Staging and Post-Therapy Assessment of Head and Neck Cancer

Variant: 1 Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.

Procedure	Appropriateness Category	Relative Radiation Level
MRI orbits face neck without and with IV contrast	Usually Appropriate	O
CT neck with IV contrast	Usually Appropriate	☢☢☢
FDG-PET/CT skull base to mid-thigh	Usually Appropriate	☢☢☢☢
US neck	May Be Appropriate	O
CT chest with IV contrast	May Be Appropriate	☢☢☢
CT chest without IV contrast	May Be Appropriate	☢☢☢
FDG-PET/MRI skull base to mid-thigh	May Be Appropriate	☢☢☢
Radiography chest	Usually Not Appropriate	☢
Radiography paranasal sinuses	Usually Not Appropriate	☢
MRA neck with IV contrast	Usually Not Appropriate	O
MRA neck without and with IV contrast	Usually Not Appropriate	O
MRA neck without IV contrast	Usually Not Appropriate	O
MRI head with IV contrast	Usually Not Appropriate	O
MRI head without and with IV contrast	Usually Not Appropriate	O
MRI head without IV contrast	Usually Not Appropriate	O
MRI orbits face neck with IV contrast	Usually Not Appropriate	O
MRI orbits face neck without IV contrast	Usually Not Appropriate	O
CT maxillofacial with IV contrast	Usually Not Appropriate	☢☢
CT maxillofacial without IV contrast	Usually Not Appropriate	☢☢
CT chest without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head with IV contrast	Usually Not Appropriate	☢☢☢
CT head without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head without IV contrast	Usually Not Appropriate	☢☢☢
CT maxillofacial without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without IV contrast	Usually Not Appropriate	☢☢☢
CTA neck with IV contrast	Usually Not Appropriate	☢☢☢

Variant: 2 Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.

Procedure	Appropriateness Category	Relative Radiation Level
MRI orbits face neck without and with IV contrast	Usually Appropriate	O
CT neck with IV contrast	Usually Appropriate	☢☢☢
FDG-PET/MRI skull base to mid-thigh	Usually Appropriate	☢☢☢
FDG-PET/CT skull base to mid-thigh	Usually Appropriate	☢☢☢☢
US neck	May Be Appropriate	O
MRI head without and with IV contrast	May Be Appropriate	O
CT maxillofacial with IV contrast	May Be Appropriate (Disagreement)	☢☢
CT maxillofacial without IV contrast	May Be Appropriate (Disagreement)	☢☢
CT chest with IV contrast	May Be Appropriate	☢☢☢
CT chest without IV contrast	May Be Appropriate	☢☢☢
Radiography chest	Usually Not Appropriate	☢
Radiography paranasal sinuses	Usually Not Appropriate	☢
MRA neck with IV contrast	Usually Not Appropriate	O
MRA neck without and with IV contrast	Usually Not Appropriate	O
MRA neck without IV contrast	Usually Not Appropriate	O
MRI head with IV contrast	Usually Not Appropriate	O
MRI head without IV contrast	Usually Not Appropriate	O
MRI orbits face neck with IV contrast	Usually Not Appropriate	O
MRI orbits face neck without IV contrast	Usually Not Appropriate	O
CT chest without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head with IV contrast	Usually Not Appropriate	☢☢☢
CT head without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head without IV contrast	Usually Not Appropriate	☢☢☢
CT maxillofacial without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without IV contrast	Usually Not Appropriate	☢☢☢
CTA neck with IV contrast	Usually Not Appropriate	☢☢☢

Variant: 3 Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.

Procedure	Appropriateness Category	Relative Radiation Level
MRI orbits face neck without and with IV contrast	Usually Appropriate	O
CT neck with IV contrast	Usually Appropriate	☢☢☢
FDG-PET/CT skull base to mid-thigh	Usually Appropriate	☢☢☢☢
US neck	May Be Appropriate	O
MRI head without and with IV contrast	May Be Appropriate	O
CT maxillofacial with IV contrast	May Be Appropriate	☢☢
CT maxillofacial without IV contrast	May Be Appropriate (Disagreement)	☢☢
CT chest with IV contrast	May Be Appropriate	☢☢☢
CT chest without IV contrast	May Be Appropriate	☢☢☢
FDG-PET/MRI skull base to mid-thigh	May Be Appropriate	☢☢☢
Radiography chest	Usually Not Appropriate	☢
Radiography paranasal sinuses	Usually Not Appropriate	☢
MRA neck with IV contrast	Usually Not Appropriate	O
MRA neck without and with IV contrast	Usually Not Appropriate	O
MRA neck without IV contrast	Usually Not Appropriate	O
MRI head with IV contrast	Usually Not Appropriate	O
MRI head without IV contrast	Usually Not Appropriate	O
MRI orbits face neck with IV contrast	Usually Not Appropriate	O
MRI orbits face neck without IV contrast	Usually Not Appropriate	O
CT chest without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head with IV contrast	Usually Not Appropriate	☢☢☢
CT head without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head without IV contrast	Usually Not Appropriate	☢☢☢
CT maxillofacial without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without IV contrast	Usually Not Appropriate	☢☢☢
CTA neck with IV contrast	Usually Not Appropriate	☢☢☢

Variant: 4 Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.

Procedure	Appropriateness Category	Relative Radiation Level
MRI orbits face neck without and with IV contrast	Usually Appropriate	O
CT neck with IV contrast	Usually Appropriate	☢☢☢
FDG-PET/CT skull base to mid-thigh	Usually Appropriate	☢☢☢☢
US neck	May Be Appropriate	O
CT chest with IV contrast	May Be Appropriate	☢☢☢
CT chest without IV contrast	May Be Appropriate	☢☢☢
FDG-PET/MRI skull base to mid-thigh	May Be Appropriate	☢☢☢
Radiography chest	Usually Not Appropriate	☢
Radiography paranasal sinuses	Usually Not Appropriate	☢
MRA neck with IV contrast	Usually Not Appropriate	O
MRA neck without and with IV contrast	Usually Not Appropriate	O
MRA neck without IV contrast	Usually Not Appropriate	O
MRI head with IV contrast	Usually Not Appropriate	O
MRI head without and with IV contrast	Usually Not Appropriate	O
MRI head without IV contrast	Usually Not Appropriate	O
MRI orbits face neck with IV contrast	Usually Not Appropriate	O
MRI orbits face neck without IV contrast	Usually Not Appropriate	O
CT maxillofacial with IV contrast	Usually Not Appropriate	☢☢
CT maxillofacial without IV contrast	Usually Not Appropriate	☢☢
CT chest without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head with IV contrast	Usually Not Appropriate	☢☢☢
CT head without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head without IV contrast	Usually Not Appropriate	☢☢☢
CT maxillofacial without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without IV contrast	Usually Not Appropriate	☢☢☢
CTA neck with IV contrast	Usually Not Appropriate	☢☢☢

Variant: 5 Treated cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Surveillance imaging or follow-up imaging for suspected or known recurrence.

