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Appropriateness Criteria

Variant 1: Adult. High-risk screening for pancreatic ductal adenocarcinoma.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 2 5 4 2
References Study Quality
14 (35856454) 4
10 (31768594) 4
MRI abdomen without and with IV contrast with MRCP Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 1 0 0 0 0 2 5 2 4
References Study Quality
10 (31768594) 4
13 (34798981) 4
14 (35856454) 4
30 (31764824) 3
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 2 2 11 0 0
References Study Quality
23 (34161128) 3
22 (32950386) 4
21 (31832740) 3
CT abdomen with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 1 0 2 2 3 3 3
References Study Quality
23 (34161128) 3
22 (32950386) 4
21 (31832740) 3
CT abdomen with IV contrast multiphase Usually appropriate Strong ☢☢☢☢ 10-30 mSv 9 9 0 0 0 0 0 1 3 2 8
References Study Quality
28 (32800574) 3
27 (29796845) 2
26 (33759561) 2
25 (29128993) 4
14 (35856454) 4
10 (31768594) 4
MRI abdomen without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 4 9 1 0 0 0
References Study Quality
10 (31768594) 4
14 (35856454) 4
32 (36273992) 4
31 (31748823) 4
MRI abdomen without IV contrast with MRCP May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 10 3 0 0 0
References Study Quality
38 (27900458) 3
37 (28116593) 4
36 (33819806) Good
35 (27663591) 4
34 (28084815) 4
33 (34223962) 3
32 (36273992) 4
31 (31748823) 4
30 (31764824) 3
10 (31768594) 4
US abdomen transabdominal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 7 5 2 0 0 0 0 0 0
References Study Quality
10 (31768594) 4
MRI abdomen without and with hepatobiliary contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 1 7 4 2 0 0 0 0
References Study Quality
29 (34193282) 4
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 2 4 1 1 0 0 0 0
References Study Quality
23 (34161128) 3
22 (32950386) 4
21 (31832740) 3
CT abdomen without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 2 5 0 1 0 0 0 0
References Study Quality
23 (34161128) 3
22 (32950386) 4
21 (31832740) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 0 3 5 2 5 0 0 0 0
References Study Quality
24 (32703312) 4
25 (29128993) 4
CT abdomen without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 0 3 5 2 3 2 0 0 0
References Study Quality
25 (29128993) 4
24 (32703312) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 2 6 0 0 0 0 0 0
References Study Quality
10 (31768594) 4
Variant 2: Adult. Clinically suspected pancreatic ductal adenocarcinoma. Abdominal symptomatology. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 1 2 5 1 4
References Study Quality
10 (31768594) 4
14 (35856454) 4
MRI abdomen without and with IV contrast with MRCP Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 4 1 4 4
References Study Quality
51 (29397657) 3
50 (29352379) 3
30 (31764824) 3
14 (35856454) 4
10 (31768594) 4
9 (29277858) 4
CT abdomen and pelvis with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 1 1 2 7 1 2
References Study Quality
41 (27519836) 3
22 (32950386) 4
21 (31832740) 3
CT abdomen with IV contrast multiphase Usually appropriate Limited ☢☢☢☢ 10-30 mSv 9 9 0 0 0 0 0 0 1 3 10
References Study Quality
9 (29277858) 4
42 (34851713) 4
MRI abdomen without and with hepatobiliary contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 1 2 2 9 1 0 0 0
References Study Quality
49 (34314825) 4
48 (31464937) 3
47 (35316674) 3
MRI abdomen without IV contrast May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 5 0 0 0 4 11 0 0 0 0
References Study Quality
36 (33819806) Good
35 (27663591) 4
34 (28084815) 4
33 (34223962) 3
30 (31764824) 3
14 (35856454) 4
MRI abdomen without IV contrast with MRCP May be appropriate Moderate O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 10 4 0 0 0
References Study Quality
10 (31768594) 4
30 (31764824) 3
36 (33819806) Good
35 (27663591) 4
34 (28084815) 4
33 (34223962) 3
US abdomen transabdominal Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 6 5 3 0 0 0 0 0 0
References Study Quality
10 (31768594) 4
52 (32527594) 3
CT abdomen and pelvis without IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 4 1 5 2 2 0 0 0 0
References Study Quality
23 (34161128) 3
22 (32950386) 4
21 (31832740) 3
CT abdomen and pelvis without and with IV contrast Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 0 2 6 2 3 2 0 0 0
References Study Quality
24 (32703312) 4
25 (29128993) 4
FDG-PET/CT skull base to mid-thigh Usually not appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 1 6 3 2 1 0 0 0
