Journal of the American College of Radiology最新文献

{"title":"The Debate Over Competency-Based Education in Radiology–Promises and Perils","authors":"Priscilla J. Slanetz MD, MPH , Ryan Cummings MD , Erin Gomez MD , J. Mark McKinney MD","doi":"10.1016/j.jacr.2024.11.026","DOIUrl":"10.1016/j.jacr.2024.11.026","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 6","pages":"Pages 691-693"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Emphysema as a Category Modifier in Lung-RADS Using a Secondary Analysis of National Lung Screening Trial","authors":"Sowon Jang MD ,&nbsp;Jihang Kim MD, PhD ,&nbsp;Seungjae Lee PhD ,&nbsp;Yeon Wook Kim MD, PhD ,&nbsp;Junghoon Kim MD ,&nbsp;Kyung Won Lee MD, PhD ,&nbsp;Choon-Taek Lee MD, PhD","doi":"10.1016/j.jacr.2025.02.041","DOIUrl":"10.1016/j.jacr.2025.02.041","url":null,"abstract":"<div><h3>Objective</h3><div>The Lung CT Reporting and Data System (Lung-RADS) does not consider emphysema, a lung cancer risk factor detectable on CT, when assessing nodule risk. This study aimed to evaluate the impact of incorporating emphysema into Lung-RADS on lung cancer diagnosis.</div></div><div><h3>Methods</h3><div>In this secondary analysis of the National Lung Screening Trial data, CT arm participants with noncalcified nodules were assigned to Lung-RADS categories, and their emphysema severity was visually dichotomized. Lung cancer rates within each Lung-RADS category were compared based on emphysema severity. A modified Lung-RADS, reclassifying nodules with significant emphysema into a higher category, was evaluated against standard Lung-RADS.</div></div><div><h3>Results</h3><div>A study of 9,444 participants (782 [8.3%] with lung cancer) revealed difference in lung cancer rates across Lung-RADS categories based on visual emphysema severity: category 2 (2.6% versus 4.9%; <em>P</em> = .007), 3 (4.9% versus 9.0%; <em>P</em> &lt; .001), 4A (9.2% versus 15.5%; <em>P</em> = .01), 4B (16.1% versus 24.1%; <em>P</em> = .12), and 4X (25.3% versus 33.2%; <em>P</em> = .008) without or with significant emphysema. Compared with standard Lung-RADS, modified Lung-RADS demonstrated a comparable area under the curve (0.73 versus 0.74, <em>P</em> = .009), increased sensitivity (61.3% versus 67.6%, <em>P</em> &lt; .001), decreased specificity (77.2% versus 71.4%, <em>P</em> &lt; .001), and improved goodness of fit (<em>P</em> = .008) for predicting lung cancer.</div></div><div><h3>Discussion</h3><div>Lung cancer rates differ by emphysema severity within Lung-RADS categories. Using the visual emphysema severity as a category modifier in Lung-RADS increased sensitivity while achieving comparable area under the curve for lung cancer.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 6","pages":"Pages 633-643"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACR Appropriateness Criteria® Imaging of Ductal Carcinoma in Situ (DCIS)","authors":"Expert Panel on Breast Imaging,&nbsp;Cherie M. Kuzmiak DO ,&nbsp;Richard E. Sharpe Jr. MD, MBA ,&nbsp;Alana A. Lewin MD ,&nbsp;Susan P. Weinstein MD ,&nbsp;Victoria Blinder MD ,&nbsp;Elizabeth H. Dibble MD ,&nbsp;Katerina Dodelzon MD ,&nbsp;Basak E. Dogan MD ,&nbsp;Lisa V. Paulis MD ,&nbsp;Jennifer Kay Plichta MD, MS ,&nbsp;Lonie R. Salkowski MD, PhD, MS ,&nbsp;Maryam Sattari MD, MS ,&nbsp;John R. Scheel MD, PhD, MPH ,&nbsp;Priscilla J. Slanetz MD, MPH","doi":"10.1016/j.jacr.2025.02.027","DOIUrl":"10.1016/j.jacr.2025.02.027","url":null,"abstract":"<div><div>Ductal carcinoma in situ (DCIS) accounts for approximately 20% of diagnosed breast cancer. It is important to understand which imaging studies are appropriate in patients with a new diagnosis or history of DCIS. Initial imaging for a new diagnosis of DCIS, consists of diagnostic mammography and/or tomosynthesis, whereas breast ultrasound and breast MRI may be appropriate as complementary examinations. Routine surveillance with annual mammography and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women who have completed breast conservation therapy for DCIS, and breast MRI may be appropriate. Advanced technologies such as contrast mammography or molecular breast imaging are usually not appropriate. In a patient with a history of mastectomy for DCIS, routine surveillance for ipsilateral recurrence with imaging is usually not appropriate. There is no role for imaging of the axilla in patients with known DCIS with or without microinvasion.