Variant 1: 67-year-old man diagnosed from PSA screening program. PSA 5.2 ng/mL, prostate within normal limits on examination. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 2: 60-year-old man, asymptomatic in PSA screening program. PSA 5.2 ng/mL, prostate without palpable abnormalities. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6. CT simulation reveals grossly distended rectum (gas and stool).

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 3: 60-year-old man, asymptomatic in PSA screening program. PSA 5.2 ng/mL, prostate within normal limits, no palpable lesions. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6. CT simulation reveals very large-volume prostate (100 mL).

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 4: 60-year-old man, asymptomatic in PSA screening program. PSA 5.2 ng/mL, prostate without palpable abnormalities. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6. Patient has bilateral hip implants.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 5: 60-year-old man, asymptomatic in PSA screening program. PSA 5.2 ng/mL, prostate without palpable abnormalities. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6. Patient has a history of inflammatory bowel disease.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 6: 60-year-old man, asymptomatic in PSA screening program. PSA 5.2 ng/mL, prostate within normal limits, no palpable lesions. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6. Patient has radical prostatectomy that reveals pT2 disease, positive apical margin, postoperative PSA of 0.2 ng/mL. Adjuvant EBRT recommended.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

Variant 7: 60-year-old man, asymptomatic in PSA screening program. PSA 5.2 ng/mL, prostate with palpable abnormalities. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6. Patient is obese, with pannus extending into radiation field.

Procedure	Appropriateness Category	SOE	Adult RRL	Peds RRL	Rating	Median	Final Tabulations
							1	2	3	4	5	6	7	8	9

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.

Appropriateness Criteria