MRI chest and abdomen without and with IV contrast
May Be Appropriate
FDG-PET/MRI skull base to mid-thigh
May Be Appropriate
CT chest abdomen pelvis with IV contrast
May Be Appropriate (Disagreement)
Radiography chest
Usually Not Appropriate
Fluoroscopy upper GI series
Usually Not Appropriate
MRI chest and abdomen without IV contrast
Usually Not Appropriate
CT chest abdomen pelvis without and with IV contrast
Usually Not Appropriate
CT chest abdomen pelvis without IV contrast
Usually Not Appropriate
CT chest and abdomen without and with IV contrast
Usually Not Appropriate
CT chest and abdomen without IV contrast
Usually Not Appropriate
Variant: 2Esophageal cancer. Imaging during treatment.
Procedure
Appropriateness Category
FDG-PET/CT skull base to mid-thigh
Usually Appropriate
MRI chest and abdomen without and with IV contrast
May Be Appropriate
FDG-PET/MRI skull base to mid-thigh
May Be Appropriate
Radiography chest
Usually Not Appropriate
Fluoroscopy upper GI series
Usually Not Appropriate
MRI chest and abdomen without IV contrast
Usually Not Appropriate
CT chest abdomen pelvis with IV contrast
Usually Not Appropriate
CT chest abdomen pelvis without and with IV contrast
Usually Not Appropriate
CT chest abdomen pelvis without IV contrast
Usually Not Appropriate
CT chest and abdomen with IV contrast
Usually Not Appropriate
CT chest and abdomen without and with IV contrast
Usually Not Appropriate
CT chest and abdomen without IV contrast
Usually Not Appropriate
Variant: 3Esophageal cancer. Posttreatment imaging. No suspected or known recurrence.
Procedure
Appropriateness Category
CT chest and abdomen with IV contrast
Usually Appropriate
FDG-PET/CT skull base to mid-thigh
Usually Appropriate
CT chest abdomen pelvis with IV contrast
May Be Appropriate
Radiography chest
Usually Not Appropriate
Fluoroscopy upper GI series
Usually Not Appropriate
MRI chest and abdomen without and with IV contrast
Usually Not Appropriate
MRI chest and abdomen without IV contrast
Usually Not Appropriate
FDG-PET/MRI skull base to mid-thigh
Usually Not Appropriate
CT chest abdomen pelvis without and with IV contrast
Usually Not Appropriate
CT chest abdomen pelvis without IV contrast
Usually Not Appropriate
CT chest and abdomen without and with IV contrast
Usually Not Appropriate
CT chest and abdomen without IV contrast
Usually Not Appropriate
Variant: 4Esophageal cancer. Posttreatment imaging. Suspected or known recurrence.
Procedure
Appropriateness Category
CT chest and abdomen with IV contrast
Usually Appropriate
FDG-PET/CT skull base to mid-thigh
Usually Appropriate
CT chest abdomen pelvis with IV contrast
May Be Appropriate (Disagreement)
Radiography chest
Usually Not Appropriate
Fluoroscopy upper GI series
Usually Not Appropriate
MRI chest and abdomen without and with IV contrast
Usually Not Appropriate
MRI chest and abdomen without IV contrast
Usually Not Appropriate
MRI head without and with IV contrast
Usually Not Appropriate
MRI head without IV contrast
Usually Not Appropriate
FDG-PET/MRI skull base to mid-thigh
Usually Not Appropriate
CT chest abdomen pelvis without and with IV contrast
Usually Not Appropriate
CT chest abdomen pelvis without IV contrast
Usually Not Appropriate
CT chest and abdomen without and with IV contrast
Usually Not Appropriate
CT chest and abdomen without IV contrast
Usually Not Appropriate
Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant. More than one procedure can be considered usually appropriate in the initial imaging evaluation when:
There are procedures that are equivalent alternatives (i.e., only one procedure will be ordered to provide the clinical information to effectively manage the patient’s care)
OR
There are complementary procedures (i.e., more than one procedure is ordered as a set or simultaneously wherein each procedure provides unique clinical information to effectively manage the patient’s care).
The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.
The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.
May Be Appropriate
4, 5, or 6
The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.
May Be Appropriate (Disagreement)
5
The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.
Usually Not Appropriate
1, 2, or 3
The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.
The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination