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Appropriateness Criteria

Variant 1: Initial staging of pretreatment endometrial cancer; assessment of local tumor extension for all tumor grades.
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 1 1 0 6 8
References Study Quality
50 (10478237) Good
57 (19724949) 3
51 (18398926) 2
24 (22119292) 4
52 (19258956) 3
53 (15031434) 2
62 (16697034) 3
56 (19727740) 1
67 (19711413) 2
68 (18212237) 3
66 (22872453) 3
63 (22609110) 2
45 (29895385) 3
48 (29789905) 4
47 (29995239) 4
54 (29970170) 3
59 (29895387) 3
61 (25928157) 3
65 (30398217) 3
64 (27631107) 2
46 (29290687) 3
60 (29667881) 3
58 (29750540) 3
49 (28493790) 3
US pelvis transvaginal May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 5 10 0 0 0
References Study Quality
51 (18398926) 2
31 (22039024) 3
52 (19258956) 3
28 (26485119) 2
69 (26197857) 2
MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 3 9 2 0 0
References Study Quality
51 (18398926) 2
62 (16697034) 3
55 (25608571) Good
63 (22609110) 2
45 (29895385) 3
48 (29789905) 4
47 (29995239) 4
54 (29970170) 3
65 (30398217) 3
64 (27631107) 2
46 (29290687) 3
49 (28493790) 3
CT pelvis with IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 2 5 2 6 0 0 0 0
References Study Quality
42 (7560323) 3
40 (18716092) 2
41 (25665953) 2
CT pelvis without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 3 4 1 0 0 1 0 0
References Study Quality
42 (7560323) 3
40 (18716092) 2
41 (25665953) 2
CT pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 2 2 2 0 0 1 1 0
References Study Quality
42 (7560323) 3
43 (18175120) 2
40 (18716092) 2
41 (25665953) 2
44 (28924863) 3
Variant 2: Pretreatment evaluation of endometrial cancer; assessment of lymph node and distant metastasis for low-grade tumor (Type I, grade 1, 2).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US pelvis transabdominal May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 1 4 5 5 0 0 0 0
References Study Quality
81 (21898632) 4
MRI abdomen without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 6 8 0 0 0 0
References Study Quality
80 (28372871) 4
MRI pelvis without and with IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 5 6 1 1 0
References Study Quality
76 (17291252) 3
78 (18581404) 2
77 (26546334) 3
79 (22821394) 2
MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 1 3 6 5 0 0 0
References Study Quality
76 (17291252) 3
78 (18581404) 2
77 (26546334) 3
79 (22821394) 2
CT chest abdomen pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 5 7 2 0 0 0
References Study Quality
71 (10775731) 3
72 (21670955) 2
FDG-PET/CT skull base to mid-thigh May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 2 3 3 5 1 0 0 0
References Study Quality
19 (10928137) 2
73 (26823564) Good
74 (30235772) 3
US abdomen Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 4 2 5 2 3 0 0 1 0
Lymphangiography pelvis Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 14 1 1 0 0 1 0 0 0
References Study Quality
75 (3049262) 4
MRI abdomen without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 3 6 2 0 0 1 0 0
References Study Quality
80 (28372871) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 7 4 1 1 2 1 1 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 3 4 4 1 0 1 0 0
Variant 3: Initial staging of pretreatment endometrial cancer; assessment of lymph node and distant metastasis for high-grade tumor (Type I, grade 3 and Type II).
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 0 1 2 7 4 1
References Study Quality
76 (17291252) 3
78 (18581404) 2
77 (26546334) 3
79 (22821394) 2
CT chest abdomen pelvis with IV contrast Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 2 3 3 5 4
References Study Quality
71 (10775731) 3
37 (26645990) 4
72 (21670955) 2
41 (25665953) 2
FDG-PET/CT skull base to mid-thigh Usually appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 1 1 0 4 1 3 4 3
References Study Quality
84 (22349717) 3
18 (16055605) 4
37 (26645990) 4
73 (26823564) Good
74 (30235772) 3
86 (29185901) 2
85 (29971187) 3
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 11 1 0 0 0
References Study Quality
81 (21898632) 4
US pelvis transabdominal May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 0 1 3 4 6 1 0 0 0
References Study Quality
81 (21898632) 4
MRI abdomen 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 0 0 0
MRI abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 0 0 0 6 7 2 0 0 0
MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 0 0 9 4 1 1 0
References Study Quality
76 (17291252) 3
78 (18581404) 2
77 (26546334) 3
79 (22821394) 2
CT chest abdomen pelvis without IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 1 9 4 0 1 0 0
Lymphangiography pelvis Usually not appropriate Limited ☢☢☢ 1-10 mSv 1 1 12 2 2 0 0 1 0 0 0
References Study Quality
75 (3049262) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 6 3 5 0 1 0 0 0 0
Variant 4: Surveillance of asymptomatic patients with treated low- or intermediate-risk endometrial cancer.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 8 0 0 0 0 0 0 1
References Study Quality
21 (17826824) 2
87 (16556457) 4
