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Variant 1: Breast cancer screening. Female. Average-risk, with less than 15% lifetime risk of breast cancer.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Digital breast tomosynthesis screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
15 (24316152) 1
12 (23623721) 1
28 (25188431) 3
16 (25058084) 3
17 (24918774) 3
31 (23901124) 3
18 (24746887) 1
33 (24896197) 3
19 (24121712) M
29 (25247407) 3
20 (25313245) 2
32 (23969151) 2
21 (23169790) 1
22 (24450665) 3
30 (23701081) 3
23 (25107868) 3
24 (23553585) 1
25 (23297332) 1
26 (22674710) 2
27 (23803075) 3
13 (24582915) 1
10 (20129267) 4
4 (21712474) 1
5 (22358016) 4
6 (26757170) 4
7 (21727289) 4
8 (24660726) 3
9 (26204111) 4
11 (28648873) 4
36 (24475859) 3
34 (24354377) 2
35 (24484063) 1
14 (23175484) 2
Mammography screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
15 (24316152) 1
12 (23623721) 1
28 (25188431) 3
16 (25058084) 3
17 (24918774) 3
31 (23901124) 3
18 (24746887) 1
33 (24896197) 3
19 (24121712) M
29 (25247407) 3
20 (25313245) 2
32 (23969151) 2
21 (23169790) 1
22 (24450665) 3
30 (23701081) 3
23 (25107868) 3
24 (23553585) 1
25 (23297332) 1
26 (22674710) 2
27 (23803075) 3
13 (24582915) 1
10 (20129267) 4
4 (21712474) 1
5 (22358016) 4
6 (26757170) 4
7 (21727289) 4
8 (24660726) 3
9 (26204111) 4
11 (28648873) 4
36 (24475859) 3
34 (24354377) 2
35 (24484063) 1
14 (23175484) 2
US breast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 1 1 0 5 9 1 0 0 0
References Study Quality
10 (20129267) 4
37 (25763719) 4
38 (25329763) 3
39 (23980217) 3
40 (23116728) 2
41 (22723501) 2
42 (23240937) 2
43 (23750571) 4
MRI breast without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
Sestamibi MBI Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
45 (21045179) 2
44 (25615744) 1
46 (25615745) 4
FDG-PET breast dedicated Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
45 (21045179) 2
44 (25615744) 1
46 (25615745) 4
Variant 2: Breast cancer screening. Female. Intermediate-risk, with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Digital breast tomosynthesis screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
15 (24316152) 1
12 (23623721) 1
28 (25188431) 3
16 (25058084) 3
17 (24918774) 3
31 (23901124) 3
18 (24746887) 1
33 (24896197) 3
19 (24121712) M
29 (25247407) 3
20 (25313245) 2
32 (23969151) 2
21 (23169790) 1
22 (24450665) 3
30 (23701081) 3
23 (25107868) 3
24 (23553585) 1
25 (23297332) 1
26 (22674710) 2
27 (23803075) 3
13 (24582915) 1
11 (28648873) 4
36 (24475859) 3
34 (24354377) 2
35 (24484063) 1
14 (23175484) 2
Mammography screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
15 (24316152) 1
12 (23623721) 1
28 (25188431) 3
16 (25058084) 3
17 (24918774) 3
31 (23901124) 3
18 (24746887) 1
33 (24896197) 3
19 (24121712) M
29 (25247407) 3
20 (25313245) 2
32 (23969151) 2
21 (23169790) 1
22 (24450665) 3
30 (23701081) 3
23 (25107868) 3
24 (23553585) 1
25 (23297332) 1
26 (22674710) 2
27 (23803075) 3
13 (24582915) 1
11 (28648873) 4
36 (24475859) 3
34 (24354377) 2
35 (24484063) 1
14 (23175484) 2
US breast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 5 10 0 0 0
References Study Quality
48 (18477782) 1
49 (22474203) 1
MRI breast without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 4 9 2 1 0
References Study Quality
53 (20651211) 3
51 (21900617) 4
50 (21900618) 3
52 (26744477) 3
47 (17392385) 4
MRI breast without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 1 12 4 0 0 0 1 0 0 0
References Study Quality
53 (20651211) 3
51 (21900617) 4
50 (21900618) 3
52 (26744477) 3
47 (17392385) 4
Sestamibi MBI Usually not appropriate Strong ☢☢☢ 1-10 mSv 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
45 (21045179) 2
44 (25615744) 1
46 (25615745) 4
FDG-PET breast dedicated Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
45 (21045179) 2
44 (25615744) 1
46 (25615745) 4
Variant 3: Breast cancer screening. Female. High-risk, with a BRCA gene mutation and their untested first-degree relatives, women with a history of chest irradiation between 10 to 30 years of age, women with 20% or greater lifetime risk of breast cancer.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Digital breast tomosynthesis screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
15 (24316152) 1
12 (23623721) 1
28 (25188431) 3
16 (25058084) 3
17 (24918774) 3
31 (23901124) 3
18 (24746887) 1
33 (24896197) 3
19 (24121712) M
29 (25247407) 3
20 (25313245) 2
32 (23969151) 2
21 (23169790) 1
22 (24450665) 3
30 (23701081) 3
23 (25107868) 3
24 (23553585) 1
25 (23297332) 1
26 (22674710) 2
27 (23803075) 3
13 (24582915) 1
10 (20129267) 4
11 (28648873) 4
36 (24475859) 3
34 (24354377) 2
35 (24484063) 1
14 (23175484) 2
Mammography screening Usually appropriate Strong ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
15 (24316152) 1
12 (23623721) 1
28 (25188431) 3
16 (25058084) 3
17 (24918774) 3
31 (23901124) 3
18 (24746887) 1
33 (24896197) 3
19 (24121712) M
29 (25247407) 3
20 (25313245) 2
32 (23969151) 2
21 (23169790) 1
22 (24450665) 3
30 (23701081) 3
23 (25107868) 3
24 (23553585) 1
25 (23297332) 1
26 (22674710) 2
27 (23803075) 3
13 (24582915) 1
10 (20129267) 4
11 (28648873) 4
36 (24475859) 3
34 (24354377) 2
35 (24484063) 1
14 (23175484) 2
MRI breast without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 0 0 0 0
References Study Quality
59 (17244718) 2
10 (20129267) 4
62 (19155400) 4
54 (17317184) 3
55 (16615112) 4
56 (16293877) 2
57 (15910949) 2
63 (16720823) 4
64 (19248993) 4
58 (24789418) 3
49 (22474203) 1
60 (20177029) 1
61 (19884532) 1
47 (17392385) 4
US breast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 6 6 0 0 0 0 0 0 0 0 0
References Study Quality
62 (19155400) 4
49 (22474203) 1
MRI breast without IV contrast Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 1 1 0 0 0 0 0 0 0 0 0
References Study Quality
59 (17244718) 2
10 (20129267) 4
62 (19155400) 4
54 (17317184) 3
55 (16615112) 4
56 (16293877) 2
57 (15910949) 2
63 (16720823) 4
64 (19248993) 4
58 (24789418) 3
49 (22474203) 1
60 (20177029) 1
61 (19884532) 1
47 (17392385) 4
Sestamibi MBI Usually not appropriate Strong ☢☢☢ 1-10 mSv 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
45 (21045179) 2
44 (25615744) 1
46 (25615745) 4
FDG-PET breast dedicated Usually not appropriate Strong ☢☢☢☢ 10-30 mSv 2 2 0 0 0 0 0 0 0 0 0
References Study Quality
45 (21045179) 2
44 (25615744) 1
46 (25615745) 4
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.