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Home Pretreatment Detection, Surveillance, and Staging of Prostate Cancer
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Prostate cancer, intermediate risk, staging 3196077
MRI-targeted biopsy prostate
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI abdomen and pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT chest abdomen pelvis with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Fluciclovine PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢
Usually appropriate
PSMA PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢
Usually appropriate
TRUS-guided biopsy prostate
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI abdomen and pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI whole body without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRI whole body without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
Choline PET/CT skull base to mid-thigh
1-10 mSv
☢☢☢
May be appropriate
Choline PET/MRI skull base to mid-thigh
1-10 mSv
☢☢☢
May be appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
Fluciclovine PET/MRI skull base to mid-thigh
1-10 mSv
☢☢☢
May be appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		May be appropriate
(Disagreement)
CT chest abdomen pelvis without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
Fluoride PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
TRUS prostate
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
FDG-PET/MRI skull base to mid-thigh
1-10 mSv
☢☢☢
Usually not appropriate
CT chest abdomen pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate