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Appropriateness Criteria

Variant 1: Initial staging of pure seminoma testicular cancer. Diagnosed by orchiectomy.
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 Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 0 1 1 3 6
References Study Quality
49 (2238301) 4
48 (8048200) 3
8 (-3186719) 4
MRI abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 1 5 3 1
References Study Quality
41 (6539790) 3
44 (16286125) 2
42 (4023233) 4
43 (1716204) 4
45 (19264179) 2
6 (23122041) 4
46 (31177136) 4
47 (32048533) 2
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 1 0 0 0 1 0 1 1 7
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
26 (25247970) 3
27 (-3186721) 4
29 (1852937) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 4 7 0 0 0
References Study Quality
41 (6539790) 3
44 (16286125) 2
42 (4023233) 4
43 (1716204) 4
45 (19264179) 2
6 (23122041) 4
46 (31177136) 4
47 (32048533) 2
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 1 2 7 2 0 0 0
References Study Quality
11 (31059667) 4
10 (31277730) 4
9 (27815687) 4
8 (-3186719) 4
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 7 3 0 0 0
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
26 (25247970) 3
27 (-3186721) 4
29 (1852937) 4
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 1 0 0 4 1 3 1 1
References Study Quality
30 (11886000) 4
31 (12471874) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 9 1 0 0 0
References Study Quality
30 (11886000) 4
31 (12471874) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
US abdomen and retroperitoneum Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 7 1 0 0 0 0 0 0
References Study Quality
50 (-3189148) 4
US scrotum Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 3 4 3 0 1 0 0 0
References Study Quality
8 (-3186719) 4
40 (-3194401) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 3 3 1 2 0 0 0 0
References Study Quality
11 (31059667) 4
10 (31277730) 4
9 (27815687) 4
8 (-3186719) 4
Bone scan whole body Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 3 4 1 0 0 0 0 0
References Study Quality
12 (11201467) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 7 2 0 0 0 0 0 0
References Study Quality
30 (11886000) 4
31 (12471874) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 2 5 6 0 0 0 0 0 0
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
26 (25247970) 3
27 (-3186721) 4
29 (1852937) 4
FDG-PET/CT whole body Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 6 5 1 1 0 0 0 0
References Study Quality
39 (11942962) 4
34 (9591582) 3
35 (10565755) 3
37 (10853816) 3
38 (12634968) 2
36 (18453520) 2
40 (-3194401) 4
Variant 2: Initial staging of nonseminoma testicular cancer. Diagnosed by orchiectomy.
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 Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 8 8 0 0 1 0 0 0 5 4 3
References Study Quality
51 (8345604) 4
49 (2238301) 4
48 (8048200) 3
9 (27815687) 4
8 (-3186719) 4
MRI abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 2 3 4 1
References Study Quality
41 (6539790) 3
44 (16286125) 2
42 (4023233) 4
43 (1716204) 4
45 (19264179) 2
6 (23122041) 4
46 (31177136) 4
47 (32048533) 2
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 1 0 0 0 1 0 0 2 7
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
26 (25247970) 3
27 (-3186721) 4
29 (1852937) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 1 5 5 2
References Study Quality
51 (8345604) 4
30 (11886000) 4
31 (12471874) 4
48 (8048200) 3
9 (27815687) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 4 7 0 0 0
References Study Quality
41 (6539790) 3
44 (16286125) 2
42 (4023233) 4
43 (1716204) 4
45 (19264179) 2
6 (23122041) 4
46 (31177136) 4
47 (32048533) 2
MRI head without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 4 2 5 2 0 0 0
References Study Quality
11 (31059667) 4
10 (31277730) 4
9 (27815687) 4
8 (-3186719) 4
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 3 8 2 0 0 0
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
26 (25247970) 3
27 (-3186721) 4
29 (1852937) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 4 8 1 0 0 0
References Study Quality
51 (8345604) 4
30 (11886000) 4
31 (12471874) 4
48 (8048200) 3
9 (27815687) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
US abdomen and retroperitoneum Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 3 8 2 0 0 0 0 0 0
References Study Quality
50 (-3189148) 4
US scrotum Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 3 3 4 0 0 0 0 0
References Study Quality
8 (-3186719) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 2 2 4 1 2 0 0 0 0
References Study Quality
11 (31059667) 4
10 (31277730) 4
9 (27815687) 4
8 (-3186719) 4
Bone scan whole body Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 4 3 1 0 0 0 0 0
References Study Quality
12 (11201467) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 4 5 0 0 0 0 0 0
References Study Quality
51 (8345604) 4
30 (11886000) 4
31 (12471874) 4
48 (8048200) 3
9 (27815687) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 2 5 6 0 0 0 0 0 0
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
26 (25247970) 3
27 (-3186721) 4
29 (1852937) 4
FDG-PET/CT whole body Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 4 1 3 2 0 0 0 0
References Study Quality
39 (11942962) 4
34 (9591582) 3
35 (10565755) 3
37 (10853816) 3
38 (12634968) 2
36 (18453520) 2
52 (17634488) 2
40 (-3194401) 4
Variant 3: Surveillance of stage IA and IB pure seminoma testicular cancer. Diagnosed by orchiectomy. No clinical suspicion of recurrence.
