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Appropriateness Criteria

Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial 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] 8 8 1 0 0 0 1 2 4 4 5
References Study Quality
10 (30299884) 4
11 (-3198150) 4
15 (33807178) 2
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 1 0 0 1 3 11
References Study Quality
15 (33807178) 2
14 (9167965) 4
12 (35976622) 4
10 (30299884) 4
13 (34794587) 4
11 (-3198150) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 1 1 0 0 0 1 4 8
References Study Quality
10 (30299884) 4
11 (-3198150) 4
17 (37061367) 4
FDG-PET/MRI skull base to mid-thigh Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 3 3 7 2 0
FDG-PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 2 0 7 6 1
References Study Quality
20 (16368753) 4
19 (24990404) 4
18 (36686301) 2
10 (30299884) 4
11 (-3198150) 4
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 8 3 3 0 2 0 1 0 0
References Study Quality
10 (30299884) 4
11 (-3198150) 4
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 2 2 5 4 1 1 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 2 3 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 9 4 2 0 0 0 0 0 0
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 2 3 2 1 0 1 0 0
References Study Quality
11 (-3198150) 4
DOTATATE PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 10 2 2 0 1 1 1 0 0
DOTATATE PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 2 1 0 1 1 1 0 0
MIBG scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 2 2 0 2 0 0 0 0
MIBG scan whole body with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv Varies 1 1 11 3 1 1 1 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] 1 1 12 0 3 0 1 0 0 0 0
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
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] 8 8 0 0 1 0 0 3 3 3 7
References Study Quality
10 (30299884) 4
11 (-3198150) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 0 0 1 1 14
References Study Quality
10 (30299884) 4
11 (-3198150) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 2 0 1 0 5 1 8
References Study Quality
10 (30299884) 4
11 (-3198150) 4
FDG-PET/MRI skull base to mid-thigh Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 4 2 7 1 1
FDG-PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 1 9 4 1
References Study Quality
20 (16368753) 4
19 (24990404) 4
18 (36686301) 2
11 (-3198150) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 3 2 1 2 5 1 1 0 0
References Study Quality
11 (-3198150) 4
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 14 1 0 0 0 0 0 0 0
References Study Quality
10 (30299884) 4
11 (-3198150) 4
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 1 5 0 3 1 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 3 4 0 0 0 1 0 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 4 4 0 0 0 0 0 0
DOTATATE PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 1 1 1 1 2 0 0 0
DOTATATE PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 11 1 1 1 1 2 0 0 0
MIBG scan whole body Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 1 2 1 1 0 0 0 0
MIBG scan whole body with SPECT or SPECT/CT area of interest Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv Varies 1 1 11 2 2 1 1 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] 1 1 8 2 5 0 0 0 0 0 0
Variant 3: Adult. Known or suspected pheochromocytoma. Initial 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] 8 8 0 0 1 0 0 2 2 6 6
References Study Quality
11 (-3198150) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 1 0 5 1 9
References Study Quality
11 (-3198150) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 1 1 0 1 0 5 3 6
References Study Quality
11 (-3198150) 4
DOTATATE PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 1 0 0 0 1 0 8 2 3
References Study Quality
9 (31254038) 4
23 (26637204) 2
DOTATATE PET/MRI skull base to mid-thigh Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv 7 7 0 0 0 1 6 1 6 2 0
MIBG scan whole body with SPECT or SPECT/CT area of interest Usually appropriate Limited ☢☢☢ 1-10 mSv Varies 7 7 0 0 0 0 2 0 12 1 1
References Study Quality
9 (31254038) 4
FDG-PET/MRI skull base to mid-thigh May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 3 5 3 3 1 0
References Study Quality
24 (35143455) 4
MIBG scan whole body May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 0 2 6 5 1 1 0
References Study Quality
9 (31254038) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 7 2 4 1 0
References Study Quality
9 (31254038) 4
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 10 1 3 0 2 0 0 1 0
References Study Quality
11 (-3198150) 4
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 5 1 5 3 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 5 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 9 3 3 0 0 0 0 0 0
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 1 2 1 4 1 1 0 0
References Study Quality
11 (-3198150) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 0 3 0 2 0 0 0 0
References Study Quality
11 (-3198150) 4
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
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] 8 8 0 0 1 0 0 2 2 4 8
References Study Quality
11 (-3198150) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 1 0 0 0 3 3 10
References Study Quality
11 (-3198150) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 2 0 1 0 4 3 7
References Study Quality
11 (-3198150) 4
DOTATATE PET/CT skull base to mid-thigh Usually appropriate Limited ☢☢☢ 1-10 mSv 7 7 0 0 0 0 3 1 7 4 1
References Study Quality
9 (31254038) 4
DOTATATE PET/MRI skull base to mid-thigh Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv 7 7 0 0 0 0 4 1 7 3 1
FDG-PET/MRI skull base to mid-thigh May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 2 1 6 3 3 1 0
MIBG scan whole body May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 4 7 2 2 1 0
MIBG scan whole body with SPECT or SPECT/CT area of interest May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv Varies 5 5 0 1 1 1 7 1 4 1 0
References Study Quality
9 (31254038) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 0 8 3 2 2 0
References Study Quality
11 (-3198150) 4
25 (24899991) 3
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 13 2 0 0 0 0 0 0 0
References Study Quality
11 (-3198150) 4
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 2 4 4 1 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 3 3 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 10 2 3 0 0 0 0 0 0
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 2 2 1 5 0 1 0 0
References Study Quality
11 (-3198150) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 0 3 0 2 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.