Procedure	Appropriateness Category	Relative Radiation Level
MRI orbits face neck without and with IV contrast	Usually Appropriate	O
CT neck with IV contrast	Usually Appropriate	☢☢☢
FDG-PET/CT skull base to mid-thigh	Usually Appropriate	☢☢☢☢
US neck	May Be Appropriate	O
CT chest with IV contrast	May Be Appropriate	☢☢☢
CT chest without IV contrast	May Be Appropriate	☢☢☢
FDG-PET/MRI skull base to mid-thigh	May Be Appropriate	☢☢☢
Radiography chest	Usually Not Appropriate	☢
Radiography paranasal sinuses	Usually Not Appropriate	☢
MRA neck with IV contrast	Usually Not Appropriate	O
MRA neck without and with IV contrast	Usually Not Appropriate	O
MRA neck without IV contrast	Usually Not Appropriate	O
MRI head with IV contrast	Usually Not Appropriate	O
MRI head without and with IV contrast	Usually Not Appropriate	O
MRI head without IV contrast	Usually Not Appropriate	O
MRI orbits face neck with IV contrast	Usually Not Appropriate	O
MRI orbits face neck without IV contrast	Usually Not Appropriate	O
CT maxillofacial with IV contrast	Usually Not Appropriate	☢☢
CT maxillofacial without IV contrast	Usually Not Appropriate	☢☢
CT chest without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head with IV contrast	Usually Not Appropriate	☢☢☢
CT head without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head without IV contrast	Usually Not Appropriate	☢☢☢
CT maxillofacial without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without IV contrast	Usually Not Appropriate	☢☢☢
CTA neck with IV contrast	Usually Not Appropriate	☢☢☢

Variant: 6 Treated nasopharynx cancer or EBV-associated unknown primary of the head and neck. Surveillance imaging or follow-up imaging for suspected or known recurrence.

Procedure	Appropriateness Category	Relative Radiation Level
MRI orbits face neck without and with IV contrast	Usually Appropriate	O
CT neck with IV contrast	Usually Appropriate	☢☢☢
FDG-PET/MRI skull base to mid-thigh	Usually Appropriate	☢☢☢
FDG-PET/CT skull base to mid-thigh	Usually Appropriate	☢☢☢☢
US neck	May Be Appropriate	O
MRI head without and with IV contrast	May Be Appropriate	O
CT maxillofacial with IV contrast	May Be Appropriate (Disagreement)	☢☢
CT maxillofacial without IV contrast	May Be Appropriate (Disagreement)	☢☢
CT chest with IV contrast	May Be Appropriate	☢☢☢
CT chest without IV contrast	May Be Appropriate	☢☢☢
Radiography chest	Usually Not Appropriate	☢
Radiography paranasal sinuses	Usually Not Appropriate	☢
MRA neck with IV contrast	Usually Not Appropriate	O
MRA neck without and with IV contrast	Usually Not Appropriate	O
MRA neck without IV contrast	Usually Not Appropriate	O
MRI head with IV contrast	Usually Not Appropriate	O
MRI head without IV contrast	Usually Not Appropriate	O
MRI orbits face neck with IV contrast	Usually Not Appropriate	O
MRI orbits face neck without IV contrast	Usually Not Appropriate	O
CT chest without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head with IV contrast	Usually Not Appropriate	☢☢☢
CT head without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head without IV contrast	Usually Not Appropriate	☢☢☢
CT maxillofacial without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without IV contrast	Usually Not Appropriate	☢☢☢
CTA neck with IV contrast	Usually Not Appropriate	☢☢☢

Variant: 7 Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.

Procedure	Appropriateness Category	Relative Radiation Level
MRI orbits face neck without and with IV contrast	Usually Appropriate	O
CT neck with IV contrast	Usually Appropriate	☢☢☢
FDG-PET/CT skull base to mid-thigh	Usually Appropriate	☢☢☢☢
US neck	May Be Appropriate	O
MRI head without and with IV contrast	May Be Appropriate	O
CT maxillofacial with IV contrast	May Be Appropriate	☢☢
CT maxillofacial without IV contrast	May Be Appropriate	☢☢
CT chest with IV contrast	May Be Appropriate	☢☢☢
CT chest without IV contrast	May Be Appropriate	☢☢☢
FDG-PET/MRI skull base to mid-thigh	May Be Appropriate	☢☢☢
Radiography chest	Usually Not Appropriate	☢
Radiography paranasal sinuses	Usually Not Appropriate	☢
MRA neck with IV contrast	Usually Not Appropriate	O
MRA neck without and with IV contrast	Usually Not Appropriate	O
MRA neck without IV contrast	Usually Not Appropriate	O
MRI head with IV contrast	Usually Not Appropriate	O
MRI head without IV contrast	Usually Not Appropriate	O
MRI orbits face neck with IV contrast	Usually Not Appropriate	O
MRI orbits face neck without IV contrast	Usually Not Appropriate	O
CT chest without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head with IV contrast	Usually Not Appropriate	☢☢☢
CT head without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head without IV contrast	Usually Not Appropriate	☢☢☢
CT maxillofacial without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without IV contrast	Usually Not Appropriate	☢☢☢
CTA neck with IV contrast	Usually Not Appropriate	☢☢☢

Variant: 8 Treated cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Surveillance imaging or follow-up imaging for suspected or known recurrence.

Procedure	Appropriateness Category	Relative Radiation Level
MRI orbits face neck without and with IV contrast	Usually Appropriate	O
CT neck with IV contrast	Usually Appropriate	☢☢☢
FDG-PET/CT skull base to mid-thigh	Usually Appropriate	☢☢☢☢
US neck	May Be Appropriate	O
CT chest with IV contrast	May Be Appropriate	☢☢☢
CT chest without IV contrast	May Be Appropriate	☢☢☢
FDG-PET/MRI skull base to mid-thigh	May Be Appropriate	☢☢☢
Radiography chest	Usually Not Appropriate	☢
Radiography paranasal sinuses	Usually Not Appropriate	☢
MRA neck with IV contrast	Usually Not Appropriate	O
MRA neck without and with IV contrast	Usually Not Appropriate	O
MRA neck without IV contrast	Usually Not Appropriate	O
MRI head with IV contrast	Usually Not Appropriate	O
MRI head without and with IV contrast	Usually Not Appropriate	O
MRI head without IV contrast	Usually Not Appropriate	O
MRI orbits face neck with IV contrast	Usually Not Appropriate	O
MRI orbits face neck without IV contrast	Usually Not Appropriate	O
CT maxillofacial with IV contrast	Usually Not Appropriate	☢☢
CT maxillofacial without IV contrast	Usually Not Appropriate	☢☢
CT chest without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head with IV contrast	Usually Not Appropriate	☢☢☢
CT head without and with IV contrast	Usually Not Appropriate	☢☢☢
CT head without IV contrast	Usually Not Appropriate	☢☢☢
CT maxillofacial without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without and with IV contrast	Usually Not Appropriate	☢☢☢
CT neck without IV contrast	Usually Not Appropriate	☢☢☢
CTA neck with IV contrast	Usually Not Appropriate	☢☢☢

Panel Members

Maria K. Gule-Monroe, MD^a; Susana Calle, MD^b; Bruno Policeni, MD, MBA^c; Amy F. Juliano, MD^d; Mohit Agarwal, MD^e; Laura QM Chow, MD^f; Prachi Dubey, MBBS, MPH^g; Elliott R. Friedman, MD^h; Mari Hagiwara, MDⁱ; Kate DuChene Hanrahan, MD, MME^j; Vikas Jain, MD^k; Tanya J. Rath, MD^l; Russell B. Smith, MD^m; Rathan M. Subramaniam, MD, PhD, MPH, MBAⁿ; M. Reza Taheri, MD, PhD^o; Sue S. Yom, MD, PhD^p; David Zander, MD^q; Judah Burns, MD^r.