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 Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 8 8 0 0 0 0 2 1 2 2 4
References Study Quality
57 (28866371) 4
8 (-3186719) 4
58 (25135991) 4
59 (19577354) 4
MRI abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 2 3 4 1
References Study Quality
41 (6539790) 3
44 (16286125) 2
42 (4023233) 4
43 (1716204) 4
45 (19264179) 2
6 (23122041) 4
46 (31177136) 4
47 (32048533) 2
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 1 0 0 0 1 0 0 2 7
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
53 (18647907) 4
30 (11886000) 4
54 (10210337) 3
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
11 (31059667) 4
10 (31277730) 4
9 (27815687) 4
28 (28081195) 2
55 (27423685) 4
8 (-3186719) 4
26 (25247970) 3
27 (-3186721) 4
56 (17416851) 1
29 (1852937) 4
US scrotum May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 5 6 1 0 0 0
References Study Quality
8 (-3186719) 4
40 (-3194401) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 4 7 0 0 0
References Study Quality
41 (6539790) 3
44 (16286125) 2
42 (4023233) 4
43 (1716204) 4
45 (19264179) 2
6 (23122041) 4
46 (31177136) 4
47 (32048533) 2
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 6 5 0 0 0
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
53 (18647907) 4
30 (11886000) 4
54 (10210337) 3
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
11 (31059667) 4
10 (31277730) 4
9 (27815687) 4
28 (28081195) 2
55 (27423685) 4
8 (-3186719) 4
26 (25247970) 3
27 (-3186721) 4
56 (17416851) 1
29 (1852937) 4
US abdomen and retroperitoneum Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 8 1 0 0 0 0 0 0
References Study Quality
50 (-3189148) 4
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 3 3 3 1 0 1 0 0 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 3 5 2 0 1 0 0 0 0
Bone scan whole body Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 4 3 1 0 0 0 0 0
References Study Quality
12 (11201467) 4
CT chest with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 0 7 6 0 0 0 0 0 0
References Study Quality
30 (11886000) 4
54 (10210337) 3
49 (2238301) 4
31 (12471874) 4
32 (17375035) 3
33 (9530036) 3
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 1 0 1 1 0 0 0
References Study Quality
30 (11886000) 4
54 (10210337) 3
49 (2238301) 4
31 (12471874) 4
32 (17375035) 3
33 (9530036) 3
CT chest without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 6 3 2 1 1 0 0 0
References Study Quality
30 (11886000) 4
54 (10210337) 3
49 (2238301) 4
31 (12471874) 4
32 (17375035) 3
33 (9530036) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 4 7 0 0 0 0 0 0
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
53 (18647907) 4
30 (11886000) 4
54 (10210337) 3
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
11 (31059667) 4
10 (31277730) 4
9 (27815687) 4
28 (28081195) 2
55 (27423685) 4
8 (-3186719) 4
26 (25247970) 3
27 (-3186721) 4
56 (17416851) 1
29 (1852937) 4
FDG-PET/CT whole body Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 2 4 1 3 1 0 0 0 0
References Study Quality
39 (11942962) 4
34 (9591582) 3
35 (10565755) 3
37 (10853816) 3
38 (12634968) 2
36 (18453520) 2
Variant 4: Surveillance of stage IA and IB nonseminoma testicular cancer. Diagnosed by orchiectomy. No clinical suspicion of recurrence.
