American College of Radiology
ACR Appropriateness Criteria®

Palpable Abdominal Mass-Suspected Neoplasm

Variant 1: Palpable abdominal mass. Suspected intra-abdominal neoplasm. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 0 0 0 0 1 12
References Study Quality
15 (6561119) 4
14 (16371582) 3
13 (24724763) 4
12 (23381506) 4
11 (26321453) 4
10 (27377325) 4
9 (6734063) 3
8 (6112538) 1
7 (24764686) 3
6 (24901125) 4
5 (27452935) 4
4 (23212183) 4
US abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 0 1 5 6 0
References Study Quality
4 (23212183) 4
5 (27452935) 4
6 (24901125) 4
19 (7084598) 4
18 (3285944) 4
17 (2407418) 3
16 (7223287) 4
20 (2152047) 4
21 (15953224) 4
22 (26507695) 2
23 (25793296) 3
MRI abdomen without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 0 7 2 1 3
References Study Quality
10 (27377325) 4
CT abdomen without IV contrast May be appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 5 6 2 2 0 0
References Study Quality
15 (6561119) 4
14 (16371582) 3
13 (24724763) 4
12 (23381506) 4
11 (26321453) 4
10 (27377325) 4
9 (6734063) 3
8 (6112538) 1
7 (24764686) 3
6 (24901125) 4
5 (27452935) 4
4 (23212183) 4
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 7 6 2 1 0 0
References Study Quality
10 (27377325) 4
CT abdomen without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 4 4 4 1 2 0 0 0
References Study Quality
9 (6734063) 3
8 (6112538) 1
7 (24764686) 3
6 (24901125) 4
5 (27452935) 4
4 (23212183) 4
15 (6561119) 4
14 (16371582) 3
13 (24724763) 4
12 (23381506) 4
11 (26321453) 4
10 (27377325) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 3 3 5 0 0 2 0 0 0
Radiography abdomen Usually not appropriate Limited ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 3 3 1 3 6 2 1 0 0 0 0
References Study Quality
27 (22524761) 4
26 (23079147) 4
25 (22200965) 4
24 (23224856) 4
Fluoroscopy contrast enema Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 6 3 1 0 0 0 0 0
References Study Quality
28 (23219189) 3
Fluoroscopy upper GI series Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 3 6 3 1 0 0 0 0 0
References Study Quality
28 (23219189) 3
Fluoroscopy upper GI series with small bowel follow-through Usually not appropriate Limited ☢☢☢ 1-10 mSv 2 2 3 6 3 1 0 0 0 0 0
References Study Quality
28 (23219189) 3
Variant 2: Palpable abdominal mass. Suspected abdominal wall mass. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US abdomen Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 1 4 8
References Study Quality
34 (23535226) 4
33 (24145938) 4
32 (26657747) 4
31 (19414084) 3
30 (25064764) 4
29 (24043554) 4
39 (28218772) 4
38 (22884230) 4
37 (26162574) 4
36 (27328495) 4
CT abdomen with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 1 4 1 2 5
References Study Quality
12 (23381506) 4
14 (16371582) 3
15 (6561119) 4
30 (25064764) 4
41 (15728607) 3
42 (29571558) 4
43 (28004137) 3
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 4 4 2 3
References Study Quality
10 (27377325) 4
35 (23763857) 3
38 (22884230) 4
29 (24043554) 4
30 (25064764) 4
40 (14975977) 3
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 5 3 5 2 1 0
References Study Quality
10 (27377325) 4
29 (24043554) 4
30 (25064764) 4
35 (23763857) 3
38 (22884230) 4
40 (14975977) 3
CT abdomen without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 0 5 6 3 1 1 0 0
References Study Quality
12 (23381506) 4
14 (16371582) 3
15 (6561119) 4
30 (25064764) 4
41 (15728607) 3
42 (29571558) 4
43 (28004137) 3
CT abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 7 6 2 0 0 0 0 0
References Study Quality
12 (23381506) 4
14 (16371582) 3
15 (6561119) 4
30 (25064764) 4
41 (15728607) 3
42 (29571558) 4
43 (28004137) 3
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 3 7 2 1 0 0 0 0 0
Radiography abdomen Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 6 3 3 0 1 0 0 0 0
Fluoroscopy contrast enema Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 4 1 0 0 0 0 0 0
Fluoroscopy upper GI series Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 3 1 0 0 0 0 0 0
Fluoroscopy upper GI series with small bowel follow-through Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 8 4 1 0 0 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.