Variant 1: 60-year-old man, asymptomatic in PSA screening program. PSA 5.2 ng/mL. Prostate within normal limits. No palpable lesions. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3+3=6. Metastatic workup negative.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 2: 69-year-old generally healthy man. Screening PSA 15.2. Gleason score 4+3 in 3/6 cores on the right, 1/6 on the left. cT2a on examination.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 3: 69-year-old man with long-standing history of coronary disease and diabetes. Myocardial infarction 3 years ago required percutaneous stenting, but since then his cardiac status has been stable. Screening PSA 15.2. Gleason score 4+3 in 3/6 cores on the right, 1/6 on the left. cT2a on examination.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 4: 70-year-old man who presented with a 3-year history of moderate dysuria, urinary frequency, and nocturia. Rectal examination shows prostate 1.5 normal size. PSA 36 ng/mL. 12 needle biopsy of prostate shows adenocarcinoma. Gleason score 4+4=8 in both right and left lobes, totaling 7 cores. Metastatic workup negative.
| 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.