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## Complete Summary

#### GUIDELINE TITLE

Follow-up of Hodgkin´s disease.

#### BIBLIOGRAPHIC SOURCE(S)

Ng AK, Constine LS, Deming RL, Wolkov HB, Hoppe RT, Abrams RA,
Mendenhall NP, Morris DE, Yahalom J, Chauvenet A, Hudson MM, Winter JN,
Mauch PM, Expert Panel on Radiation Oncology-Hodgkin\'s Disease Work
Group. Follow-up of Hodgkin\'s Disease. \[online publication\]. Reston
(VA): American College of Radiology (ACR); 2005. 6 p. \[43 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

It updates a previous version: Deming RL, Constine LS, Elman AJ, Hoppe
RT, Mauch PM, Dosoretz DE, Pistenmaa DA, Prosnitz LR, Wolkov HB, Yahalom
J, Chauvenet A, Connors JM, Glick JH, Leibel S. Follow-up of Hodgkin\'s
disease. American College of Radiology. ACR Appropriateness Criteria.
Radiology 2000 Jun;215(Suppl):1269-79.

The appropriateness criteria are reviewed annually and updated by the
panels as needed, depending on introduction of new and highly
significant scientific evidence.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Hodgkin\'s disease

-   Complications of Hodgkin\'s disease

#### GUIDELINE CATEGORY

Evaluation\
Management\
Prevention

#### CLINICAL SPECIALTY

Oncology\
Radiation Oncology\
Radiology

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

To provide appropriate recommendations for the follow-up evaluation of
patients after treatment for Hodgkin\'s disease

#### TARGET POPULATION

Patients (adolescent/young adult) with Hodgkin\'s disease who have
completed their treatment and response assessment

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Evaluation/Management/Prevention**

1.  Interim history and physical exam

2.  Radiographic tests

    -   Chest x-ray (CXR)

    -   Chest, abdomen, pelvic computed tomography (CT)

    -   Positron emission tomography (PET)

    -   Mammogram

3.  Exercise tolerance test and echocardiogram

4.  Laboratory tests

    -   Complete blood count (CBC)

    -   Erythrocyte sedimentation rate (ESR)

    -   Chemistry panel (CHEM)

    -   Thyroid panel

    -   Lipid profile

5.  Patient education and counseling

#### MAJOR OUTCOMES CONSIDERED

Utility of radiologic examination in the follow-up evaluation of
Hodgkin\'s disease

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The guideline developer performed literature searches of peer-reviewed
medical journals and the major applicable articles were identified and
collected.

#### NUMBER OF SOURCE DOCUMENTS

The total number of source documents identified as the result of the
literature search is not known.

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Not Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

One or two topic leaders within a panel assume the responsibility of
developing an evidence table for each clinical condition, based on
analysis of the current literature. These tables serve as a basis for
developing a narrative specific to each clinical condition.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus (Delphi)

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Since data available from existing scientific studies are usually
insufficient for meta-analysis, broad-based consensus techniques are
needed for reaching agreement in the formulation of the appropriateness
criteria. The American College of Radiology (ACR) Appropriateness
Criteria panels use a modified Delphi technique to arrive at consensus.
Serial surveys are conducted by distributing questionnaires to
consolidate expert opinions within each panel. These questionnaires are
distributed to the participants along with the evidence table and
narrative as developed by the topic leader(s). Questionnaires are
completed by participants in their own professional setting without
influence of the other members. Voting is conducted using a scoring
system from 1-9, indicating the least to the most appropriate imaging
examination or therapeutic procedure. The survey results are collected,
tabulated in anonymous fashion, and redistributed after each round. A
maximum of three rounds is conducted and opinions are unified to the
highest degree possible. Eighty percent agreement is considered a
consensus. This modified Delphi technique enables individual, unbiased
expression, is economical, easy to understand, and relatively simple to
conduct.

