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Appropriateness Criteria

Variant 1: Female. Age 40 years or older. Postsurgical excision with nonmalignant pathology. Asymptomatic. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Digital breast tomosynthesis screening Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 17
References Study Quality
1 (28648873) 4
18 (20601590) 3
17 (-3194409) 4
Mammography screening Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 0 0 17
References Study Quality
1 (28648873) 4
18 (20601590) 3
17 (-3194409) 4
MRI breast without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 3 0 1 0 12 1 0 0 0
US breast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 11 4 0 1 1 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 9 6 2 0 0 0 0 0 0
References Study Quality
11 (30172804) 4
13 (29299726) 4
12 (25423143) 3
15 (26492902) 4
16 (24639339) 4
14 (27425222) 4
42 (-3194411) 4
Mammography diagnostic Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 12 4 1 0 0 0 0 0 0
References Study Quality
11 (30172804) 4
13 (29299726) 4
12 (25423143) 3
15 (26492902) 4
20 (31825261) 4
16 (24639339) 4
14 (27425222) 4
42 (-3194411) 4
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
FDG-PET breast dedicated Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 0 0 0 0 0 0 0
Sestamibi MBI Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 0 0 0 0 0 0 0
Variant 2: Female. Age 30 to 39 years. Postsurgical excision with nonmalignant pathology. Asymptomatic. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Digital breast tomosynthesis screening May be appropriate Limited ☢☢ 0.1-1mSv 4 4 5 1 1 4 6 0 0 0 0
References Study Quality
1 (28648873) 4
17 (-3194409) 4
Mammography screening May be appropriate Limited ☢☢ 0.1-1mSv 4 4 4 1 2 5 5 0 0 0 0
References Study Quality
1 (28648873) 4
17 (-3194409) 4
MRI breast without and with IV contrast May be appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 5 5 4 1 1 2 9 0 0 0 0
US breast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 3 2 2 0 0 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 13 4 0 0 0 0 0 0 0
Mammography diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 14 3 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
FDG-PET breast dedicated Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 0 0 0 0 0 0 0
Sestamibi MBI Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 0 0 0 0 0 0 0
Variant 3: Adult female younger than 30 years of age. Postsurgical excision with nonmalignant pathology. Asymptomatic. 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 not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 1 0 0 0
Digital breast tomosynthesis diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 17 0 0 0 0 0 0 0 0
Digital breast tomosynthesis screening Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
1 (28648873) 4
17 (-3194409) 4
Mammography diagnostic Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 17 0 0 0 0 0 0 0 0
Mammography screening Usually not appropriate Limited ☢☢ 0.1-1mSv 1 1 17 0 0 0 0 0 0 0 0
References Study Quality
1 (28648873) 4
17 (-3194409) 4
MRI breast without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 12 1 3 1 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 17 0 0 0 0 0 0 0 0
FDG-PET breast dedicated Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 0 0 0 0 0 0 0
Sestamibi MBI Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 17 0 0 0 0 0 0 0 0
Variant 4: Adult female. Postsurgical excision for breast cancer. Positive margins. Asymptomatic. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Digital breast tomosynthesis diagnostic May be appropriate (Disagreement) Expert Opinion ☢☢ 0.1-1mSv 5 5 6 0 0 1 5 4 0 1 0
Mammography diagnostic May be appropriate Strong ☢☢ 0.1-1mSv 5 5 0 0 0 0 9 5 2 1 0
References Study Quality
25 (24674371) 2
24 (31182403) 2
MRI breast without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 9 5 1 0 1
References Study Quality