References Study Quality
9 (29277858) 4
46 (28180987) 3
45 (33063453) 3
44 (35717098) 4
43 (29143875) 4
Variant 3: Adult. Pancreatic ductal adenocarcinoma. Locoregional disease staging or pretreatment planning or posttreatment evaluation related to neoadjuvant therapy or surgical planning.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 0 0 9 4 1
References Study Quality
83 (29664340) 3
82 (29516979) 3
81 (31993737) 3
80 (30667305) 3
51 (29397657) 3
36 (33819806) Good
35 (27663591) 4
34 (28084815) 4
33 (34223962) 3
30 (31764824) 3
10 (31768594) 4
9 (29277858) 4
MRI abdomen without and with IV contrast with MRCP Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 0 8 4 1
References Study Quality
24 (32703312) 4
32 (36273992) 4
87 (34903501) Good
86 (35486167) Good
85 (34756699) 3
84 (34654379) 3
CT abdomen with IV contrast multiphase Usually appropriate Strong ☢☢☢☢ 10-30 mSv 9 9 0 0 0 0 0 0 1 0 14
References Study Quality
68 (27780664) 3
67 (34223961) Good
66 (31799875) 3
65 (30931954) 3
64 (28339284) 3
63 (31012758) 3
62 (30333055) 3
61 (28770287) 4
60 (35213359) 4
59 (31953587) 3
58 (30116961) 3
57 (31495760) 3
56 (29063133) 2
55 (27798447) 3
54 (24152957) 2
42 (34851713) 4
27 (29796845) 2
26 (33759561) 2
21 (31832740) 3
9 (29277858) 4
MRI abdomen without and with hepatobiliary contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 1 0 10 3 1 0 0
References Study Quality
9 (29277858) 4
42 (34851713) 4
50 (29352379) 3
51 (29397657) 3
CT abdomen and pelvis with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 1 0 5 4 3 2 0
References Study Quality
41 (27519836) 3
CT abdomen and pelvis without and with IV contrast May be appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 2 5 2 5 0 1 0 0
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 2 4 9 0 0 0 0
References Study Quality
79 (29402376) 3
78 (31092213) 4
77 (29017830) 3
76 (24721105) 3
75 (23922481) M
74 (35410786) 3
46 (28180987) 3
45 (33063453) 3
44 (35717098) 4
43 (29143875) 4
42 (34851713) 4
9 (29277858) 4
US abdomen transabdominal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 2 1 0 0 0 0 0 0
MRI abdomen without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 1 2 10 2 0 0 0 0 0
MRI abdomen without IV contrast with MRCP Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 1 1 12 1 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 7 3 0 1 0 0 0 0
Variant 4: Adult. Pancreatic ductal adenocarcinoma. Distant metastatic evaluation. Initial staging or postprocedure surveillance for metastatic disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI abdomen without and with hepatobiliary contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 1 1 8 4 1
References Study Quality
9 (29277858) 4
42 (34851713) 4
MRI abdomen without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 0 2 9 3 1
References Study Quality
9 (29277858) 4
42 (34851713) 4
CT abdomen and pelvis with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 0 3 10 2
References Study Quality
94 (36057929) 3
93 (36241752) 4
92 (30241869) 3
56 (29063133) 2
54 (24152957) 2
41 (27519836) 3
9 (29277858) 4
CT abdomen with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 1 1 12 1 0
References Study Quality
54 (24152957) 2
56 (29063133) 2
92 (30241869) 3
94 (36057929) 3
CT chest abdomen pelvis with IV contrast Usually appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 0 0 0 0 0 2 6 6 1
References Study Quality
89 (32378193) 3
88 (32132508) 3
41 (27519836) 3
MRI abdomen without IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 4 4 2 2 2 7 2 0 0 0 0
CT abdomen with IV contrast multiphase May be appropriate (Disagreement) Expert Opinion ☢☢☢☢ 10-30 mSv 5 5 0 0 2 0 1 0 7 3 2
References Study Quality
9 (29277858) 4
54 (24152957) 2
56 (29063133) 2
92 (30241869) 3
94 (36057929) 3
FDG-PET/CT skull base to mid-thigh May be appropriate Limited ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 11 1 1 0 0
References Study Quality
43 (29143875) 4
44 (35717098) 4
95 (29782393) 4
96 (31806148) 4
US abdomen transabdominal Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 3 0 0 0 0 0 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 3 3 1 0 0 0 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 6 3 0 0 0 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 0 3 7 4 1 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 0 7 7 0 0 0 1 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 4 2 7 2 0 0 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 5 2 2 0 0 0 0 0
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.