American College of Radiology
ACR Appropriateness Criteria®

Liver Lesion — Initial Characterization

Variant 1: Indeterminate >1 cm lesion on initial imaging with ultrasound. Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 5 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Variant 2: Indeterminate >1 cm lesion on initial imaging with CT (without or with contrast). Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 5 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Variant 3: Indeterminate >1 cm lesion on initial imaging with noncontrast-enhanced MRI. Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 5 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Variant 4: Indeterminate >1 cm lesion on initial imaging with ultrasound. Known history of an extrahepatic malignancy.
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver Usually appropriate Varies Varies 7 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body May be appropriate ☢☢☢☢ 10-30 mSv 6 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Variant 5: Indeterminate >1 cm lesion on initial imaging with CT (without or with contrast). Known history of an extrahepatic malignancy.
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver Usually appropriate Varies Varies 7 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body May be appropriate ☢☢☢☢ 10-30 mSv 6 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Variant 6: Indeterminate >1 cm lesion on initial imaging with noncontrast-enhanced MRI. Known history of an extrahepatic malignancy.
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver Usually appropriate Varies Varies 7 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body May be appropriate ☢☢☢☢ 10-30 mSv 6 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Variant 7: Indeterminate >1 cm lesion on initial imaging with ultrasound. Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
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 O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 6 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 2 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 2 n/a 0 0 0 0 0 0 0 0 0
Variant 8: Indeterminate >1 cm lesion on initial imaging with CT (without or with contrast). Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
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 O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 6 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 2 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 2 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Variant 9: Indeterminate >1 cm lesion on initial imaging with noncontrast-enhanced MRI. Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
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 O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 6 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 2 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 2 n/a 0 0 0 0 0 0 0 0 0
Variant 10: Indeterminate <1 cm lesion on initial imaging with ultrasound. Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver Usually not appropriate Varies Varies 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 2 n/a 0 0 0 0 0 0 0 0 0
Variant 11: Indeterminate <1 cm lesion on initial imaging with CT (without or with contrast). Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver Usually not appropriate Varies Varies 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 2 n/a 0 0 0 0 0 0 0 0 0
Variant 12: Indeterminate <1 cm lesion on initial imaging with noncontrast-enhanced MRI. Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver Usually not appropriate Varies Varies 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 2 n/a 0 0 0 0 0 0 0 0 0
Variant 13: Indeterminate <1 cm lesion on initial imaging with ultrasound. Known history of an extrahepatic malignancy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 6 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body May be appropriate ☢☢☢☢ 10-30 mSv 4 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
Variant 14: Indeterminate <1 cm lesion on initial imaging with CT (without or with contrast). Known history of an extrahepatic malignancy.
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 6 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body May be appropriate ☢☢☢☢ 10-30 mSv 4 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Variant 15: Indeterminate <1 cm lesion on initial imaging with noncontrast-enhanced MRI. Known history of an extrahepatic malignancy.
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 O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 6 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body May be appropriate ☢☢☢☢ 10-30 mSv 4 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 4 n/a 0 0 0 0 0 0 0 0 0
Variant 16: Indeterminate <1 cm lesion on initial imaging with ultrasound. Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
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 O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 6 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
Variant 17: Indeterminate <1 cm lesion on initial imaging with CT (without or with contrast). Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
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 O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 6 n/a 0 0 0 0 0 0 0 0 0
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Variant 18: Indeterminate <1 cm lesion on initial imaging with noncontrast-enhanced MRI. Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
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 O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
CT abdomen with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 n/a 0 0 0 0 0 0 0 0 0
Percutaneous image-guided biopsy liver May be appropriate Varies Varies 6 n/a 0 0 0 0 0 0 0 0 0
FDG-PET/CT whole body Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m sulfur colloid scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Tc-99m RBC scan liver Usually not appropriate ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
In-111 somatostatin receptor scintigraphy Usually not appropriate ☢☢☢☢ 10-30 mSv 3 n/a 0 0 0 0 0 0 0 0 0
US abdomen May be appropriate O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.