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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 Limited ☢ <0.1 mSv ☢ <0.03 mSv [ped] 9 9 0 0 1 0 1 0 3 3 10
References Study Quality
62 (12010321) 4
28 (21586938) 3
MRI abdomen and pelvis without and with IV contrast Usually appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 3 1 2 6 5
MRI pelvis without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 1 0 0 1 0 5 6 3 2
References Study Quality
20 (19457808) 4
47 (1631289) 4
34 (25615755) 1
37 (23746384) 2
46 (16793197) 2
45 (22989110) 2
38 (21688007) 2
43 (25835087) 3
42 (23801469) 2
41 (27190913) 2
40 (21924408) 2
39 (23040723) 2
44 (24637583) 2
33 (15615961) 2
35 (19247665) 2
36 (19332849) 2
48 (19914691) 3
CT abdomen and pelvis with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 7 7 1 0 0 1 0 3 8 3 2
CT abdomen and pelvis without and with IV contrast Usually appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 9 9 0 0 0 0 0 0 0 3 14
MRI pelvis without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 5 0 2 3 3 5 4 1 0 0
References Study Quality
20 (19457808) 4
47 (1631289) 4
34 (25615755) 1
37 (23746384) 2
46 (16793197) 2
45 (22989110) 2
38 (21688007) 2
43 (25835087) 3
42 (23801469) 2
41 (27190913) 2
40 (21924408) 2
39 (23040723) 2
44 (24637583) 2
33 (15615961) 2
35 (19247665) 2
36 (19332849) 2
48 (19914691) 3
CT abdomen and pelvis without IV contrast May be appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 1 8 3 4 0 1 1 0
CT chest with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 2 2 10 2 0 0 0
References Study Quality
63 (27375033) 4
64 (25096609) 4
CT chest without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 0 2 12 2 0 0 0
References Study Quality
63 (27375033) 4
64 (25096609) 4
FDG-PET/CT skull base to mid-thigh May be appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 1 0 0 0 7 6 3 0 0
References Study Quality
57 (23790129) 4
53 (27601364) 2
50 (24341486) 2
52 (26847182) 2
56 (25623843) 4
51 (23179944) 1
54 (19652070) 2
58 (16741302) 2
55 (20679618) 3
US pelvis (bladder) Usually not appropriate Strong O 0 mSv O 0 mSv [ped] 3 3 3 3 6 2 2 1 0 1 0
References Study Quality
20 (19457808) 4
74 (15285748) 3
69 (25842745) 3
71 (15749550) 3
73 (1459827) 4
68 (8364777) 3
72 (20028917) 2
70 (17715306) 3
75 (11186470) 4
Radiography intravenous urography Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 4 6 4 2 0 1 0 1 0
References Study Quality
31 (21512076) 3
MRI abdomen and pelvis without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 3 3 1 1 7 3 3 2 0 0 0
MRI abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 1 3 11 2 0 0 0 0 0
References Study Quality
49 (18372452) 4
MRI abdomen without IV contrast Usually not appropriate Expert Consensus 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 Limited O 0 mSv O 0 mSv [ped] 3 3 1 7 4 2 3 1 0 0 0
References Study Quality
5 (21178055) 4
76 (12712482) 4
MRI head without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 2 3 11 3 0 0 1 0 0 0
References Study Quality
5 (21178055) 4
76 (12712482) 4
Bone scan whole body Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 0 10 4 1 0 0 0 0
References Study Quality
65 (2965914) 4
66 (8653315) 3
67 (17671529) 4
CT abdomen with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 2 8 1 4 0 1 0 0
CT abdomen without IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 6 7 1 0 0 1 0 0
CT chest without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 2 7 3 1 0 0 0 0
References Study Quality
63 (27375033) 4
64 (25096609) 4
CT pelvis with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 3 6 5 1 1 0 0 0
References Study Quality
20 (19457808) 4
26 (26513586) 2
23 (22198726) 3
25 (23323729) 3
24 (22446350) 3
16 (-3111280) 4
17 (-3111282) 4
19 (19457811) 4
2 (17157629) 4
21 (8470608) 4
18 (10961281) 4
22 (10799162) 3
27 (14733775) 2
CT pelvis without IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 6 3 4 1 2 0 0 0
References Study Quality
20 (19457808) 4
26 (26513586) 2
23 (22198726) 3
25 (23323729) 3
24 (22446350) 3
16 (-3111280) 4
17 (-3111282) 4
19 (19457811) 4
2 (17157629) 4
21 (8470608) 4
18 (10961281) 4
22 (10799162) 3
27 (14733775) 2
CT abdomen without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 2 6 9 0 0 0 0 0 0
CT pelvis without and with IV contrast Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 3 7 4 1 0 0 0 0
References Study Quality
20 (19457808) 4
26 (26513586) 2
23 (22198726) 3
25 (23323729) 3
24 (22446350) 3
16 (-3111280) 4
17 (-3111282) 4
19 (19457811) 4
2 (17157629) 4
21 (8470608) 4
18 (10961281) 4
22 (10799162) 3
27 (14733775) 2
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.