If consensus cannot be reached by the Delphi technique, the panel is
convened and group consensus techniques are utilized. The strengths and
weaknesses of each test or procedure are discussed and consensus reached
whenever possible. If \"No consensus\" appears in the rating column,
reasons for this decision are added to the comment sections.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Criteria developed by the Expert Panels are reviewed by the American
College of Radiology (ACR) Committee on Appropriateness Criteria.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**ACR Appropriateness Criteria®**

**Clinical Condition: Routine Follow-up Evaluation for Hodgkin\'s
Disease after Completion of Treatment and Response Assessment**

**Variant 1: Adolescent/young adult, male or female, now without signs
or symptoms, IIA supradiaphragmatic Hodgkin\'s Disease (HD), treated
with combined chemo-radiation therapy (XRT).**

  ----------------------------------------------------------------------------
  **Radiologic Exam        **Appropriateness   **Comments**
  Procedure**              Rating**            
  ------------------------ ------------------- -------------------------------
  **History and Physical   9                    
  Examination**\                               
  \                                            
  Q2-4 months times 2                          
  years. Then Q6 months                        
  times 3 years; then                          
  yearly for life                              

  **CXR**\                 8                   Unless chest computed
  \                                            tomography (CT) performed
  CXR 2-3 times per year                       
  times 5 years, then                          
  yearly                                       

  **Chest/Abdomen/Pelvic   8                    
  CT**\                                        
  \                                            
  Q6 months times 2 years.                     
  Then yearly times 3                          
  years                                        

  **PET**                  No Consensus        See summary of literature
                                               review

  **Screening Exercise     9                    
  Tolerance Test and                           
  Echocardiogram**\                            
  \                                            
  If symptomatic                               

  Periodic                 8                   Depending on mediastinal
                                               irradiation, adriamycin dose,
                                               and other risk factors

  **Mammogram**\           9                   For females only
  \                                            
  Annual, beginning 8-10                       
  years after treatment or                     
  by age 40                                    

  **Chest CT for Lung      1                    
  Cancer Screening**\                          
  \                                            
  Annual, beginning 5                          
  years after treatment                        

  Annual, beginning 5      No Consensus        Studies are ongoing
  years after treatment                        
  only if smoker                               

  **Laboratory Tests**\    8                    
  \                                            
  CBC 1-2 times per year                       

  Chemistry panel 1-2      8                    
  times per year                               

  Thyroid panel 1-2 times  8                    
  per year                                     

  ESR 1-2 times per year   8                    

  Lipid profile            7                    
  periodically                                 

  **Patient Education and  9                    
  Counseling**\                                
  \                                            
  Increased long-term risk                     
  of second malignancy                         
  (especially breast                           
  cancer risk) and cardiac                     
  disease                                      

  Monthly self-breast      9                    
  examination                                  

  Regular exercise         9                    

  Healthy diet             9                    

  Smoking cessation if     9                    
  current smoker                               

  ***Appropriateness                           
  Criteria Scale*\                             
  1 2 3 4 5 6 7 8 9\                           
  1 = Least appropriate 9                      
  = Most appropriate**                         
  ----------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 2: Adolescent/young adult, male or female, now without signs
or symptoms, IIA subdiaphragmatic HD, treated with combined chemo-XRT.**

  ----------------------------------------------------------------------------
  **Radiologic Exam        **Appropriateness   **Comments**
  Procedure**              Rating**            
  ------------------------ ------------------- -------------------------------
  **History and Physical   9                    
  Examination**\                               
  \                                            
  Q2-4 months times 2                          
  years. Then Q6 months                        
  times 3 years then                           
  yearly for life                              

  **CXR**\                 8                   At least once per year, unless
  \                                            chest CT performed
  CXR once a year                              

  **Chest/Abdomen/Pelvic   8                    
  CT**\                                        
  \                                            
  Once a year times 5                          
  years                                        

  **PET**                  No Consensus        See summary of literature
                                               review

  **Screening Exercise     9                    
  Tolerance Test &                             
  Echocardiogram**\                            
  \                                            
  If symptomatic                               

  Periodic                 8                   Depending on mediastinal
                                               irradiation, adriamycin dose,
                                               and other risk factors.

