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Lung Cancer: Surveillance After Therapy
Variant: 1
Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest without IV contrast | May Be Appropriate (Disagreement) | ☢☢☢ |
| Radiography chest | Usually Not Appropriate | ☢ |
| MRI chest without and with IV contrast | Usually Not Appropriate | O |
| MRI chest without 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 |
| Bone scan whole body | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis 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 neck 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 chest with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CTA chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with 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 | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Not Appropriate | ☢☢☢☢ |
Variant: 2
Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI head without and with IV contrast | Usually Appropriate | O |
| MRI head without IV contrast | Usually Appropriate | O |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest abdomen pelvis with IV contrast | May Be Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | May Be Appropriate | ☢☢☢☢ |
| Radiography chest | Usually Not Appropriate | ☢ |
| MRI chest without and with IV contrast | Usually Not Appropriate | O |
| MRI chest without IV contrast | Usually Not Appropriate | O |
| Bone scan whole body | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without 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 neck 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 chest with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CTA chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and 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 | ☢☢☢☢ |
Variant: 3
Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI head without and with IV contrast | Usually Appropriate | O |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest without IV contrast | Usually Appropriate | ☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Appropriate | ☢☢☢☢ |
| Radiography chest | May Be Appropriate | ☢ |
| MRI chest without and with IV contrast | May Be Appropriate | O |
| MRI head without IV contrast | May Be Appropriate | O |
| Bone scan whole body | May Be Appropriate | ☢☢☢ |
| CT abdomen and pelvis with IV contrast | May Be Appropriate | ☢☢☢ |
| CT head with IV contrast | May Be Appropriate | ☢☢☢ |
| CT neck with IV contrast | May Be Appropriate | ☢☢☢ |
| CTA chest with IV contrast | May Be Appropriate | ☢☢☢ |
| CT chest abdomen pelvis with IV contrast | May Be Appropriate | ☢☢☢☢ |
| MRI chest without IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and 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 neck without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT neck without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CTA chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and 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 | ☢☢☢☢ |
Variant: 4
Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI head without and with IV contrast | Usually Appropriate | O |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest abdomen pelvis with IV contrast | Usually Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Appropriate | ☢☢☢☢ |
| Radiography chest | May Be Appropriate | ☢ |
| MRI chest without and with IV contrast | May Be Appropriate | O |
| MRI head without IV contrast | May Be Appropriate | O |
| Bone scan whole body | May Be Appropriate | ☢☢☢ |
| CT abdomen and pelvis with IV contrast | May Be Appropriate | ☢☢☢ |
| CT chest without IV contrast | May Be Appropriate | ☢☢☢ |
| CT head with IV contrast | May Be Appropriate | ☢☢☢ |
| CT head without IV contrast | May Be Appropriate | ☢☢☢ |
| CT neck with IV contrast | May Be Appropriate | ☢☢☢ |
| CTA chest with IV contrast | May Be Appropriate | ☢☢☢ |
| CT chest abdomen pelvis without IV contrast | May Be Appropriate | ☢☢☢☢ |
| MRI chest without IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT head 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 chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Rachna Madan, MBBSa; Raquelle H. El Alam, MDb; Christopher M. Walker, MDc; Tami J. Bang, MDd; Twyla B. Bartel, DO, MBAe; Kiran Batra, MDf; Anupama G. Brixey, MDg; Jared D. Christensen, MD, MBAh; Christian W. Cox, MDi; Anne V. Gonzalez, MD, MScj; Brent P. Little, MDk; Natalie S. Lui, MDl; Hannah Maxfield, MDm; William H. Moore, MDn; Angel Qin, MDo; Girish S. Shroff, MDp; Kazuhiro Yasufuku, MD, PhDq; Jonathan H. Chung, MDr.
Summary of Literature Review
Introduction/Background
Discussion of Procedures by Variant
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
A. Bone scan whole body
A. Bone scan whole body
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
B. CT abdomen and pelvis with IV contrast
B. CT abdomen and pelvis with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
C. CT abdomen and pelvis without and with IV contrast
C. CT abdomen and pelvis without and with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
D. CT abdomen and pelvis without IV contrast
D. CT abdomen and pelvis without IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
E. CT chest abdomen pelvis with IV contrast
E. CT chest abdomen pelvis with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
F. CT chest abdomen pelvis without and with IV contrast
F. CT chest abdomen pelvis without and with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
G. CT chest abdomen pelvis without IV contrast
G. CT chest abdomen pelvis without IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
H. CT chest with IV contrast
H. CT chest with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
I. CT chest without and with IV contrast
I. CT chest without and with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
J. CT chest without IV contrast
J. CT chest without IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
K. CT head with IV contrast
K. CT head with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
L. CT head without and with IV contrast
L. CT head without and with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
M. CT head without IV contrast
M. CT head without IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
N. CT neck with IV contrast
N. CT neck with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
O. CT neck without and with IV contrast
O. CT neck without and with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
P. CT neck without IV contrast
P. CT neck without IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
Q. CTA chest with IV contrast
Q. CTA chest with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
R. CTA chest without and with IV contrast
R. CTA chest without and with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
S. FDG-PET/CT skull base to mid-thigh
S. FDG-PET/CT skull base to mid-thigh
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
T. MRI chest without and with IV contrast
T. MRI chest without and with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
U. MRI chest without IV contrast
U. MRI chest without IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
V. MRI head without and with IV contrast
V. MRI head without and with IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
W. MRI head without IV contrast
W. MRI head without IV contrast
Variant 1: Variant 1: Adult. Noninvasive imaging surveillance following treatment of stage I-III non–small-cell lung cancer. Routine surveillance.