Summary of Literature Review

Introduction/Background

Special Imaging Considerations

Discussion of Procedures by Variant

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
A. CT chest with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
B. CT chest without and with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
C. CT chest without IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
D. CT head with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
E. CT head without and with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
F. CT head without IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
G. CT maxillofacial with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
H. CT maxillofacial without and with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
I. CT maxillofacial without IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
J. CT neck with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
K. CT neck without and with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
L. CT neck without IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
M. CTA neck with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
N. FDG-PET/CT skull base to mid-thigh

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
O. FDG-PET/MRI skull base to mid-thigh

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
P. MRA neck with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
Q. MRA neck without and with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
R. MRA neck without IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
S. MRI head with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
T. MRI head without and with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
U. MRI head without IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
V. MRI orbits face neck with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
W. MRI orbits face neck without and with IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
X. MRI orbits face neck without IV contrast

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
Y. Radiography chest

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
Z. Radiography paranasal sinuses

Variant 1: Suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Initial staging.
[. US neck

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
A. CT chest with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
B. CT chest without and with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
C. CT chest without IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
D. CT head with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
E. CT head without and with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
F. CT head without IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
G. CT maxillofacial with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
H. CT maxillofacial without and with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
I. CT maxillofacial without IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
J. CT neck with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
K. CT neck without and with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
L. CT neck without IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
M. CTA neck with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
N. FDG-PET/CT skull base to mid-thigh

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
O. FDG-PET/MRI skull base to mid-thigh

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
P. MRA neck with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
Q. MRA neck without and with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
R. MRA neck without IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
S. MRI head with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
T. MRI head without and with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
U. MRI head without IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
V. MRI orbits face neck with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
W. MRI orbits face neck without and with IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
X. MRI orbits face neck without IV contrast

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
Y. Radiography chest

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
Z. Radiography paranasal sinuses

Variant 2: Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck. Initial staging.
[. US neck

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
A. CT chest with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
B. CT chest without and with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
C. CT chest without IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
D. CT head with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
E. CT head without and with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
F. CT head without IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
G. CT maxillofacial with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
H. CT maxillofacial without and with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
I. CT maxillofacial without IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
J. CT neck with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
K. CT neck without and with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
L. CT neck without IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
M. CTA neck with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
N. FDG-PET/CT skull base to mid-thigh

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
O. FDG-PET/MRI skull base to mid-thigh

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
P. MRA neck with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
Q. MRA neck without and with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
R. MRA neck without IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
S. MRI head with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
T. MRI head without and with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
U. MRI head without IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
V. MRI orbits face neck with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
W. MRI orbits face neck without and with IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
X. MRI orbits face neck without IV contrast

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
Y. Radiography chest

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
Z. Radiography paranasal sinuses

Variant 3: Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Initial staging.
[. US neck

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
A. CT chest with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
B. CT chest without and with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
C. CT chest without IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
D. CT head with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
E. CT head without and with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
F. CT head without IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
G. CT maxillofacial with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
H. CT maxillofacial without and with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
I. CT maxillofacial without IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
J. CT neck with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
K. CT neck without and with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
L. CT neck without IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
M. CTA neck with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
N. FDG-PET/CT skull base to mid-thigh

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
O. FDG-PET/MRI skull base to mid-thigh

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
P. MRA neck with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
Q. MRA neck without and with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
R. MRA neck without IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
S. MRI head with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
T. MRI head without and with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
U. MRI head without IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
V. MRI orbits face neck with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
W. MRI orbits face neck without and with IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
X. MRI orbits face neck without IV contrast

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
Y. Radiography chest

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
Z. Radiography paranasal sinuses

Variant 4: Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Initial staging.
[. US neck

Variant 5: Treated cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Surveillance imaging or follow-up imaging for suspected or known recurrence.

Variant 6: Treated nasopharynx cancer or EBV-associated unknown primary of the head and neck. Surveillance imaging or follow-up imaging for suspected or known recurrence.

Variant 6: Treated nasopharynx cancer or EBV-associated unknown primary of the head and neck. Surveillance imaging or follow-up imaging for suspected or known recurrence.
A. CT chest with IV contrast

Variant 6: Treated nasopharynx cancer or EBV-associated unknown primary of the head and neck. Surveillance imaging or follow-up imaging for suspected or known recurrence.
Y. Radiography chest

Variant 6: Treated nasopharynx cancer or EBV-associated unknown primary of the head and neck. Surveillance imaging or follow-up imaging for suspected or known recurrence.
[. US neck

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
A. CT chest with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
B. CT chest without and with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
C. CT chest without IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
D. CT head with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
E. CT head without and with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
F. CT head without IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
G. CT maxillofacial with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
H. CT maxillofacial without and with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
I. CT maxillofacial without IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
J. CT neck with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
K. CT neck without and with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
L. CT neck without IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
M. CTA neck with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
N. FDG-PET/CT skull base to mid-thigh

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
O. FDG-PET/MRI skull base to mid-thigh

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
P. MRA neck with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
Q. MRA neck without and with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
R. MRA neck without IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
S. MRI head with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
T. MRI head without and with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
U. MRI head without IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
V. MRI orbits face neck with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
W. MRI orbits face neck without and with IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
X. MRI orbits face neck without IV contrast

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
Y. Radiography chest

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
Z. Radiography paranasal sinuses

Variant 7: Treated cancer of the paranasal sinuses or nasal cavity. Surveillance imaging or follow-up imaging for suspected or known recurrence.
[. US neck

Variant 8: Treated cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Surveillance imaging or follow-up imaging for suspected or known recurrence.

Variant 8: Treated cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Surveillance imaging or follow-up imaging for suspected or known recurrence.
A. CT chest with IV contrast

Variant 8: Treated cancer of a major salivary gland (parotid, submandibular, and sublingual glands). Surveillance imaging or follow-up imaging for suspected or known recurrence.
[. US neck

Summary of Highlights

Supporting Documents

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.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Gender Equality and Inclusivity Clause

The ACR acknowledges the limitations in applying inclusive language when citing research studies that predates the use of the current understanding of language inclusive of diversity in sex, intersex, gender, and gender-diverse people. The data variables regarding sex and gender used in the cited literature will not be changed. However, this guideline will use the terminology and definitions as proposed by the National Institutes of Health.

Appropriateness Category Names and Definitions

Appropriateness Category Name	Appropriateness Rating	Appropriateness Category Definition
Usually Appropriate	7, 8, or 9	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.

Relative Radiation Level Information

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria^® Radiation Dose Assessment Introduction document.

Relative Radiation Level Designations
Relative Radiation Level*	Adult Effective Dose Estimate Range	Pediatric Effective Dose Estimate Range
O	0 mSv	0 mSv
☢	<0.1 mSv	<0.03 mSv
☢☢	0.1-1 mSv	0.03-0.3 mSv
☢☢☢	1-10 mSv	0.3-3 mSv
☢☢☢☢	10-30 mSv	3-10 mSv
☢☢☢☢☢	30-100 mSv	10-30 mSv
*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.”