  **Chest CT for Lung      1                    
  Cancer Screening**\                          
  \                                            
  Annual, beginning 5                          
  years after treatment if                     
  received alkylating                          
  agent chemotherapy                           

  Annual, beginning 5      No consensus        Studies are ongoing.
  years after treatment                        
  only if smoker                               

  **Laboratory Tests**\    8                    
  \                                            
  CBC 1-2 times per year                       

  Chemistry panel 1-2      8                    
  times per year                               

  ESR 1-2 times per year   8                    

  **Patient Education and  9                    
  Counseling**\                                
  \                                            
  Increased long-term risk                     
  of second malignancy                         

  Regular exercise         9                    

  Healthy diet             9                    

  Smoking cessation if     9                    
  current smoker                               

  ***Appropriateness                           
  Criteria Scale*\                             
  1 2 3 4 5 6 7 8 9\                           
  1 = Least appropriate 9                      
  = Most appropriate**                         
  ----------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

Routine follow-up evaluation of patients after treatment for Hodgkin\'s
disease serves several functions. Detection of relapse is the most
important in the first 5 years after treatment. For long-term survivors,
the focus should be on detection of second neoplasms monitoring for
other late effects of therapy, and patient education.

**Detection of Relapse**

Hodgkin\'s disease remains the main cause of patient death during the
first 10 to 15 years of follow-up. Routine follow-up studies are used to
detect relapse early so that salvage therapy can be instituted quickly.

The majority of relapses occur within the first 5 years of treatment. As
part of follow-up to detect recurrences in addition to interim history
(Hx) and physical examination (PE), radiographic tests that have been
advocated include chest x-ray (CXR), abdominal radiograph (KUB),
computed tomography (CT), gallium scan, and more recently, position
emission tomography (PET) scan. Blood work commonly performed includes
complete blood count (CBC), erythrocyte sedimentation rate (ESR),
lactate dehydrogenase (LDH), serum copper, and chemistry panel (CHEM).

Interim history appears to be the most valuable follow-up tool in
detecting relapse of Hodgkin\'s disease. In their review of early-stage
Hodgkin\'s disease patients treated at Stanford, a study found that 55%
(59 of 107) of the detected relapses were discovered on the basis of the
history, with the most commonly reported symptom being a new lump,
followed by constitutional symptoms (fever, night sweats, weight loss)
and pain. In a series from Christie Hospital in Manchester, England, a
study found that 81% (30 of 37) of relapses were diagnosed in patients
who reported symptoms, with the most common symptoms being a new lump,
followed by cough, night sweats, and weight loss. One study from Canada
found that 45% (10 of 22) of relapses stemmed from patient concerns and
18% (4 of 22) from physician concerns. Physical examination also plays
an important role. In the Stanford series, 14% (15 of 107) of the
relapses were detected by PE. In the Manchester series, 5% (2 of 37) of
relapses were detected by physical examination. Chest x-ray is also
useful in detecting recurrence of Hodgkin\'s disease. In the Stanford
series, 23% (24 of 107) of relapses were detected by CXR. In the
Manchester series, 5% (2 of 37) of relapses were detected by CXR. In the
series from Canada, 18% (4 of 22) of relapses were detected by CXR.

