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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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
Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	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.

American College of Radiology ACR Appropriateness Criteria®