American College of Radiology
ACR Appropriateness Criteria®

Breast Imaging of Pregnant and Lactating Women

Variant 1: Breast cancer screening during lactation. 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 appropriate ☢☢ 0.1-1mSv 8 8 1 0 0 0 5 0 2 4 4
Digital breast tomosynthesis screening Usually appropriate ☢☢ 0.1-1mSv 8 8 0 1 0 0 4 1 1 2 7
US breast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 1 1 2 8 4 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 5 2 3 0 4 2 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 1 15 1 0 0 0 0 0 0 0
Variant 2: Breast cancer screening during pregnancy. Age younger than 30 at high risk. 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 appropriate ☢☢ 0.1-1mSv 7 7 0 0 0 0 2 0 8 2 4
Digital breast tomosynthesis screening Usually appropriate ☢☢ 0.1-1mSv 7 7 1 0 0 0 3 3 3 3 3
US breast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 0 1 1 10 4 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
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 1 15 1 0 0 0 0 0 0 0
Variant 3: Breast cancer screening during pregnancy. Age 30 to 39 years at elevated risk (intermediate or high risk). 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 appropriate ☢☢ 0.1-1mSv 7 7 0 0 0 0 1 1 7 3 4
Digital breast tomosynthesis screening Usually appropriate ☢☢ 0.1-1mSv 7 7 1 0 0 0 1 4 3 3 4
US breast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 1 1 2 10 2 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 16 0 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 16 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 1 16 0 0 0 0 0 0 0 0
Variant 4: Breast cancer screening during pregnancy. Age 40 years or older, any risk level. 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 appropriate ☢☢ 0.1-1mSv 9 9 0 0 0 0 1 0 1 3 11
Digital breast tomosynthesis screening Usually appropriate ☢☢ 0.1-1mSv 9 9 0 0 0 0 1 0 0 2 13
US breast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 1 1 3 1 8 2 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 16 0 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
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 1 16 0 0 0 0 0 0 0 0
Variant 5: Pregnant women with a palpable breast mass. 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 0 0 0 0 16
Mammography diagnostic May be appropriate ☢☢ 0.1-1mSv 5 5 0 0 0 0 10 4 1 1 0
Digital breast tomosynthesis diagnostic May be appropriate ☢☢ 0.1-1mSv 5 5 0 0 0 0 9 5 2 0 0
Image-guided core biopsy breast Usually not appropriate Varies Varies 1 1 12 1 1 0 0 2 0 0 0
Image-guided fine needle aspiration breast Usually not appropriate Varies Varies 1 1 12 1 2 1 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 1 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 16 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 1 15 0 0 0 1 0 0 0 0
Variant 6: Clinically suspicious nipple discharge during pregnancy. 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 0 1 0 3 12
Mammography diagnostic Usually appropriate ☢☢ 0.1-1mSv 7 7 0 0 0 0 3 4 3 4 2
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 7 7 0 0 0 0 3 4 4 3 2
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 16 0 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 16 0 0 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 1 16 0 0 0 0 0 0 0 0
Variant 7: Locoregional staging of newly diagnosed breast cancer during pregnancy. 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 0 0 0 2 12
Digital breast tomosynthesis diagnostic Usually appropriate ☢☢ 0.1-1mSv 9 9 0 1 0 0 0 0 1 2 12
US axilla Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 2 1 1 1 11
US breast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 3 2 6 1 2 1 1 0 0
MRI breast without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 0 1 0 0
MRI breast without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 15 0 1 0 0 0 0 0 0
Tc-99m sestamibi MBI Usually not appropriate ☢☢☢ 1-10 mSv 1 1 15 0 1 0 0 0 0 0 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.