American College of Radiology
ACR Appropriateness Criteria®

Staging and Follow-up of Ovarian Cancer

Variant 1: Initial staging of pretreatment ovarian cancer.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 1 0 1 2 1 13
References Study Quality
14 (7480729) 3
39 (18519739) 2
40 (20683405) 2
43 (1947112) 3
52 (7676985) 3
57 (25783507) 2
58 (12794595) 2
59 (23994535) 2
64 (17264334) 3
65 (3336709) 3
66 (2917315) 3
67 (3258096) 3
68 (14730048) 4
CT chest abdomen pelvis with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv 8 8 0 0 0 1 0 1 5 3 8
References Study Quality
70 (19955956) 4
71 (21193598) 2
72 (11222208) 4
73 (11566689) 4
MRI abdomen and pelvis without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 0 3 2 9 4 1 0
References Study Quality
31 (19620444) 2
68 (14730048) 4
74 (10644099) 3
75 (22302265) 3
76 (10831697) 1
77 (17157627) 4
78 (18485169) 3
FDG-PET/CT skull base to mid-thigh May be appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 6 6 0 0 0 2 4 11 2 0 0
References Study Quality
33 (11418411) 3
79 (17625380) 3
80 (12034950) 2
81 (26350201) 2
82 (24463640) 3
32 (19926121) 2
34 (18827492) 3
35 (18682935) 2
36 (19252950) 2
37 (20042226) 2
68 (14730048) 4
83 (14684544) 2
CT abdomen and pelvis without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 5 1 11 1 1 0 0 0
CT chest abdomen pelvis without IV contrast May be appropriate ☢☢☢☢ 10-30 mSv 4 4 1 3 4 9 2 0 0 0 0
MRI abdomen and pelvis without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 0 3 3 5 7 1 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 5 7 4 1 1 0 0 0
References Study Quality
5 (20858663) 3
14 (7480729) 3
39 (18519739) 2
40 (20683405) 2
43 (1947112) 3
52 (7676985) 3
57 (25783507) 2
58 (12794595) 2
59 (23994535) 2
60 (18704437) 3
61 (17233859) 3
62 (19098191) 3
63 (20981128) 4
64 (17264334) 3
65 (3336709) 3
66 (2917315) 3
67 (3258096) 3
68 (14730048) 4
CT chest abdomen pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 3 3 2 4 8 3 1 0 0 1 0
References Study Quality
70 (19955956) 4
71 (21193598) 2
72 (11222208) 4
73 (11566689) 4
US abdomen and pelvis transabdominal Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 6 3 4 3 1 1 0 0 0
US pelvis transvaginal Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 5 4 6 1 1 1 0 0 0
References Study Quality
30 (9623473) 4
Fluoroscopy contrast enema Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 4 2 1 0 0 0 0 1
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 1 1 0 1 0 0 0 0
Variant 2: Extent of disease in suspected or known recurrence of ovarian cancer.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 9 9 0 0 0 1 0 1 3 3 10
References Study Quality
5 (20858663) 3
43 (1947112) 3
52 (7676985) 3
58 (12794595) 2
59 (23994535) 2
86 (18418592) 3
87 (26745811) 3
CT chest abdomen pelvis with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv 9 9 0 0 0 1 0 0 4 4 9
References Study Quality
43 (1947112) 3
52 (7676985) 3
58 (12794595) 2
59 (23994535) 2
86 (18418592) 3
87 (26745811) 3
FDG-PET/CT skull base to mid-thigh Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 1 0 0 1 2 2 2 8 2
References Study Quality
10 (21415197) 4
19 (16515575) 3
34 (18827492) 3
86 (18418592) 3
87 (26745811) 3
88 (18378417) Good
89 (17404789) 2
90 (11373212) 3
91 (17208284) 3
92 (21752752) 4
MRI abdomen and pelvis without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 1 5 3 8 2 0 0
References Study Quality
88 (18378417) Good
CT abdomen and pelvis without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 5 2 8 3 1 0 0 0
CT chest abdomen pelvis without IV contrast May be appropriate ☢☢☢☢ 10-30 mSv 4 4 1 4 2 9 2 1 0 0 0
MRI abdomen and pelvis without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 1 3 3 8 2 2 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 5 8 3 1 1 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 3 3 2 4 8 3 1 1 0 0 0
References Study Quality
5 (20858663) 3
43 (1947112) 3
52 (7676985) 3
58 (12794595) 2
59 (23994535) 2
86 (18418592) 3
87 (26745811) 3
US abdomen and pelvis transabdominal Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 3 13 1 0 1 0 0 0
US pelvis transvaginal Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 5 10 1 1 1 0 0 0
Fluoroscopy contrast enema Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 3 1 0 0 0 0 1
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 15 0 2 0 1 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.