26 (25091598) 3
27 (20545940) 4
24 (31182403) 2
US breast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 1 3 1 0 0 0 0
Digital breast tomosynthesis screening Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 12 1 1 0 0 1 1 0 0
Mammography screening Usually not appropriate Expert Consensus ☢☢ 0.1-1mSv 1 1 14 0 0 0 0 0 1 1 0
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 2 0 0 0 0 0 0 0
FDG-PET breast dedicated Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 12 2 1 0 0 0 0 0 1
Sestamibi MBI Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 1 1 0 0 0 0 0 0
Variant 5: Adult female. Surveillance following completion of breast conservation therapy for breast cancer. Negative margins. With or without radiation. Asymptomatic.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Digital breast tomosynthesis diagnostic Usually appropriate Limited ☢☢ 0.1-1mSv 8 8 1 0 0 0 2 0 2 4 7
References Study Quality
36 (25904721) 3
40 (24113745) 3
57 (22692036) 3
34 (29748762) 3
43 (29064749) 4
59 (27163158) 3
44 (31685110) 4
45 (29450753) 4
53 (28822394) 4
37 (28341031) 4
46 (22005943) 4
47 (20091247) 4
48 (28749724) 3
23 (27810132) 4
30 (22872291) 3
58 (31313678) 3
54 (29102277) 4
49 (29353367) 4
33 (23860534) 4
35 (29718790) 4
50 (23408106) 4
55 (21951942) 4
41 (24106867) 3
22 (20956827) 4
56 (28675577) 4
28 (30207076) 4
61 (32529566) 3
60 (33350890) 3
52 (-3194403) 4
51 (-3194405) 4
42 (-3194411) 4
Digital breast tomosynthesis screening Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 1 0 0 0 0 1 5 10
References Study Quality
36 (25904721) 3
40 (24113745) 3
57 (22692036) 3
34 (29748762) 3
43 (29064749) 4
59 (27163158) 3
44 (31685110) 4
67 (31161975) 4
45 (29450753) 4
53 (28822394) 4
37 (28341031) 4
46 (22005943) 4
47 (20091247) 4
48 (28749724) 3
23 (27810132) 4
30 (22872291) 3
58 (31313678) 3
54 (29102277) 4
49 (29353367) 4
33 (23860534) 4
35 (29718790) 4
50 (23408106) 4
55 (21951942) 4
41 (24106867) 3
22 (20956827) 4
56 (28675577) 4
28 (30207076) 4
61 (32529566) 3
60 (33350890) 3
52 (-3194403) 4
51 (-3194405) 4
Mammography diagnostic Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 1 0 1 0 2 3 9
References Study Quality
36 (25904721) 3
40 (24113745) 3
57 (22692036) 3
34 (29748762) 3
43 (29064749) 4
59 (27163158) 3
44 (31685110) 4
45 (29450753) 4
53 (28822394) 4
37 (28341031) 4
46 (22005943) 4
47 (20091247) 4
48 (28749724) 3
23 (27810132) 4
30 (22872291) 3
58 (31313678) 3
54 (29102277) 4
49 (29353367) 4
33 (23860534) 4
35 (29718790) 4
50 (23408106) 4
55 (21951942) 4
41 (24106867) 3
22 (20956827) 4
56 (28675577) 4
28 (30207076) 4
61 (32529566) 3
60 (33350890) 3
52 (-3194403) 4
51 (-3194405) 4
42 (-3194411) 4
Mammography screening Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 1 0 0 0 0 0 2 14
References Study Quality
36 (25904721) 3
40 (24113745) 3
57 (22692036) 3
34 (29748762) 3
43 (29064749) 4
59 (27163158) 3
44 (31685110) 4
45 (29450753) 4
53 (28822394) 4
37 (28341031) 4
46 (22005943) 4
47 (20091247) 4
48 (28749724) 3
23 (27810132) 4
30 (22872291) 3
58 (31313678) 3
54 (29102277) 4
49 (29353367) 4
33 (23860534) 4
35 (29718790) 4
50 (23408106) 4
55 (21951942) 4
41 (24106867) 3
22 (20956827) 4
56 (28675577) 4
28 (30207076) 4
61 (32529566) 3
60 (33350890) 3
52 (-3194403) 4
51 (-3194405) 4
US breast May be appropriate Limited O 0 mSv O 0 mSv [ped] 4 4 5 2 1 1 5 1 1 0 0
References Study Quality
75 (26663035) 3
77 (23695431) 3
73 (28786298) 4
74 (27184247) 3
72 (31038406) 3
76 (21208726) 3
MRI breast without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 1 8 3 4 0 0
References Study Quality
69 (29357842) 3
65 (28700966) 4
70 (26142951) 3
67 (31161975) 4
71 (20605594) 3
68 (31738203) 3
62 (26400412) 3
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 14 0 1 0 0 0 1 0 0
FDG-PET breast dedicated Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 0 0 1 0 0 0 0 1
Sestamibi MBI Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 15 0 0 0 0 0 0 1 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.