Variant 1: 25-year-old woman with cHL: clinical stage (CS) IIIA, with mediastinal, splenic, and para-aortic involvement, all sites nonbulky (<5 cm), and IPS <3; completed 6 cycles of ABVD, followed by restaging PET/CT showing a CR (Deauville 2) and residual mediastinal mass of 2 cm.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 2: 25-year-old woman with cHL: CS IIIA, with mediastinal, splenic, and para-aortic involvement, all sites nonbulky (<5 cm), and IPS <3.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 3: 52-year-old man with cHL: CS IVB, with bulky (>10 cm) mediastinal, splenic, para-aortic, and bone marrow involvement, albumin <4 g/dL, hemoglobin <10.5 g/dL, and IPS 5.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 4: 52-year-old man with cHL: CS IVB, with bulky (>10 cm) mediastinal, splenic, para-aortic (<5 cm), and bone marrow involvement, albumin <4 g/dL, and hemoglobin <10.5 g/dL; 50% reduction in mediastinal mass with residual FDG avidity limited to the mediastinum after 2 cycles of ABVD (Deauville 4); restaging PET/CT after 4 cycles of ABVD showed a complete metabolic response (Deauville 2); completed 6 cycles of ABVD. Final PET/CT assessment shows a 4-cm residual mediastinal mass, Deauville 2.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 5: 52-year-old man with cHL: CS IVB, with bulky (>10 cm) mediastinal, splenic, para-aortic (<5 cm), and bone marrow involvement, albumin <4 g/dL, and hemoglobin <10.5 g/dL; 50% reduction in mediastinal mass with residual FDG avidity limited to the mediastinum after 2 cycles of ABVD (Deauville 4); restaging PET/CT after 4 cycles of ABVD showed a partial metabolic response (Deauville 4). After 6 cycles of ABVD, the residual mediastinal mass is 4 cm and final PET/CT assessment still Deauville 4 only in mediastinum. All other sites are <2.5 cm.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
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.