In the last 10 to 15 years, CT scan is routinely included in the
follow-up of Hodgkin\'s disease patients. In the series from Canada, 9%
(2 of 22) of relapses were detected by CT scans. Nuclear imaging studies
are also increasingly performed as part of follow-up. A number of
studies reviewed the role of gallium scan and PET scan in predicting
preclinical relapses. One study reviewed 101 patients who had been
treated for Hodgkin\'s disease and underwent gallium scans post-therapy.
The positive predictive value (PPV) for relapse was 100% (although only
four patients had positive gallium scans post-treatment), and the
negative predictive value was 83.5%. In another series on 60 patients,
10 of 46 patients with a negative re-staging gallium scan subsequently
relapsed (negative predictive value \[NPV\] = 78%). In the remaining 14
patients with a positive re-staging gallium scan, 11 underwent further
therapy and remained disease-free, and three died of progressive
disease. In another study, 93 lymphoma patients (44 Hodgkin\'s disease
\[HD\], 49 non-Hodgkin\'s lymphoma \[NHL\]) underwent PET scan as well
as CT and ultrasound post therapy. Among the 44 Hodgkin\'s disease
patients (total of 59 scans), the sensitivity, specificity, PPV, and NPV
of PET scan were 100%, 82%, 81%, and 100%, respectively, while for
CT/ultrasound they were 83%, 23%, 43%, and 67%, respectively. A study
from Germany also compared PET with conventional imaging methods in 81
patients treated for Hodgkin\'s disease, showing a sensitivity and
specificity of 95% and 89%, respectively, for PET scan in predicting
relapses, while the sensitivity and specificity of conventional imaging
methods were 95% and 39%, respectively. The superior specificity of PET
scan compared with conventional imaging methods in these studies
reflects the ability of PET scan to detect active disease in abnormal
residual masses on CT post treatment. It should be noted that most of
the literature to date has focused on the ability of post therapy
nuclear imaging in predicting relapses, which may have implications on
selecting patients for further therapy. However, no data are available
on how frequently nuclear imaging studies, compared with other follow-up
methods, pick up recurrences over the course of follow-up care.

Limited data are available on the role of routine blood work in
detecting relapses. In the Stanford series, only one relapse was
detected by an elevated ESR. CBC, CHEM, and serum copper did not detect
any relapse. In the series from Canada, abnormal laboratory findings
picked up the same number of relapses as CT scans (2 of 22, 9%) though
at a lower cost.

**Detection of Second Malignancies**

Numerous studies have demonstrated that patients who survive Hodgkin\'s
disease are at increased risk for second neoplasms. Solid tumors
comprise the majority of cases of second malignancies, with the most
common ones being breast cancer and lung cancer.

Breast cancers after Hodgkin\'s disease typically occur after a long
latency of 10 to 15 years. Available data suggest that they are similar
to primary breast cancers in their histologic characteristics, although
synchronous or metachronous cases are more frequently seen. Young age at
irradiation (under 30 to 35) has been consistently shown to be a major
risk factor. More recent data showed that the risk increases with
increasing prior radiation dose to the breast tissue. Women who
underwent premature menopause from either chemotherapy or pelvic
irradiation appeared to be at decreased risk, suggesting an effect of
the hormonal milieu on the radiogenic breast cancer. Mammography has
been shown to be an effective tool for screening even among these young
women. In one study , 81% of 37 women with breast cancer after
Hodgkin\'s disease had mammographic abnormalities of a mass and/or
microcalcifications. Another study prospectively evaluated the utility
of mammogram in 90 female survivors of Hodgkin\'s disease. During the
study period, 10 women developed 12 breast cancers, all of which were
evident on mammogram. The high frequency of mammographically detected
abnormalities supports the value of mammographic screening in these
patients. In a study on breast cancer after Hodgkin\'s disease, the
authors found that the proportion of patients with early-stage breast
cancer was higher in cases that were diagnosed after 1990, which may be
due to the more frequent use of mammography screening in the more recent
era. The role of breast magnetic resonance imaging has been studied in
other high-risk populations, but it remains unproven in female survivors
of Hodgkin\'s disease. The effectiveness of tamoxifen as chemoprevention
has been demonstrated in other high-risk patients, but whether the data
is applicable to women who survived Hodgkin\'s disease is unclear.