References

1.	Rettig EM, D'Souza G. Epidemiology of head and neck cancer. [Review]. Surgical Oncology Clinics of North America. 24(3):379-96, 2015 Jul.
2.	NCCN Clinical Practice Guidelines in Oncology. Head and Neck Cancers. Version 1.2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf.
3.	Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017.
4.	Hoang JK, Oldan JD, Mandel SJ, et al. ACR Appropriateness Criteria® Thyroid Disease. J Am Coll Radiol 2019;16:S300-S14.
5.	Policeni B, Corey AS, Burns J, et al. ACR Appropriateness Criteria® Cranial Neuropathy. J Am Coll Radiol 2017;14:S406-S20.
6.	Aulino JM, Kirsch CFE, Burns J, et al. ACR Appropriateness Criteria® Neck Mass-Adenopathy. J Am Coll Radiol 2019;16:S150-S60.
7.	American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=164+&releaseId=2.
8.	Prasad R, Chen B. Imaging Evaluation of the Head and Neck Oncology Patient. Cancer Treat Res. 174:59-86, 2018.
9.	Sanli Y, Zukotynski K, Mittra E, et al. Update 2018: 18F-FDG PET/CT and PET/MRI in Head and Neck Cancer. [Review]. Clin Nucl Med. 43(12):e439-e452, 2018 Dec.
10.	Rohde M, Nielsen AL, Johansen J, et al. Head-to-Head Comparison of Chest X-Ray/Head and Neck MRI, Chest CT/Head and Neck MRI, and 18F-FDG PET/CT for Detection of Distant Metastases and Synchronous Cancer in Oral, Pharyngeal, and Laryngeal Cancer. J Nucl Med. 58(12):1919-1924, 2017 12.
11.	de Bree R, Deurloo EE, Snow GB, Leemans CR. Screening for distant metastases in patients with head and neck cancer. Laryngoscope. 110(3 Pt 1):397-401, 2000 Mar.
12.	de Bree R, Ljumanovic R, Hazewinkel MJ, Witte BI, Castelijns JA. Radiologic extranodal spread and matted nodes: Important predictive factors for development of distant metastases in patients with high-risk head and neck cancer. Head Neck. 38 Suppl 1:E1452-8, 2016 04.
13.	Senft A, Hoekstra OS, Castelijns JA, Leemans CR, de Bree R. Pretreatment screening for distant metastases in the Dutch head and neck centers: 10 years later. European Archives of Oto-Rhino-Laryngology. 273(10):3287-91, 2016 Oct.
14.	Jackel MC, Reischl A, Huppert P. Efficacy of radiologic screening for distant metastases and second primaries in newly diagnosed patients with head and neck cancer. Laryngoscope. 117(2):242-7, 2007 Feb.
15.	Fukuhara T, Fujiwara K, Fujii T, et al. Usefulness of chest CT scan for head and neck cancer. Auris Nasus Larynx. 42(1):49-52, 2015 Feb.
16.	Halimi C, Barry B, De Raucourt D, et al. Guidelines of the French Society of Otorhinolaryngology (SFORL), short version. Diagnosis of local recurrence and metachronous locations in head and neck oncology. Eur Ann Otorhinolaryngol Head Neck Dis. 132(5):287-90, 2015 Nov.
17.	Lee JR, Kim JS, Roh JL, et al. Detection of occult primary tumors in patients with cervical metastases of unknown primary tumors: comparison of (18)F FDG PET/CT with contrast-enhanced CT or CT/MR imaging-prospective study. Radiology. 274(3):764-71, 2015 Mar.
18.	Ong TK, Kerawala CJ, Martin IC, Stafford FW. The role of thorax imaging in staging head and neck squamous cell carcinoma. Journal of Cranio-Maxillo-Facial Surgery. 27(6):339-44, 1999 Dec.
19.	Senft A, Hoekstra OS, Witte BI, Leemans CR, de Bree R. Screening for distant metastases in head and neck cancer patients using FDG-PET and chest CT: validation of an algorithm. European Archives of Oto-Rhino-Laryngology. 273(9):2643-50, 2016 Sep.
20.	Piersiala K, Akst LM, Hillel AT, Best SR. Clinical practice patterns in laryngeal cancer and introduction of CT lung screening. Am J Otolaryngol. 40(4):520-524, 2019 Jul - Aug.
21.	Jaspers GW, Witjes MJ, Groen HJ, Groen H, Rodiger LA, Roodenburg JL. Strategies for patients with newly diagnosed oral squamous cell carcinoma and a positive chest CT. A cohort study on the effects on treatment planning and incidence. Eur J Surg Oncol. 37(3):272-7, 2011 Mar.
22.	Locatello LG, Bruno C, Pietragalla M, et al. A critical evaluation of computed tomography-derived depth of invasion in the preoperative assessment of oral cancer staging. Oral Oncol. 107:104749, 2020 08.
23.	Madana J, Laliberte F, Morand GB, et al. Computerized tomography based tumor-thickness measurement is useful to predict postoperative pathological tumor thickness in oral tongue squamous cell carcinoma. J Otolaryngol Head Neck Surg. 44:49, 2015 Nov 16.
24.	Yoon BC, Buch K, Cunnane ME, Sadow PM, Varvares MA, Juliano AF. Comparison between computed tomography and ultrasound for presurgical evaluation of oral tongue squamous cell carcinoma tumor thickness. American Journal of Otolaryngology. 42(6):103089, 2021 Nov-Dec.
25.	Yoon BC, Bulbul MD, Sadow PM, et al. Comparison of Intraoperative Sonography and Histopathologic Evaluation of Tumor Thickness and Depth of Invasion in Oral Tongue Cancer: A Pilot Study. Ajnr: American Journal of Neuroradiology. 41(7):1245-1250, 2020 07.
26.	Waech T, Pazahr S, Guarda V, Rupp NJ, Broglie MA, Morand GB. Measurement variations of MRI and CT in the assessment of tumor depth of invasion in oral cancer: A retrospective study. Eur J Radiol. 135:109480, 2021 Feb.
27.	Handschel J, Naujoks C, Depprich RA, et al. CT-scan is a valuable tool to detect mandibular involvement in oral cancer patients. Oral Oncol. 48(4):361-6, 2012 Apr.
28.	Naz N, Sattar J, Ashrafi SK. Diagnostic Accuracy of Computed Tomography in Detecting Bone Invasion due to Squamous Cell Carcinoma of Buccal Mucosa. J Coll Physicians Surg Pak. 28(11):829-833, 2018 Nov.
29.	Slieker FJB, Dankbaar JW, de Bree R, Van Cann EM. Detecting Bone Invasion of the Maxilla by Oral Squamous Cell Carcinoma: Diagnostic Accuracy of Preoperative Computed Tomography Versus Magnetic Resonance Imaging. J Oral Maxillofac Surg. 78(9):1645-1652, 2020 Sep.
30.	Adolphs AP, Boersma NA, Diemel BD, et al. A systematic review of computed tomography detection of cartilage invasion in laryngeal carcinoma. [Review]. Laryngoscope. 125(7):1650-5, 2015 Jul.
31.	Farrow ES, Boulanger T, Wojcik T, Lemaire AS, Raoul G, Julieron M. Magnetic resonance imaging and computed tomography in the assessment of mandibular invasion by squamous cell carcinoma of the oral cavity. Influence on surgical management and post-operative course. Rev Stomatol Chir Maxillofac Chir Orale. 117(5):311-321, 2016 Nov.
32.	Suzuki N, Kuribayashi A, Sakamoto K, et al. Diagnostic abilities of 3T MRI for assessing mandibular invasion of squamous cell carcinoma in the oral cavity: comparison with 64-row multidetector CT. Dentomaxillofac Radiol. 48(4):20180311, 2019 May.
