancer. Staging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen and pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 2 6 3 1
References Study Quality
113 (27043655) 3
112 (30759371) 3
111 (31909690) 4
110 (26181182) 3
109 (21115873) 4
20 (23271765) 4
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 1 3 5 3
References Study Quality
49 (26215604) M
115 (22109291) 3
114 (15197809) 3
Bone scan whole body Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 2 6 6
References Study Quality
80 (28958581) Good
20 (23271765) 4
97 (30972933) 4
96 (30519933) 2
95 (31127357) Good
79 (29043431) 2
78 (28317247) 3
Choline PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 0 0 1 0 7 4 2
References Study Quality
100 (30448957) 3
99 (25649494) 3
98 (31358294) Good
96 (30519933) 2
Choline PET/MRI skull base to mid-thigh Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 0 0 1 1 6 4 2
References Study Quality
101 (29323548) 2
100 (30448957) 3
99 (25649494) 3
98 (31358294) Good
96 (30519933) 2
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 1 3 6 4
References Study Quality
20 (23271765) 4
Fluciclovine PET/MRI skull base to mid-thigh Usually appropriate Strong ☢☢☢ 1-10 mSv 7 7 0 0 0 0 1 3 5 4 1
References Study Quality
98 (31358294) Good
102 (29147764) 2
105 (29294158) 2
106 (32347780) 2
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 1 1 2 7 2
References Study Quality
20 (23271765) 4
Fluciclovine PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 2 1 5 5 1
References Study Quality
98 (31358294) Good
102 (29147764) 2
106 (32347780) 2
Fluoride PET/CT whole body Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 0 0 1 0 6 5 1
References Study Quality
79 (29043431) 2
108 (30382380) 3
107 (30877561) Good
PSMA PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv 8 8 0 0 0 0 0 1 3 4 6
References Study Quality
121 (26682756) 2
120 (30120038) 2
119 (32209449) 2
117 (28957842) 2
MRI abdomen and pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 3 7 2 1 0
References Study Quality
20 (23271765) 4
113 (27043655) 3
112 (30759371) 3
111 (31909690) 4
110 (26181182) 3
109 (21115873) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 3 4 2 1 2
References Study Quality
49 (26215604) M
115 (22109291) 3
114 (15197809) 3
MRI whole body without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 1 6 2 2 1
References Study Quality
49 (26215604) M
96 (30519933) 2
117 (28957842) 2
115 (22109291) 3
114 (15197809) 3
108 (30382380) 3
MRI whole body without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 1 0 6 1 3 2 0
References Study Quality
49 (26215604) M
96 (30519933) 2
108 (30382380) 3
117 (28957842) 2
115 (22109291) 3
114 (15197809) 3
CT abdomen and pelvis without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 0 4 4 3 2 0
References Study Quality
20 (23271765) 4
CT abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 5 5 10 1 0 0 0 0 1 1 0
CT chest abdomen pelvis without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 1 0 0 5 3 3 2 0
References Study Quality
20 (23271765) 4
MRI-targeted biopsy prostate Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 4 6 1 0 1 1 0 0 0
TRUS prostate Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 1 0 1 0 1 0 0
TRUS-guided biopsy prostate Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 7 0 0 0 0 0 0 0
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 3 3 4 1 6 0 1 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] 1 1 10 1 0 0 1 0 0 1 0
FDG-PET/CT whole body Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 1 6 0 0 1 1 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.