Lung cancer is another well-documented second malignancy after
Hodgkin\'s disease. In addition to radiation therapy, prior chemotherapy
exposure (alkylating agents in particular) significantly increases the
lung cancer risk in a dose-dependent manner. Several studies showed that
tobacco use further adds to the risk of lung cancer after Hodgkin\'s
disease. In a case-control study, those who been treated with radiation
therapy and alkylating agents had a seven-fold increased risk of lung
cancer after Hodgkin\'s disease compared with survivors who did not have
more than 5 Gy of radiation exposure and had never been exposed to
alkylating agents. However, among those with the treatment exposures as
well as tobacco exposure, there was a 49-fold increased risk, suggesting
a multiplicative interaction between tobacco use and the alkylating
agents and/or radiation. Unlike breast cancer, the prognosis of lung
cancer after Hodgkin\'s disease is poor, with a median survival of only
about a year. Given the significantly increased risk of lung cancer
after Hodgkin\'s disease especially among smokers, and the associated
poor prognosis, the question has been raised whether these patients may
benefit from chest CT screening. The role of low-dose chest CT as
screening is currently being studied in a prospective randomized trial
in another high-risk group, but survivors of Hodgkin\'s disease are not
included in the study.

**Detection of Nonmalignant Late Effects of Treatment**

A number of studies have shown that patients who have been cured of the
Hodgkin\'s disease are at significantly increased risk of death from
cardiac disease compared with the normal population.

A wide spectrum of radiation-induced cardiovascular disease has been
identified in asymptomatic survivors of Hodgkin\'s disease, including
pericardial disease, coronary artery disease, cardiomyopathy, valvular
disease, arrhythmia, and autonomic dysfunction.

The major contributor to the excess risk of cardiac mortality after
Hodgkin\'s disease is coronary artery disease, accounting for two-thirds
of all cases of fatal cardiac events in survivors of Hodgkin\'s disease.
The main risk factor is mediastinal irradiation, and a dose-response
relationship has been shown. The presence of other traditional cardiac
risk factors further increases the risk of cardiovascular disease after
Hodgkin\'s disease. There may be a role for screening for and treatment
of modifiable cardiac risk factors, and also cardiac screening tests for
subclinical coronary artery disease in survivors of Hodgkin\'s disease.
Whether they can reduce the cardiac mortality in these patients remain
unproven at this time.

The role of cardiac screening for other cardiac structural abnormalities
was addressed in a prospective study from Stanford University, in which
294 asymptomatic patients treated with mediastinal irradiation for
Hodgkin\'s disease underwent electrocardiography and echocardiography
screening. The prevalence of valvular abnormality increased
significantly with increasing follow-up time. Furthermore, the
abnormality was rarely picked up on auscultation, with a diastolic
murmur detected in only 6.3% of the patients who were found to have
valvular disease on echocardiogram. These findings support the value of
screening echocardiogram in identifying patients who may benefit from
endocarditis prophylaxis. In addition to valvular disease, the patients
were also found to be significantly more likely than expected to have
depressed left ventricular fractional shortening, regional wall motion
abnormality, decreased left ventricular mass, and pericardial
thickening, all of which also increased with increasing time from
initial irradiation. The high prevalence of asymptomatic cardiac
structural abnormalities requiring interventions noted with increasing
follow-up time led to the authors\' conclusion that screening
echocardiography may be beneficial, particularly in those who have
survived 10 years following mediastinal irradiation.

Irradiation to the upper mediastinum and low neck can result in thyroid
abnormalities. An analysis of patients treated for Hodgkin\'s disease at
Stanford demonstrated that the 20-year actuarial risk of thyroid
abnormality was 50%, with 90% of the cases being hypothyroidism.
Fifty-seven percent of patients with primary hypothyroidism had
subclinical disease detected by an elevated serum TSH level with a
normal FT4 level. The greatest risk of hypothyroidism occurred during
the first 5 years after treatment, but new cases continued to emerge
beyond 20 years after Hodgkin\'s disease. In a study among pediatric
Hodgkin\'s disease survivors, risk factors for the development of
hypothyroidism included increasing radiation dose, older age at
diagnosis, and female gender.

Other late effects of Hodgkin\'s disease treatment include pulmonary
dysfunction, infertility, immunosuppression, fatigue, psychological
distress, and social maladaptation. Awareness of the potential
consequences of treatment is necessary for physicians conducting patient
follow-up to detect problems at the earliest possible time.