33.	Cho SJ, Lee JH, Suh CH, et al. Comparison of diagnostic performance between CT and MRI for detection of cartilage invasion for primary tumor staging in patients with laryngo-hypopharyngeal cancer: a systematic review and meta-analysis. Eur Radiol. 30(7):3803-3812, 2020 Jul.
34.	Wu JH, Zhao J, Li ZH, et al. Comparison of CT and MRI in Diagnosis of Laryngeal Carcinoma with Anterior Vocal Commissure Involvement. Sci. rep.. 6:30353, 2016 08 02.
35.	Bae MR, Roh JL, Kim JS, et al. 18F-FDG PET/CT versus CT/MR imaging for detection of neck lymph node metastasis in palpably node-negative oral cavity cancer. J Cancer Res Clin Oncol. 146(1):237-244, 2020 Jan.
36.	Cho JK, Ow TJ, Lee AY, et al. Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg. 157(3):439-447, 2017 09.
37.	Kim SJ, Pak K, Kim K. Diagnostic accuracy of F-18 FDG PET or PET/CT for detection of lymph node metastasis in clinically node negative head and neck cancer patients; A systematic review and meta-analysis. Am J Otolaryngol. 40(2):297-305, 2019 Mar - Apr.
38.	Lee HJ, Kim J, Woo HY, Kang WJ, Lee JH, Koh YW. 18F-FDG PET-CT as a supplement to CT/MRI for detection of nodal metastasis in hypopharyngeal SCC with palpably negative neck. Laryngoscope. 125(7):1607-12, 2015 Jul.
39.	Sohn B, Koh YW, Kang WJ, Lee JH, Shin NY, Kim J. Is there an additive value of 18 F-FDG PET-CT to CT/MRI for detecting nodal metastasis in oropharyngeal squamous cell carcinoma patients with palpably negative neck?. Acta Radiol. 57(11):1352-1359, 2016 Nov.
40.	Erdogan N, Bulbul E, Songu M, et al. Puffed-cheek computed tomography: a dynamic maneuver for imaging oral cavity tumors. Ear Nose Throat J. 91(9):383-4, 386, 2012 Sep.
41.	Cannavale A, Corona M, Nardis P, et al. Computed Tomography Angiography findings can predict massive bleeding in head and neck tumours. Eur J Radiol. 125:108910, 2020 Apr.
42.	Ryan JL, Aaron VD, Sims JB. PET/MRI vs PET/CT in Head and Neck Imaging: When, Why, and How?. [Review]. Semin Ultrasound CT MR. 40(5):376-390, 2019 Oct.
43.	Ghanooni R, Delpierre I, Magremanne M, et al. 18F-FDG PET/CT and MRI in the follow-up of head and neck squamous cell carcinoma. Contrast Media Mol Imaging. 6(4):260-6, 2011 Jul-Aug.
44.	Huang SH, Chien CY, Lin WC, et al. A comparative study of fused FDG PET/MRI, PET/CT, MRI, and CT imaging for assessing surrounding tissue invasion of advanced buccal squamous cell carcinoma. Clin Nucl Med. 36(7):518-25, 2011 Jul.
45.	Kim SY, Kim JS, Doo H, et al. Combined [18F]fluorodeoxyglucose positron emission tomography and computed tomography for detecting contralateral neck metastases in patients with head and neck squamous cell carcinoma. Oral Oncol. 47(5):376-80, 2011 May.
46.	Yongkui L, Jian L, Wanghan, Jingui L. 18FDG-PET/CT for the detection of regional nodal metastasis in patients with primary head and neck cancer before treatment: a meta-analysis. [Review]. Surg Oncol. 22(2):e11-6, 2013 Jun.
47.	Chaukar D, Dandekar M, Kane S, et al. Relative value of ultrasound, computed tomography and positron emission tomography imaging in the clinically node-negative neck in oral cancer. Asia Pac J Clin Oncol. 12(2):e332-8, 2016 Jun.
48.	Qualliotine JR, Mydlarz WK, Chan JY, Zhou X, Wang H, Agrawal N. Comparing staging by positron emission tomography with contrast-enhanced computed tomography and by pathology in head and neck squamous cell carcinoma. J Laryngol Otol. 129(12):1213-9, 2015 Dec.
49.	Lowe VJ, Duan F, Subramaniam RM, et al. Multicenter Trial of [18F]fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Staging of Head and Neck Cancer and Negative Predictive Value and Surgical Impact in the N0 Neck: Results From ACRIN 6685. J Clin Oncol. 37(20):1704-1712, 2019 07 10.
50.	Chaput A, Robin P, Podeur F, et al. Diagnostic performance of 18 fluorodesoxyglucose positron emission/computed tomography and magnetic resonance imaging in detecting T1-T2 head and neck squamous cell carcinoma. Laryngoscope. 128(2):378-385, 2018 02.
51.	Lang Kuhs KA, Wood CB, Wiggleton J, et al. Transcervical sonography and human papillomavirus 16 E6 antibodies are sensitive for the detection of oropharyngeal cancer. Cancer. 126(11):2658-2665, 2020 06 01.
52.	Becker M, Zaidi H. Imaging in head and neck squamous cell carcinoma: the potential role of PET/MRI. [Review]. Br J Radiol. 87(1036):20130677, 2014 Apr.
53.	Partovi S, Kohan A, Vercher-Conejero JL, et al. Qualitative and quantitative performance of 18F-FDG-PET/MRI versus 18F-FDG-PET/CT in patients with head and neck cancer. AJNR Am J Neuroradiol. 35(10):1970-5, 2014 Oct.
54.	Schaarschmidt BM, Heusch P, Buchbender C, et al. Locoregional tumour evaluation of squamous cell carcinoma in the head and neck area: a comparison between MRI, PET/CT and integrated PET/MRI. Eur J Nucl Med Mol Imaging. 43(1):92-102, 2016 Jan.
55.	Schlittenbauer T, Zeilinger M, Nkenke E, et al. Positron emission tomography-computed tomography versus positron emission tomography-magnetic resonance imaging for diagnosis of oral squamous cell carcinoma: A pilot study. J Craniomaxillofac Surg. 43(10):2129-35, 2015 Dec.
56.	Sekine T, de Galiza Barbosa F, Kuhn FP, et al. PET+MR versus PET/CT in the initial staging of head and neck cancer, using a trimodality PET/CT+MR system. Clin Imaging. 42:232-239, 2017 Mar - Apr.
57.	Chen J, Hagiwara M, Givi B, et al. Assessment of metastatic lymph nodes in head and neck squamous cell carcinomas using simultaneous 18F-FDG-PET and MRI. Sci. rep.. 10(1):20764, 2020 11 27.
58.	Sekine T, Barbosa FG, Sah BR, et al. PET/MR Outperforms PET/CT in Suspected Occult Tumors. Clin Nucl Med. 42(2):e88-e95, 2017 Feb.
59.	Park SI, Guenette JP, Suh CH, et al. The diagnostic performance of CT and MRI for detecting extranodal extension in patients with head and neck squamous cell carcinoma: a systematic review and diagnostic meta-analysis. Eur Radiol. 31(4):2048-2061, 2021 Apr.
60.	Allegra E, Ferrise P, Trapasso S, et al. Early glottic cancer: role of MRI in the preoperative staging. Biomed Res Int. 2014:890385, 2014.
61.	Hagiwara M, Nusbaum A, Schmidt BL. MR assessment of oral cavity carcinomas. [Review]. Magn Reson Imaging Clin N Am. 20(3):473-94, 2012 Aug.
62.	Stoeckli SJ, Haerle SK, Strobel K, Haile SR, Hany TF, Schuknecht B. Initial staging of the neck in head and neck squamous cell carcinoma: a comparison of CT, PET/CT, and ultrasound-guided fine-needle aspiration cytology. Head Neck. 34(4):469-76, 2012 Apr.