US pelvis transabdominal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 10 1 0 0 0 0 0 0
References Study Quality
21 (17826824) 2
87 (16556457) 4
US pelvis transvaginal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 10 0 0 0 0 0 1 0
References Study Quality
21 (17826824) 2
87 (16556457) 4
Radiography chest Usually not appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 2 2 4 10 1 0 0 0 0 0 0
References Study Quality
87 (16556457) 4
90 (7557610) 2
MRI abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 6 1 2 0 0 0 0 0
References Study Quality
80 (28372871) 4
MRI abdomen without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 5 7 1 2 0 0 0 0 0
References Study Quality
80 (28372871) 4
MRI pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 4 10 1 0 0 0 0 0 0
References Study Quality
80 (28372871) 4
MRI pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 8 7 0 0 0 0 1 1 0
References Study Quality
80 (28372871) 4
CT chest abdomen pelvis with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 7 0 1 1 0 0 0 1
References Study Quality
88 (21752752) 4
19 (10928137) 2
89 (18386467) 4
87 (16556457) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 10 5 1 0 0 1 0 0 0
References Study Quality
88 (21752752) 4
19 (10928137) 2
89 (18386467) 4
87 (16556457) 4
CT chest abdomen pelvis without IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 8 5 1 2 0 0 1 0 0
References Study Quality
88 (21752752) 4
19 (10928137) 2
89 (18386467) 4
87 (16556457) 4
Variant 5: Surveillance of asymptomatic patients with treated high-risk endometrial cancer.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 4 4 1 2 0 6 5 1 0 0 0
References Study Quality
87 (16556457) 4
90 (7557610) 2
CT chest abdomen pelvis with IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 1 9 3 1 0 0
References Study Quality
81 (21898632) 4
84 (22349717) 3
83 (19705246) 2
92 (25838164) 3
CT chest abdomen pelvis without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 2 7 4 2 0 0 0
References Study Quality
81 (21898632) 4
84 (22349717) 3
83 (19705246) 2
92 (25838164) 3
US abdomen Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 9 7 0 0 0 0 0 0 1
References Study Quality
21 (17826824) 2
87 (16556457) 4
US pelvis transabdominal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 9 0 0 0 0 0 0 0
References Study Quality
21 (17826824) 2
87 (16556457) 4
US pelvis transvaginal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 9 0 0 0 0 0 0 0
References Study Quality
21 (17826824) 2
87 (16556457) 4
MRI abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 3 5 3 1 2 1 0 0 0
References Study Quality
80 (28372871) 4
MRI abdomen without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 2 6 3 3 1 0 0 0 0
References Study Quality
80 (28372871) 4
MRI pelvis without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 2 7 1 2 2 0 0 0
References Study Quality
36 (23431227) 4
80 (28372871) 4
93 (25969637) 4
MRI pelvis without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 3 6 5 0 0 0 0 0
References Study Quality
36 (23431227) 4
80 (28372871) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 6 7 1 1 1 1 0 0 0
References Study Quality
81 (21898632) 4
84 (22349717) 3
83 (19705246) 2
92 (25838164) 3
Variant 6: Posttherapy evaluation of clinically suspected recurrence of known endometrial cancer.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 2 12 0 0
References Study Quality
94 (17515380) 4
93 (25969637) 4
MRI pelvis without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 1 0 0 1 2 4 3 6
References Study Quality
94 (17515380) 4
36 (23431227) 4
93 (25969637) 4
95 (23652852) 3
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 1 4 3 9
References Study Quality
71 (10775731) 3
FDG-PET/CT skull base to mid-thigh Usually appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 1 5 8 3
References Study Quality
97 (12846541) 3
96 (23107613) Good
US abdomen May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 1 0 0 4 6 3 1 0 0
References Study Quality
81 (21898632) 4
Radiography chest May be appropriate Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 5 5 0 0 0 2 7 5 1 0 0
References Study Quality
87 (16556457) 4
90 (7557610) 2
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 0 2 6 3 3 0 0
References Study Quality
94 (17515380) 4
93 (25969637) 4
MRI pelvis without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 5 7 2 0 0
References Study Quality
94 (17515380) 4
36 (23431227) 4
93 (25969637) 4
95 (23652852) 3
CT chest abdomen pelvis without IV contrast May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 1 3 3 3 5 0 0 1
References Study Quality
71 (10775731) 3
US pelvis transabdominal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 3 1 5 3 3 1 0 0 1
References Study Quality
21 (17826824) 2
80 (28372871) 4
87 (16556457) 4
US pelvis transvaginal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 4 1 5 3 3 0 0 0 1
References Study Quality
21 (17826824) 2
80 (28372871) 4
87 (16556457) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 3 7 4 0 1 0 0 0 0
References Study Quality
71 (10775731) 3
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.