Variant 1: 52-year-old woman with remote hysterectomy for cervical dysplasia and 1- x 1.5- x 1 cm invasive SCC involving right vaginal fornix without paravaginal extension.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| FDG-PET/CT whole body | Usually appropriate | ☢☢☢☢ 10-30 mSv | ☢☢☢☢ 3-10 mSv [ped] | 8 | n/a | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| FDG-PET/CT whole body | Usually appropriate | ☢☢☢☢ 10-30 mSv | ☢☢☢☢ 3-10 mSv [ped] | 8 | n/a | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| Radiography chest | May be appropriate | ☢ <0.1 mSv | ☢ <0.03 mSv [ped] | 6 | n/a | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Variant 2: 68-year-old woman with FIGO stage II SCC of distal vagina, 3 x 3 x 4 cm in size involving suburethral area. No nodal involvement or distant disease by PET/CT.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 3: 65-year-old woman with FIGO stage III SCC of the vagina with full-length involvement and pelvic sidewall extension measuring 5 x 7 x 7 cm. PET/CT shows bulky primary disease and a 2- x 3 cm external iliac lymph node but no distant metastases.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 4: 85-year-old woman with FIGO stage IVB SCC of the vagina with pelvic sidewall fixation, pain, and vaginal bleeding. PET/CT shows FDG-avid lymphadenopathy in the pelvis, inguinal nodes, and mediastinum, as well as pulmonary metastases. Karnofsky performance status is 50.
| 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.