63.	Hwang HS, Perez DA, Orloff LA. Comparison of positron emission tomography/computed tomography imaging and ultrasound in staging and surveillance of head and neck and thyroid cancer. Laryngoscope. 119(10):1958-65, 2009 Oct.
64.	Ashraf M, Biswas J, Jha J, et al. Clinical utility and prospective comparison of ultrasonography and computed tomography imaging in staging of neck metastases in head and neck squamous cell cancer in an Indian setup. Int J Clin Oncol. 16(6):686-93, 2011 Dec.
65.	Pellini R, Manciocco V, Turri-Zanoni M, et al. Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer: the role of US, MRI and FDG-PET/TC scans to assess residual neck disease. J Craniomaxillofac Surg. 42(8):1834-9, 2014 Dec.
66.	Faraji F, Coquia SF, Wenderoth MB, et al. Evaluating oropharyngeal carcinoma with transcervical ultrasound, CT, and MRI. Oral Oncol. 78:177-185, 2018 03.
67.	Klein Nulent TJW, Noorlag R, Van Cann EM, et al. Intraoral ultrasonography to measure tumor thickness of oral cancer: A systematic review and meta-analysis. Oral Oncol. 77:29-36, 2018 02.
68.	Rocchetti F, Tenore G, Montori A, et al. Preoperative evaluation of tumor depth of invasion in oral squamous cell carcinoma with intraoral ultrasonography: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 131(1):130-138, 2021 Jan.
69.	Smiley N, Anzai Y, Foster S, Dillon J. Is Ultrasound a Useful Adjunct in the Management of Oral Squamous Cell Carcinoma?. J Oral Maxillofac Surg. 77(1):204-217, 2019 Jan.
70.	Dhoot NM, Singh S, Choudhury B, et al. Evaluation of hypopharyngeal carcinoma using high-resolution ultrasound: comparison with CT. J Clin Ultrasound. 42(3):143-9, 2014 Mar-Apr.
71.	Hu Q, Zhu SY, Zhang Z, Luo F, Mao YP, Guan XH. Assessment of glottic squamous cell carcinoma: comparison of sonography and non-contrast-enhanced magnetic resonance imaging. J Ultrasound Med. 30(11):1467-74, 2011 Nov.
72.	Hu Q, Luo F, Zhu SY, Zhang Z, Mao YP, Hui Guan X. Staging of laryngeal carcinoma: comparison of high-frequency sonography and contrast-enhanced computed tomography. Clin Radiol. 67(2):140-7, 2012 Feb.
73.	Rzepakowska A, Osuch-Wojcikiewicz E, Bruzgielewicz A, Niemczyk K. How useful is ultrasound in the assessment of local advancement of laryngeal cancer?. Otolaryngol Pol. 69(2):21-6, 2015.
74.	Xiao BB, Chen QY, Sun XS, et al. Low value of whole-body dual-modality [18f]fluorodeoxyglucose positron emission tomography/computed tomography in primary staging of stage I-II nasopharyngeal carcinoma: a nest case-control study. Eur Radiol. 31(7):5222-5233, 2021 Jul.
75.	Mohandas A, Marcus C, Kang H, Truong MT, Subramaniam RM. FDG PET/CT in the management of nasopharyngeal carcinoma. [Review]. AJR Am J Roentgenol. 203(2):W146-57, 2014 Aug.
76.	Juliano A, Moonis G. Computed Tomography Versus Magnetic Resonance in Head and Neck Cancer: When to Use What and Image Optimization Strategies. [Review]. Magn Reson Imaging Clin N Am. 26(1):63-84, 2018 Feb.
77.	Hu YC, Chang CH, Chen CH, et al. Impact of intracranial extension on survival in stage IV nasopharyngeal carcinoma: identification of a subset of patients with better prognosis. Jpn J Clin Oncol. 41(1):95-102, 2011 Jan.
78.	King AD, Ahuja AT, Leung SF, et al. Neck node metastases from nasopharyngeal carcinoma: MR imaging of patterns of disease. Head & Neck. 22(3):275-81, 2000 May.
79.	Al Tamimi AS, Zaheer S, Ng DC, Osmany S. The incidence and sites of Nasopharyngeal carcinoma (NPC) metastases on FDG PET/CT scans. Oral Oncol. 51(11):1047-1050, 2015 Nov.
80.	Dumrongpisutikul N, Luangcharuthorn K. Imaging characteristics of nasopharyngeal carcinoma for predicting distant metastasis. Clin Radiol. 74(10):818.e9-818.e15, 2019 Oct.
81.	King AD, Woo JKS, Ai QY, et al. Complementary roles of MRI and endoscopic examination in the early detection of nasopharyngeal carcinoma. Ann Oncol. 30(6):977-982, 2019 06 01.
82.	Ng SH, Chan SC, Yen TC, et al. Staging of untreated nasopharyngeal carcinoma with PET/CT: comparison with conventional imaging work-up. European Journal of Nuclear Medicine & Molecular Imaging. 36(1):12-22, 2009 Jan.
83.	Shen G, Zhang W, Jia Z, Li J, Wang Q, Deng H. Meta-analysis of diagnostic value of 18F-FDG PET or PET/CT for detecting lymph node and distant metastases in patients with nasopharyngeal carcinoma. [Review]. Br J Radiol. 87(1044):20140296, 2014 Dec.
84.	Kao CH, Hsieh JF, Tsai SC, et al. Comparison of 18-fluoro-2-deoxyglucose positron emission tomography and computed tomography in detection of cervical lymph node metastases of nasopharyngeal carcinoma. Annals of Otology, Rhinology & Laryngology. 109(12 Pt 1):1130-4, 2000 Dec.
85.	Traylor KS, Koontz N, Mosier K. Squamous Cell Carcinoma: PET/CT and PET/MRI of the Pretreatment and Post-Treatment Neck. [Review]. Semin Ultrasound CT MR. 40(5):400-413, 2019 Oct.
86.	Cheng Y, Bai L, Shang J, et al. Preliminary clinical results for PET/MR compared with PET/CT in patients with nasopharyngeal carcinoma. Oncol Rep. 43(1):177-187, 2020 Jan.
87.	Liu FY, Lin CY, Chang JT, et al. 18F-FDG PET can replace conventional work-up in primary M staging of nonkeratinizing nasopharyngeal carcinoma. Journal of Nuclear Medicine. 48(10):1614-9, 2007 Oct.
88.	Yi X, Fan M, Liu Y, Zhang H, Liu S. 18 FDG PET and PET-CT for the detection of bone metastases in patients with head and neck cancer. A meta-analysis. J Med Imaging Radiat Oncol. 57(6):674-9, 2013 Dec.
89.	Chan SC, Yeh CH, Yen TC, et al. Clinical utility of simultaneous whole-body 18F-FDG PET/MRI as a single-step imaging modality in the staging of primary nasopharyngeal carcinoma. European Journal of Nuclear Medicine & Molecular Imaging. 45(8):1297-1308, 2018 07.
90.	Lai V, Khong PL. Updates on MR imaging and 18F-FDG PET/CT imaging in nasopharyngeal carcinoma. Oral Oncol. 50(6):539-48, 2014 Jun.
91.	Zhang SX, Han PH, Zhang GQ, et al. Comparison of SPECT/CT, MRI and CT in diagnosis of skull base bone invasion in nasopharyngeal carcinoma. Biomed Mater Eng. 24(1):1117-24, 2014.
92.	King AD, Vlantis AC, Yuen TW, et al. Detection of Nasopharyngeal Carcinoma by MR Imaging: Diagnostic Accuracy of MRI Compared with Endoscopy and Endoscopic Biopsy Based on Long-Term Follow-Up. AJNR Am J Neuroradiol. 36(12):2380-5, 2015 Dec.
93.	Gao Y, Zhu SY, Dai Y, Lu BF, Lu L. Diagnostic accuracy of sonography versus magnetic resonance imaging for primary nasopharyngeal carcinoma. J Ultrasound Med. 33(5):827-34, 2014 May.
