Variant 1: Adult female, 40 years of age or older. Palpable breast mass. Initial imaging.
Variant 2: Adult female, 40 years of age or older. Palpable breast mass. Mammography findings are suspicious or highly suggestive of malignancy (BI-RADS 4 or 5). Next imaging study.
Variant 3: Adult female, 40 years of age or older. Palpable breast mass. Diagnostic mammography, DBT, and US findings are probably benign (BI-RADS 3). Next imaging study.
Variant 4: Adult female, 40 years of age or older. Palpable breast mass. Mammography findings are benign (BI-RADS 2) at the site of palpable mass. Next imaging study.
Variant 5: Adult female, 40 years of age or older. Palpable breast mass. Mammography findings are negative (BI-RADS 1). Next imaging study.
Variant 6: Adult female, younger than 30 years of age. Palpable breast mass. Initial imaging.
Variant 7: Adult female, younger than 30 years of age. Palpable breast mass. US findings are suspicious or highly suggestive of malignancy (BI-RADS 4 or 5). Next imaging study.
Variant 8: Adult female, younger than 30 years of age. Palpable breast mass. US findings probably benign (BI-RADS 3). Next imaging study.
Variant 9: Adult female, younger than 30 years of age. Palpable breast mass. US findings benign (BI-RADS 2). Next imaging study.
Variant 10: Adult female, younger than 30 years of age. Palpable breast mass. US findings negative (BI-RADS 1). Next imaging study.
Variant 11: Adult female, 30 to 39 years of age. Palpable breast mass. Initial imaging.
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.