Variant 1: 70-year-old man, former smoker with 2-cm peripheral right upper lobe (RUL) adenocarcinoma; PET shows hypermetabolic uptake at RUL lesion but is otherwise negative; mediastinoscopy negative; FEV1 60% predicted; Karnofsky Performance Scale (KPS) 90.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 2: 68-year-old woman with 4.2-cm left upper lobe (LUL) adenocarcinoma on CT-guided biopsy; PET shows hypermetabolic uptake at lingular lesion but is otherwise negative; FEV1 70% predicted; KPS 70; concurrent rheumatoid arthritis under control.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 3: 73-year-old woman with COPD, on stable 2 L oxygen by nasal prongs, new 1-cm LUL lesion on chest radiograph after upper respiratory tract infection treated successfully with antibiotics; PET shows hypermetabolic uptake at LUL lesion with SUV 5 but is otherwise negative; bronchoscopy washings positive for adenocarcinoma; FEV1 40%; DLCO 45% predicted; KPS 70.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 4: 83-year-old man with 3-cm right infrahilar adenocarcinoma; PET shows hypermetabolic uptake at right lesion with SUV 10 but is otherwise negative; FEV1 40% predicted; KPS 70.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
Variant 5: 70-year-old man with new 2-cm RUL PET-avid lesion with SUV 5 but otherwise negative. The pulmonologist’s assessment is that the lesion is too peripheral to sample and that a CT biopsy would be unsafe, which was confirmed by an experienced interventional radiologist. FEV1 50%/DLCO 50% predicted; KPS 70, wears supplemental O2 at night.
| 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.