94.	Dulguerov P, Jacobsen MS, Allal AS, Lehmann W, Calcaterra T. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer. 92(12):3012-29, 2001 Dec 15.
95.	Kim SH, Mun SJ, Kim HJ, Kim SL, Kim SD, Cho KS. Differential Diagnosis of Sinonasal Lymphoma and Squamous Cell Carcinoma on CT, MRI, and PET/CT. Otolaryngol Head Neck Surg. 159(3):494-500, 2018 09.
96.	Sen S, Chandra A, Mukhopadhyay S, Ghosh P. Imaging Approach to Sinonasal Neoplasms. [Review]. Neuroimaging Clin N Am. 25(4):577-93, 2015 Nov.
97.	Sen S, Chandra A, Mukhopadhyay S, Ghosh P. Sinonasal Tumors: Computed Tomography and MR Imaging Features. [Review]. Neuroimaging Clin N Am. 25(4):595-618, 2015 Nov.
98.	Jegoux F, Metreau A, Louvel G, Bedfert C. Paranasal sinus cancer. [Review]. Eur Ann Otorhinolaryngol Head Neck Dis. 130(6):327-35, 2013 Dec.
99.	Koeller KK. Radiologic Features of Sinonasal Tumors. [Review]. Head Neck Pathol. 10(1):1-12, 2016 Mar.
100.	Haerle SK, Soyka MB, Fischer DR, et al. The value of 18F-FDG-PET/CT imaging for sinonasal malignant melanoma. European Archives of Oto-Rhino-Laryngology. 269(1):127-33, 2012 Jan.
101.	Laubenbacher C, Saumweber D, Wagner-Manslau C, et al. Comparison of fluorine-18-fluorodeoxyglucose PET, MRI and endoscopy for staging head and neck squamous-cell carcinomas. Journal of Nuclear Medicine. 36(10):1747-57, 1995 Oct.
102.	Wild D, Eyrich GK, Ciernik IF, Stoeckli SJ, Schuknecht B, Goerres GW. In-line (18)F-fluorodeoxyglucose positron emission tomography with computed tomography (PET/CT) in patients with carcinoma of the sinus/nasal area and orbit. Journal of Cranio-Maxillo-Facial Surgery. 34(1):9-16, 2006 Jan.
103.	Ogawa T, Kojima I, Wakamori S, et al. Clinical utility of apparent diffusion coefficient and diffusion-weighted magnetic resonance imaging for resectability assessment of head and neck tumors with skull base invasion. Head Neck. 42(10):2896-2904, 2020 10.
104.	Touska P, Connor SEJ. Recent advances in MRI of the head and neck, skull base and cranial nerves: new and evolving sequences, analyses and clinical applications. [Review]. Br J Radiol. 92(1104):20190513, 2019 Dec.
105.	Wang XY, Yan F, Hao H, Wu JX, Chen QH, Xian JF. Improved performance in differentiating benign from malignant sinonasal tumors using diffusion-weighted combined with dynamic contrast-enhanced magnetic resonance imaging. Chin Med J. 128(5):586-92, 2015 Mar 05.
106.	Kong X, Li H, Han Z. The diagnostic role of ultrasonography, computed tomography, magnetic resonance imaging, positron emission tomography/computed tomography, and real-time elastography in the differentiation of benign and malignant salivary gland tumors: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 128(4):431-443.e1, 2019 Oct.
107.	Maraghelli D, Pietragalla M, Cordopatri C, et al. Magnetic resonance imaging of salivary gland tumours: Key findings for imaging characterisation. [Review]. European Journal of Radiology. 139:109716, 2021 Jun.
108.	Freling N, Crippa F, Maroldi R. Staging and follow-up of high-grade malignant salivary gland tumours: The role of traditional versus functional imaging approaches - A review. [Review]. Oral Oncol. 60:157-66, 2016 09.
109.	Thoeny HC. Imaging of salivary gland tumours. [Review] [38 refs]. Cancer Imaging. 7:52-62, 2007 Apr 30.
110.	Larson CR, Wiggins RH. FDG-PET Imaging of Salivary Gland Tumors. [Review]. Semin Ultrasound CT MR. 40(5):391-399, 2019 Oct.
111.	Ettl T, Schwarz-Furlan S, Gosau M, Reichert TE. Salivary gland carcinomas. [Review]. Oral Maxillofac Surg. 16(3):267-83, 2012 Sep.
112.	Lee YY, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. [Review] [44 refs]. European Journal of Radiology. 66(3):419-36, 2008 Jun.
113.	Liu Y, Li J, Tan YR, Xiong P, Zhong LP. Accuracy of diagnosis of salivary gland tumors with the use of ultrasonography, computed tomography, and magnetic resonance imaging: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 119(2):238-245.e2, 2015 Feb.
114.	Westergaard-Nielsen M, Rohde M, Godballe C, et al. Up-front F18-FDG PET/CT in suspected salivary gland carcinoma. Ann Nucl Med. 33(8):554-563, 2019 Aug.
115.	Badger D, Aygun N. Imaging of Perineural Spread in Head and Neck Cancer. [Review]. Radiol Clin North Am. 55(1):139-149, 2017 Jan.
116.	Gerwel A, Kosik K, Jurkiewicz D. US in preoperative evaluation of parotid gland neoplasms. Otolaryngol Pol. 69(2):27-33, 2015.
117.	Kim JW, Roh JL, Kim JS, et al. (18)F-FDG PET/CT surveillance at 3-6 and 12 months for detection of recurrence and second primary cancer in patients with head and neck squamous cell carcinoma. Br J Cancer. 109(12):2973-9, 2013 Dec 10.
118.	Cheung PK, Chin RY, Eslick GD. Detecting Residual/Recurrent Head Neck Squamous Cell Carcinomas Using PET or PET/CT: Systematic Review and Meta-analysis. [Review]. Otolaryngol Head Neck Surg. 154(3):421-32, 2016 Mar.
119.	Suenaga Y, Kitajima K, Ishihara T, et al. FDG-PET/contrast-enhanced CT as a post-treatment tool in head and neck squamous cell carcinoma: comparison with FDG-PET/non-contrast-enhanced CT and contrast-enhanced CT. Eur Radiol. 26(4):1018-30, 2016 Apr.
120.	Zammit-Maempel I, Kurien R, Paleri V. Outcomes of synchronous pulmonary nodules detected on computed tomography in head and neck cancer patients: 12-year retrospective review of a consecutive cohort. J Laryngol Otol. 130(6):575-80, 2016 Jun.
121.	Iovoli AJ, Platek AJ, Degraaff L, et al. Routine surveillance scanning in HNSCC: Lung screening CT scans have value but head and neck scans do not. Oral Oncol. 86:273-277, 2018 11.
122.	Fakhry N, Michel J, Colavolpe C, Varoquaux A, Dessi P, Giovanni A. Screening for distant metastases before salvage surgery in patients with recurrent head and neck squamous cell carcinoma: a retrospective case series comparing thoraco-abdominal CT, positron emission tomography and abdominal ultrasound. Clinical Otolaryngology. 37(3):197-206, 2012 Jun.
123.	Sullivan BP, Parks KA, Dean NR, Rosenthal EL, Carroll WR, Magnuson JS. Utility of CT surveillance for primary site recurrence of squamous cell carcinoma of the head and neck. Head & Neck. 33(11):1547-50, 2011 Nov.
124.	Hermans R, Pameijer FA, Mancuso AA, Parsons JT, Mendenhall WM. Laryngeal or hypopharyngeal squamous cell carcinoma: can follow-up CT after definitive radiation therapy be used to detect local failure earlier than clinical examination alone?. Radiology. 214(3):683-7, 2000 Mar.