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 Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 0 0 0 0 2 2 7
References Study Quality
8 (-3186719) 4
MRI abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 2 4 3 1
References Study Quality
41 (6539790) 3
44 (16286125) 2
42 (4023233) 4
43 (1716204) 4
45 (19264179) 2
6 (23122041) 4
46 (31177136) 4
47 (32048533) 2
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 1 0 0 0 1 0 1 1 7
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
53 (18647907) 4
30 (11886000) 4
54 (10210337) 3
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
55 (27423685) 4
8 (-3186719) 4
26 (25247970) 3
27 (-3186721) 4
56 (17416851) 1
29 (1852937) 4
US scrotum May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 4 7 1 1 0 0
References Study Quality
8 (-3186719) 4
40 (-3194401) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 4 7 0 0 0
References Study Quality
41 (6539790) 3
44 (16286125) 2
42 (4023233) 4
43 (1716204) 4
45 (19264179) 2
6 (23122041) 4
46 (31177136) 4
47 (32048533) 2
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 5 6 0 0 0
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
53 (18647907) 4
30 (11886000) 4
54 (10210337) 3
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
55 (27423685) 4
8 (-3186719) 4
26 (25247970) 3
27 (-3186721) 4
56 (17416851) 1
29 (1852937) 4
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 0 2 4 4 2 0 0
References Study Quality
30 (11886000) 4
31 (12471874) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 7 4 1 0 0
References Study Quality
30 (11886000) 4
31 (12471874) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
US abdomen and retroperitoneum Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 3 9 1 0 0 0 0 0 0
References Study Quality
50 (-3189148) 4
MRI head without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 3 3 3 1 0 1 0 0 0
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 3 5 2 0 1 0 0 0 0
Bone scan whole body Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 4 3 1 0 0 0 0 0
References Study Quality
12 (11201467) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 4 1 0 2 0 1 0 0
References Study Quality
30 (11886000) 4
31 (12471874) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 4 7 0 0 0 0 0 0
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
53 (18647907) 4
30 (11886000) 4
54 (10210337) 3
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
55 (27423685) 4
8 (-3186719) 4
26 (25247970) 3
27 (-3186721) 4
56 (17416851) 1
29 (1852937) 4
FDG-PET/CT whole body Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 3 2 1 0 0 0 0
References Study Quality
39 (11942962) 4
34 (9591582) 3
35 (10565755) 3
37 (10853816) 3
38 (12634968) 2
36 (18453520) 2
52 (17634488) 2
Variant 5: Surveillance of stage IA and IB pure seminoma and nonseminoma testicular cancer. Diagnosed by orchiectomy. Suspected recurrence.
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 Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 7 7 0 1 0 0 0 1 5 4 2
References Study Quality
57 (28866371) 4
8 (-3186719) 4
58 (25135991) 4
59 (19577354) 4
MRI abdomen and pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 1 6 3 1
References Study Quality
41 (6539790) 3
44 (16286125) 2
42 (4023233) 4
43 (1716204) 4
45 (19264179) 2
6 (23122041) 4
46 (31177136) 4
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 1 0 0 0 0 0 2 0 8
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
8 (-3186719) 4
26 (25247970) 3
27 (-3186721) 4
56 (17416851) 1
29 (1852937) 4
CT chest with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 1 0 0 0 1 2 4 3
References Study Quality
30 (11886000) 4
54 (10210337) 3
49 (2238301) 4
31 (12471874) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
US scrotum May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 4 5 3 0 0 0
References Study Quality
8 (-3186719) 4
40 (-3194401) 4
MRI abdomen and pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 4 6 1 0 0
References Study Quality
41 (6539790) 3
44 (16286125) 2
42 (4023233) 4
43 (1716204) 4
45 (19264179) 2
6 (23122041) 4
46 (31177136) 4
47 (32048533) 2
MRI head without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 3 5 0 0 0
CT abdomen and pelvis without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 5 6 0 0 0
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
8 (-3186719) 4
26 (25247970) 3
27 (-3186721) 4
56 (17416851) 1
29 (1852937) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 1 7 5 0 0 0
References Study Quality
30 (11886000) 4
54 (10210337) 3
49 (2238301) 4
31 (12471874) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
FDG-PET/CT whole body May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 3 3 6 1 0 0
References Study Quality
39 (11942962) 4
34 (9591582) 3
35 (10565755) 3
37 (10853816) 3
38 (12634968) 2
36 (18453520) 2
US abdomen and retroperitoneum Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 7 2 0 0 0 0 0 0
References Study Quality
50 (-3189148) 4
MRI head without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 2 5 5 0 1 0 0 0 0
Bone scan whole body Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 2 2 2 3 0 0 0 0
References Study Quality
12 (11201467) 4
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 8 2 0 0 0 0 0 0
References Study Quality
30 (11886000) 4
54 (10210337) 3
49 (2238301) 4
31 (12471874) 4
8 (-3186719) 4
32 (17375035) 3
33 (9530036) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 2 5 3 1 1 1 0 0 0
References Study Quality
13 (3791844) 4
16 (20032141) 4
19 (7051132) 4
22 (6975027) 3
21 (3055609) 4
14 (8386073) 4
15 (6175771) 3
7 (2297631) 3
18 (7237052) 4
17 (9242768) 2
20 (7069838) 3
23 (19863418) 4
6 (23122041) 4
25 (25763725) 4
24 (22180527) 3
28 (28081195) 2
8 (-3186719) 4
26 (25247970) 3
27 (-3186721) 4
56 (17416851) 1
29 (1852937) 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.