X. Radiography chest
X. Radiography chest
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
A. Bone scan whole body
A. Bone scan whole body
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
B. CT abdomen and pelvis with IV contrast
B. CT abdomen and pelvis with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
C. CT abdomen and pelvis without and with IV contrast
C. CT abdomen and pelvis without and with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
D. CT abdomen and pelvis without IV contrast
D. CT abdomen and pelvis without IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
E. CT chest abdomen pelvis with IV contrast
E. CT chest abdomen pelvis with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
F. CT chest abdomen pelvis without and with IV contrast
F. CT chest abdomen pelvis without and with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
G. CT chest abdomen pelvis without IV contrast
G. CT chest abdomen pelvis without IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
H. CT chest with IV contrast
H. CT chest with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
I. CT chest without and with IV contrast
I. CT chest without and with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
J. CT chest without IV contrast
J. CT chest without IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
K. CT head with IV contrast
K. CT head with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
L. CT head without and with IV contrast
L. CT head without and with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
M. CT head without IV contrast
M. CT head without IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
N. CT neck with IV contrast
N. CT neck with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
O. CT neck without and with IV contrast
O. CT neck without and with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
P. CT neck without IV contrast
P. CT neck without IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
Q. CTA chest with IV contrast
Q. CTA chest with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
R. CTA chest without and with IV contrast
R. CTA chest without and with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
S. FDG-PET/CT skull base to mid-thigh
S. FDG-PET/CT skull base to mid-thigh
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
T. MRI chest without and with IV contrast
T. MRI chest without and with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
U. MRI chest without IV contrast
U. MRI chest without IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
V. MRI head without and with IV contrast
V. MRI head without and with IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
W. MRI head without IV contrast
W. MRI head without IV contrast
Variant 2: Variant 2: Adult. Noninvasive imaging surveillance following treatment of stage I-III small-cell lung cancer. Routine surveillance.
X. Radiography chest
X. Radiography chest
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
A. Bone scan whole body
A. Bone scan whole body
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
B. CT abdomen and pelvis with IV contrast
B. CT abdomen and pelvis with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
C. CT abdomen and pelvis without and with IV contrast
C. CT abdomen and pelvis without and with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
D. CT abdomen and pelvis without IV contrast
D. CT abdomen and pelvis without IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
E. CT chest abdomen pelvis with IV contrast
E. CT chest abdomen pelvis with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
F. CT chest abdomen pelvis without and with IV contrast
F. CT chest abdomen pelvis without and with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
G. CT chest abdomen pelvis without IV contrast
G. CT chest abdomen pelvis without IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
H. CT chest with IV contrast
H. CT chest with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
I. CT chest without and with IV contrast
I. CT chest without and with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
J. CT chest without IV contrast
J. CT chest without IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
K. CT head with IV contrast
K. CT head with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
L. CT head without and with IV contrast
L. CT head without and with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
M. CT head without IV contrast
M. CT head without IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
N. CT neck with IV contrast
N. CT neck with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
O. CT neck without and with IV contrast
O. CT neck without and with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
P. CT neck without IV contrast
P. CT neck without IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
Q. CTA chest with IV contrast
Q. CTA chest with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
R. CTA chest without and with IV contrast
R. CTA chest without and with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
S. FDG-PET/CT skull base to mid-thigh
S. FDG-PET/CT skull base to mid-thigh
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
T. MRI chest without and with IV contrast
T. MRI chest without and with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
U. MRI chest without IV contrast
U. MRI chest without IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
V. MRI head without and with IV contrast
V. MRI head without and with IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
W. MRI head without IV contrast
W. MRI head without IV contrast
Variant 3: Adult. Posttreatment evaluation of stage I-III non–small-cell lung cancer. Suspected recurrence or progression.
X. Radiography chest
X. Radiography chest
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
A. Bone scan whole body
A. Bone scan whole body
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
B. CT abdomen and pelvis with IV contrast
B. CT abdomen and pelvis with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
C. CT abdomen and pelvis without and with IV contrast
C. CT abdomen and pelvis without and with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
D. CT abdomen and pelvis without IV contrast
D. CT abdomen and pelvis without IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
E. CT chest abdomen pelvis with IV contrast
E. CT chest abdomen pelvis with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
F. CT chest abdomen pelvis without and with IV contrast
F. CT chest abdomen pelvis without and with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
G. CT chest abdomen pelvis without IV contrast
G. CT chest abdomen pelvis without IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
H. CT chest with IV contrast
H. CT chest with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
I. CT chest without and with IV contrast
I. CT chest without and with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
J. CT chest without IV contrast
J. CT chest without IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
K. CT head with IV contrast
K. CT head with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
L. CT head without and with IV contrast
L. CT head without and with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
M. CT head without IV contrast
M. CT head without IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
N. CT neck with IV contrast
N. CT neck with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
O. CT neck without and with IV contrast
O. CT neck without and with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
P. CT neck without IV contrast
P. CT neck without IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
Q. CTA chest with IV contrast
Q. CTA chest with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
R. CTA chest without and with IV contrast
R. CTA chest without and with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
S. FDG-PET/CT skull base to mid-thigh
S. FDG-PET/CT skull base to mid-thigh
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
T. MRI chest without and with IV contrast
T. MRI chest without and with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
U. MRI chest without IV contrast
U. MRI chest without IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
V. MRI head without and with IV contrast
V. MRI head without and with IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
W. MRI head without IV contrast
W. MRI head without IV contrast
Variant 4: Variant 4: Adult. Posttreatment evaluation of stage I-III small-cell lung cancer. Suspected recurrence or progression.
X. Radiography chest
X. Radiography chest
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.” |
||
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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.