American College of Radiology
ACR Appropriateness Criteria®

Pretreatment Staging of Muscle-Invasive Bladder Cancer

Variant 1: Pretreatment staging of muscle-invasive bladder cancer.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest Usually appropriate ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 1 0 1 0 3 3 10
CT abdomen and pelvis without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 0 0 0 3 14
MRI abdomen and pelvis without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 3 1 2 6 5
CT abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 0 0 1 0 3 8 3 2
MRI pelvis without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 1 0 0 1 0 5 6 3 2
FDG-PET/CT skull base to mid-thigh May be appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 1 0 0 0 7 6 3 0 0
MRI pelvis without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 2 3 3 5 4 1 0 0
CT chest with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 2 2 10 2 0 0 0
CT chest without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 2 12 2 0 0 0
CT abdomen and pelvis without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 1 8 3 4 0 1 1 0
CT chest without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 2 7 3 1 0 0 0 0
CT pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 6 3 4 1 2 0 0 0
MRI abdomen without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 6 6 3 2 0 0 0 0
MRI head without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 7 4 2 3 1 0 0 0
US pelvis (bladder) Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 3 3 6 2 2 1 0 1 0
CT abdomen without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 6 7 1 0 0 1 0 0
CT abdomen with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 2 8 1 4 0 1 0 0
CT pelvis with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 3 6 5 1 1 0 0 0
CT pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 7 4 1 0 0 0 0
MRI abdomen without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 3 11 2 0 0 0 0 0
Tc-99m bone scan whole body Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 0 10 4 1 0 0 0 0
CT abdomen without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 6 9 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 1 7 3 3 2 0 0 0
MRI head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 3 11 3 0 0 1 0 0 0
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 4 6 4 2 0 1 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.