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Home Staging and Follow-up of Vulvar Cancer
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vulvar cancer, primary tumor <=2cm, confined to vulva or perineum, <=1mm stromal invasion, initial pretreatment staging 3193990
US duplex Doppler and US-guided fine-needle aspiration biopsy groin
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
US duplex Doppler groin
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
US-guided fine needle aspiration biopsy groin
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Radiography chest
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
MRI pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Lymphoscintigraphy groin
0.1-1mSv
☢☢
Usually not appropriate
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vulvar cancer, primary tumor <=4cm, >1mm stromal invasion, confined to vulva or perineum, initial pretreatment staging 3194044
MRI pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US duplex Doppler and US-guided fine-needle aspiration biopsy groin
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
(Disagreement)
Lymphoscintigraphy groin
0.1-1mSv
☢☢
May be appropriate
US duplex Doppler groin
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
US-guided fine needle aspiration biopsy groin
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Radiography chest
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vulvar cancer, primary tumor <=4cm, >1mm stromal invasion, minimal involvement of urethra or vagina or anus, initial pretreatment staging 3194045
MRI pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US duplex Doppler and US-guided fine-needle aspiration biopsy groin
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
(Disagreement)
Lymphoscintigraphy groin
0.1-1mSv
☢☢
May be appropriate
US duplex Doppler groin
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
US-guided fine needle aspiration biopsy groin
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Radiography chest
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vulvar cancer, primary tumor any size, more than minimal involvement of urethra or vagina or anus, initial pretreatment staging 3194047
MRI pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT chest abdomen pelvis with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
US duplex Doppler and US-guided fine-needle aspiration biopsy groin
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
US-guided fine needle aspiration biopsy groin
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRI pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
CT pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT chest abdomen pelvis without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
US duplex Doppler groin
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Radiography chest
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Lymphoscintigraphy groin
0.1-1mSv
☢☢
Usually not appropriate
CT pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vulvar cancer, primary tumor >4 cm, initial pretreatment staging 3194046
MRI pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT chest abdomen pelvis with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
US duplex Doppler and US-guided fine-needle aspiration biopsy groin
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
US-guided fine needle aspiration biopsy groin
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRI pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
CT pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT chest abdomen pelvis without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
US duplex Doppler groin
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Radiography chest
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Lymphoscintigraphy groin
0.1-1mSv
☢☢
Usually not appropriate
CT pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vulvar cancer, treated, recurrence suspected 3193993
MRI pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT chest abdomen pelvis with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
US duplex Doppler and US-guided fine-needle aspiration biopsy groin
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
US-guided fine needle aspiration biopsy groin
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRI pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
CT pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
CT pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
CT chest abdomen pelvis without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
US duplex Doppler groin
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Radiography chest
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT chest abdomen pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
CT pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
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