American College of Radiology
ACR Appropriateness Criteria®

Breast Implant Evaluation

Variant 1: Evaluation of saline breast implants. Asymptomatic patient. Any age. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography screening Usually not appropriate ☢☢ 0.1-1mSv 1 1 15 0 0 0 1 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 0 0 0 0
US breast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 0 0 1 0
Digital breast tomosynthesis screening Usually not appropriate ☢☢ 0.1-1mSv 1 1 15 0 1 0 0 0 0 0 0
Variant 2: Evaluation of saline breast implants. Clinical examination equivocal for implant rupture. Age younger than 30 years. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 1 0 1 4 10
Mammography diagnostic Usually not appropriate ☢☢ 0.1-1mSv 3 3 3 4 3 3 2 1 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate ☢☢ 0.1-1mSv 3 3 3 4 3 2 3 1 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 2 0 0 0 0 0 1 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 14 1 0 0 0 0 0 1 0
Variant 3: Evaluation of saline breast implants. Clinical examination equivocal for implant rupture. Age 30-39 years. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 8 8 0 0 0 2 1 0 5 3 5
US breast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 4 4 7
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 8 8 0 0 1 0 2 0 4 4 5
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 14 1 0 0 0 0 0 1 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 14 1 0 0 0 0 1 0 0
Variant 4: Evaluation of saline breast implants. Clinical examination equivocal for implant rupture. Age 40 years or older. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 9 9 0 0 0 1 1 0 0 4 10
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 9 9 0 0 1 0 1 0 0 3 11
US breast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 9 4 0 1 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 2 0 0 0 0 0 1 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 2 0 0 0 0 0 1 0
Variant 5: Evaluation of silicone breast implants. Asymptomatic patient. Any age. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography screening Usually not appropriate ☢☢ 0.1-1mSv 1 1 13 1 1 0 1 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 9 3 2 0 1 0 0 1 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 2 1 0 1 0 1 0 0
US breast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 3 1 0 0 0 0 1 0
Digital breast tomosynthesis screening Usually not appropriate ☢☢ 0.1-1mSv 1 1 13 1 0 0 2 0 0 0 0
Variant 6: Evaluation of silicone breast implants. Suspected implant complication. Age younger than 30 years. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI breast without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 1 0 2 4 8
US breast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 1 0 2 0 5 1 7
Mammography diagnostic Usually not appropriate ☢☢ 0.1-1mSv 1 1 10 2 1 1 1 1 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 2 0 0 1 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate ☢☢ 0.1-1mSv 1 1 10 1 3 1 0 1 0 0 0
Variant 7: Evaluation of silicone breast implants. Suspected implant complication. Age 30-39 years. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI breast without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 1 0 1 0 0 1 1 3 9
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 7 7 0 0 1 1 3 2 3 3 3
US breast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 3 1 5 1 6
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 7 7 0 0 0 0 1 1 9 2 3
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 12 3 0 0 0 0 1 0 0
Variant 8: Evaluation of silicone breast implants. Suspected implant complication. Age 40 years or older. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI breast without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 1 3 2 9
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 8 8 0 0 0 0 0 1 7 4 4
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 7 7 0 0 1 1 3 0 4 3 4
US breast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 5 1 0 2 0 6 0 6 0 1
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 12 3 0 0 0 1 0 0 0
Variant 9: Evaluation of unexplained axillary adenopathy. Silicone breast implants (current or prior). Age younger than 30 years. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US axilla Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 0 1 14
Mammography diagnostic Usually not appropriate ☢☢ 0.1-1mSv 2 2 5 5 2 2 2 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 7 4 3 0 0 1 0 1 0
Digital breast tomosynthesis diagnostic Usually not appropriate ☢☢ 0.1-1mSv 2 2 4 5 3 2 2 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 10 3 0 1 1 0 0 1 0
Variant 10: Evaluation of unexplained axillary adenopathy. Silicone breast implants (current or prior). Age 30-39 years. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 9 9 0 0 1 1 2 0 3 1 8
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 9 9 0 0 1 0 2 1 3 1 8
US axilla Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 3 0 12
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 7 5 2 0 0 1 0 1 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 9 3 0 2 1 0 0 1 0
Variant 11: Evaluation of unexplained axillary adenopathy. Silicone breast implants (current or prior). Age 40 years or older. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 9 9 0 0 0 1 1 0 1 2 11
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 9 9 0 0 1 0 1 0 1 1 12
US axilla Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 0 1 1 4 10
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 7 5 2 0 0 1 0 1 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 9 4 0 1 1 0 0 1 0
Variant 12: Suspected breast implant associated anaplastic large cell lymphoma (BIA-ALCL) (delayed seroma, swelling, mass, pain but no erythema, warmth or skin changes that would raise concern for inflammatory breast cancer or mastitis). Any age. Breast implant of any type. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 1 0 0 0 1 2 12
Mammography diagnostic May be appropriate (Disagreement) ☢☢ 0.1-1mSv 5 5 0 0 2 2 6 4 1 0 1
MRI breast without and with IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 4 2 1 5 1 3 2 1 1 0
Digital breast tomosynthesis diagnostic May be appropriate ☢☢ 0.1-1mSv 5 5 0 0 1 2 7 4 1 0 1
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 9 5 1 0 0 0 0 1 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.