125.	Rivelli V, Luebbers HT, Weber FE, Cordella C, Gratz KW, Kruse AL. Screening recurrence and lymph node metastases in head and neck cancer: the role of computer tomography in follow-up. Head Neck Oncol. 3:18, 2011 Mar 25.
126.	Sheikhbahaei S, Marcus C, Subramaniam RM. 18F FDG PET/CT and Head and Neck Cancer: Patient Management and Outcomes. [Review]. PET clinics. 10(2):125-45, 2015 Apr.
127.	Muller J, Hullner M, Strobel K, Huber GF, Burger IA, Haerle SK. The value of (18) F-FDG-PET/CT imaging in oral cavity cancer patients following surgical reconstruction. Laryngoscope. 125(8):1861-8, 2015 Aug.
128.	Kim ES, Yoon DY, Moon JY, et al. Detection of loco-regional recurrence in malignant head and neck tumors: a comparison of CT, MRI, and FDG PET-CT. Acta Radiol. 60(2):186-195, 2019 Feb.
129.	Helsen N, Van den Wyngaert T, Carp L, Stroobants S. FDG-PET/CT for treatment response assessment in head and neck squamous cell carcinoma: a systematic review and meta-analysis of diagnostic performance. Eur J Nucl Med Mol Imaging. 45(6):1063-1071, 2018 06.
130.	McDermott M, Hughes M, Rath T, et al. Negative predictive value of surveillance PET/CT in head and neck squamous cell cancer. AJNR Am J Neuroradiol. 34(8):1632-6, 2013 Aug.
131.	Sagardoy T, Fernandez P, Ghafouri A, et al. Accuracy of (18) FDG PET-CT for treatment evaluation 3 months after completion of chemoradiotherapy for head and neck squamous cell carcinoma: 2-year minimum follow-up. Head Neck. 38 Suppl 1:E1271-6, 2016 04.
132.	Dunsky KA, Wehrmann DJ, Osman MM, Thornberry BM, Varvares MA. PET-CT and the detection of the asymptomatic recurrence or second primary lesions in the treated head and neck cancer patient. Laryngoscope. 123(9):2161-4, 2013 Sep.
133.	Robin P, Abgral R, Valette G, et al. Diagnostic performance of FDG PET/CT to detect subclinical HNSCC recurrence 6 months after the end of treatment. Eur J Nucl Med Mol Imaging. 42(1):72-8, 2015 Jan.
134.	Mori M, Tsukuda M, Horiuchi C, et al. Efficacy of fluoro-2-deoxy-D-glucose positron emission tomography to evaluate responses to concurrent chemoradiotherapy for head and neck squamous cell carcinoma. Auris Nasus Larynx. 38(6):724-9, 2011 Dec.
135.	Sjovall J, Wahlberg P, Almquist H, Kjellen E, Brun E. A prospective study of positron emission tomography for evaluation of neck node response 6 weeks after radiotherapy in patients with head and neck squamous cell carcinoma. Head Neck. 38 Suppl 1:E473-9, 2016 04.
136.	Leung AS, Rath TJ, Hughes MA, Kim S, Branstetter BF 4th. Optimal timing of first posttreatment FDG PET/CT in head and neck squamous cell carcinoma. Head Neck. 38 Suppl 1:E853-8, 2016 04.
137.	Covello M, Cavaliere C, Aiello M, et al. Simultaneous PET/MR head-neck cancer imaging: Preliminary clinical experience and multiparametric evaluation. Eur J Radiol. 84(7):1269-76, 2015 Jul.
138.	Romeo V, Iorio B, Mesolella M, et al. Simultaneous PET/MRI in assessing the response to chemo/radiotherapy in head and neck carcinoma: initial experience. Med Oncol. 35(7):112, 2018 Jun 19.
139.	Kangelaris GT, Yom SS, Huang K, Wang SJ. Limited utility of routine surveillance MRI following chemoradiation for advanced-stage oropharynx carcinoma. International journal of otolaryngology. 2010, 2010.
140.	Lin CM, Wang CP, Chen CN, et al. The application of ultrasound in detecting lymph nodal recurrence in the treated neck of head and neck cancer patients. Sci. rep.. 7(1):3958, 2017 06 21.
141.	Park JJ, Emmerling O, Westhofen M. Role of neck ultrasound during follow-up care of head and neck squamous cell carcinomas. Acta Oto-Laryngologica. 132(2):218-24, 2012 Feb.
142.	Teo PT, Tan NC, Khoo JB. Imaging appearances for recurrent nasopharyngeal carcinoma and post-salvage nasopharyngectomy. [Review]. Clin Radiol. 68(11):e629-38, 2013 Nov.
143.	Wei J, Pei S, Zhu X. Comparison of 18F-FDG PET/CT, MRI and SPECT in the diagnosis of local residual/recurrent nasopharyngeal carcinoma: A meta-analysis. [Review]. Oral Oncol. 52:11-7, 2016 Jan.
144.	Xie CM, Liu XW, Li H, et al. Computed tomographic findings of skull base bony changes after radiotherapy for nasopharyngeal carcinoma: implications for local recurrence. J Otolaryngol Head Neck Surg. 40(4):300-10, 2011 Aug.
145.	Chan SC, Ng SH, Chang JT, et al. Advantages and pitfalls of 18F-fluoro-2-deoxy-D-glucose positron emission tomography in detecting locally residual or recurrent nasopharyngeal carcinoma: comparison with magnetic resonance imaging. European Journal of Nuclear Medicine & Molecular Imaging. 33(9):1032-40, 2006 Sep.
146.	Chan SC, Yen TC, Ng SH, et al. Differential roles of 18F-FDG PET in patients with locoregional advanced nasopharyngeal carcinoma after primary curative therapy: response evaluation and impact on management. Journal of Nuclear Medicine. 47(9):1447-54, 2006 Sep.
147.	Yakoob MY, Theodoratou E, Jabeen A, et al. Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria. [Review]. BMC Public Health. 11 Suppl 3:S23, 2011 Apr 13.
148.	Li Z, Li Y, Li N, Shen L. Positron emission tomography/computed tomography outperforms MRI in the diagnosis of local recurrence and residue of nasopharyngeal carcinoma: An update evidence from 44 studies. Cancer Med. 8(1):67-79, 2019 01.
149.	Chan SC, Kuo WH, Wang HM, et al. Prognostic implications of post-therapy (18)F-FDG PET in patients with locoregionally advanced nasopharyngeal carcinoma treated with chemoradiotherapy. Ann Nucl Med. 27(8):710-9, 2013 Oct.
150.	Lamarre ED, Batra PS, Lorenz RR, et al. Role of positron emission tomography in management of sinonasal neoplasms--a single institution's experience. Am J Otolaryngol. 33(3):289-95, 2012 May-Jun.
151.	Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. [Review] [153 refs]. Lancet. 371(9625):1695-709, 2008 May 17.
152.	Kirchner J, Schaarschmidt BM, Sauerwein W, et al. 18 F-FDG PET/MRI vs MRI in patients with recurrent adenoid cystic carcinoma. Head Neck. 41(1):170-176, 2019 01.
153.	Park HL, Yoo IeR, Lee N, et al. The Value of F-18 FDG PET for Planning Treatment and Detecting Recurrence in Malignant Salivary Gland Tumors: Comparison with Conventional Imaging Studies. Nuclear Medicine & Molecular Imaging. 47(4):242-8, 2013 Dec.
154.	Queiroz MA, Huellner MW. PET/MR in cancers of the head and neck. [Review]. Semin Nucl Med. 45(3):248-65, 2015 May.
155.	American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf.

Disclaimer

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.