**Abbreviations**

-   CBC, complete blood count

-   CT, computed tomography

-   CXR, chest x-ray

-   ESR, erythrocyte sedimentation rate

-   PET, positron emission tomography

-   Q, every

#### CLINICAL ALGORITHM(S)

Algorithms were not developed from criteria guidelines.

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The recommendations are based on analysis of the current literature and
expert panel consensus.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Selection of appropriate radiologic imaging procedures for follow-up
evaluation of patients with Hodgkin\'s disease

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

An American College of Radiology (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 exams 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
U.S. Food and Drug Administration (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.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Personal Digital Assistant (PDA) Downloads

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Living with Illness\
Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Ng AK, Constine LS, Deming RL, Wolkov HB, Hoppe RT, Abrams RA,
Mendenhall NP, Morris DE, Yahalom J, Chauvenet A, Hudson MM, Winter JN,
Mauch PM, Expert Panel on Radiation Oncology-Hodgkin\'s Disease Work
Group. Follow-up of Hodgkin\'s Disease. \[online publication\]. Reston
(VA): American College of Radiology (ACR); 2005. 6 p. \[43 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1999 (revised 2005)

#### GUIDELINE DEVELOPER(S)

American College of Radiology - Medical Specialty Society

#### SOURCE(S) OF FUNDING

The American College of Radiology (ACR) provided the funding and the
resources for these ACR Appropriateness Criteria®.

#### GUIDELINE COMMITTEE

Committee on Appropriateness Criteria, Expert Panel on Radiation
Oncology\--Hodgkin\'s Disease Work Group

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Panel Members*: Andrea Ka-Min Ng, MD (*Review Author*); Louis S.
Constine, MD (*Co-Author*); Richard L. Deming, MD (*Co-Author*); Harvey
B. Wolkov, MD (*Co-Author*); Richard T. Hoppe, MD (*Hodgkin\'s Work
Group Panel Chair*); Ross A. Abrams, MD ; Nancy P. Mendenhall, MD; David
Eric Morris, MD; Joachim Yahalom, MD; Allen Chauvenet, MD; Melissa M.
Hudson, MD; Jane N. Winter, MD; Peter M. Mauch, MD

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

It updates a previous version: Deming RL, Constine LS, Elman AJ, Hoppe
RT, Mauch PM, Dosoretz DE, Pistenmaa DA, Prosnitz LR, Wolkov HB, Yahalom
J, Chauvenet A, Connors JM, Glick JH, Leibel S. Follow-up of Hodgkin\'s
disease. American College of Radiology. ACR Appropriateness Criteria.
Radiology 2000 Jun;215(Suppl):1269-79.

The appropriateness criteria are reviewed annually and updated by the
panels as needed, depending on introduction of new and highly
significant scientific evidence.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[American College of Radiology (ACR) Web
site](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonRadiationOncologyHodgkinsWorkGroup/FollowUpofHodgkinsDiseaseDoc2.aspx).

ACR Appropriateness Criteria® *Anytime*, *Anywhere*™ (PDA application).
Available from the [ACR Web
site](http://www.acr.org/SecondaryMainMenuCategories/ACRStore/FeaturedCategories/QualityandSafety/ac_pda.aspx).

Print copies: Available from the American College of Radiology, 1891
Preston White Drive, Reston, VA 20191. Telephone: (703) 648-8900.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   ACR Appropriateness Criteria®. Background and development. Reston
    (VA): American College of Radiology; 2 p. Electronic copies:
    Available in Portable Document Format (PDF) from the [American
    College of Radiology (ACR) Web
    site](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/background_dev.aspx).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on December 15, 2005. The updated
information was verified by the guideline developer on January 19, 2006.

#### COPYRIGHT STATEMENT

Instructions for downloading, use, and reproduction of the American
College of Radiology (ACR) Appropriateness Criteria® may be found on the
[ACR Web
site.](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/ACRAppropriatenessCriteriaTermsandConditionsDoc1.aspx)

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008