</div><div>The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages S274-S299"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACR Appropriateness Criteria® Colorectal Cancer Screening: 2024 Update","authors":"Expert Panel on Gastrointestinal Imaging,&nbsp;Desencia E. Thomas MD ,&nbsp;Natally Horvat MD, PhD ,&nbsp;Kathryn J. Fowler MD ,&nbsp;James H. Birkholz MD ,&nbsp;Brooks D. Cash MD ,&nbsp;Bari Dane MD ,&nbsp;Reema H. Dbouk MD ,&nbsp;Nader Hanna MD ,&nbsp;Janet Hurley MD ,&nbsp;Elena K. Korngold MD ,&nbsp;Jason A. Pietryga MD ,&nbsp;Paula Yeghiayan MD ,&nbsp;Jason A. Zell DO, MPH ,&nbsp;Jennifer Zreloff MD ,&nbsp;David H. Kim MD","doi":"10.1016/j.jacr.2025.02.032","DOIUrl":"10.1016/j.jacr.2025.02.032","url":null,"abstract":"<div><div>This document serves to update the 2018 ACR Appropriateness Criteria® colorectal screening guidance document. In light of new recommendations from the US Preventative Services Task Force (USPSTF), an updated literature review of the imaging procedures for the screening of colorectal cancer was performed. Average-risk, elevated-risk, and high-risk individuals as well as those individuals who had an incomplete colonoscopy or were unable to tolerate colonoscopy were included. CT colonography without contrast was found to be usually appropriate for individuals at average and elevated risk between 45 to 75 years of age at initial screening. Additionally, CT colonography without contrast was found to be usually appropriate in individuals at average risk, elevated risk, and at high risk after incomplete colonoscopy or unable to tolerate colonoscopy. Other imaging procedures such as barium fluoroscopy and CT of the abdomen and pelvis were usually not appropriate. CT colonography without contrast, barium fluoroscopy, and CT of the abdomen and pelvis were usually not appropriate in high-risk individuals who can undergo a complete colonoscopy.</div><div>The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages S190-S201"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACR Appropriateness Criteria® Acute Spinal Trauma: 2024 Update","authors":"Expert Panel on Neurological Imaging,&nbsp;Alvand Hassankhani MD ,&nbsp;Colbey W. Freeman MD ,&nbsp;James Banks MD ,&nbsp;Matthew S. Parsons MD ,&nbsp;Daniel E. Wessell MD, PhD ,&nbsp;Troy A. Hutchins MD ,&nbsp;Leon Lenchik MD ,&nbsp;Judah Burns MD ,&nbsp;Rami W. Eldaya MD, MBA ,&nbsp;Brent Griffith MD ,&nbsp;Sean M. Hickey MD ,&nbsp;Majid A. Khan MD ,&nbsp;Brandon Lawrence MD ,&nbsp;Theodore S. Paisley MD ,&nbsp;Charles Reitman MD ,&nbsp;Alexander E. Ropper MD ,&nbsp;Vinil N. Shah MD ,&nbsp;Scott D. Steenburg MD ,&nbsp;Vincent M. Timpone MD ,&nbsp;Bruno Policeni MD, MBA","doi":"10.1016/j.jacr.2025.02.013","DOIUrl":"10.1016/j.jacr.2025.02.013","url":null,"abstract":"<div><div>Due to its wide spectrum of injury patterns, imaging of acute blunt spine trauma can present many challenges. CT is generally the first-line imaging modality, as it is fast, accurate, and easily accessible. Choice of appropriate imaging is important, as overuse of imaging is associated with prolonged emergency visits and unnecessary hospital admission, potentially leading to iatrogenic injuries and an increase in economic burden. In contrast, failure to identify injuries can have severe consequences.</div><div>The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages S48-S66"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Staging and Post-Therapy Assessment of Head and Neck Cancer","authors":"Corey Feuer ,&nbsp;Sharon L. D’Souza MD, MPH","doi":"10.1016/j.jacr.2024.06.017","DOIUrl":"10.1016/j.jacr.2024.06.017","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Page 617"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACR Appropriateness Criteria® Chronic Dyspnea-Noncardiovascular Origin: 2024 Update","authors":"Expert Panel on Thoracic Imaging,&nbsp;Jared D. Christensen MD, MBA ,&nbsp;Michael Harowicz MD ,&nbsp;Christopher M. Walker MD ,&nbsp;Brent P. Little MD ,&nbsp;Kiran Batra MD ,&nbsp;Anupama G. Brixey MD ,&nbsp;Melissa B. Carroll MD ,&nbsp;Lydia Chelala MD ,&nbsp;Christian W. Cox MD ,&nbsp;M. Bradley Drummond MD, MHS ,&nbsp;Nicole M. Geissen DO ,&nbsp;Jason Halpern MD ,&nbsp;Rachna Madan MBBS ,&nbsp;Venu Pararath Gopalakrishnan MD ,&nbsp;Girish S. Shroff MD ,&nbsp;Christina S. Thornton MD, PhD ,&nbsp;Jennifer Zreloff MD ,&nbsp;Jonathan H. Chung MD","doi":"10.1016/j.jacr.2025.02.034","DOIUrl":"10.1016/j.jacr.2025.02.034","url":null,"abstract":"<div><div>For patients with chronic dyspnea of noncardiovascular origin, chest radiography is usually appropriate as the first-line imaging modality. Chest CT without contrast is either usually appropriate or may be appropriate as a second-line option for conditions of unclear etiology or suspected chronic obstructive pulmonary disease, small airways disease, and post–COVID-19 complications. Chest CT with contrast may have a role in patients with pleura/chest wall disease or diaphragm dysfunction. Although MRI, fluoroscopy, and FDG-PET/CT have limited roles, special imaging techniques such as inspiratory/expiratory CT and hyperpolarized xenon gas MRI are noted for their specific uses. This document aims to help clinicians choose the most suitable imaging tests, enhancing diagnostic accuracy and patient care.</div><div>The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages S163-S176"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACR Appropriateness Criteria® Management of Iliac Artery Occlusive Disease: 2024 Update","authors":"Expert Panel on Interventional Radiology,&nbsp;Matthew J. Scheidt MD ,&nbsp;Parag J. Patel MD ,&nbsp;Nicholas Fidelman MD ,&nbsp;Charles Y. Kim MD ,&nbsp;Mikhail C.S.S. Higgins MD, MPH ,&nbsp;Osmanuddin Ahmed MD ,&nbsp;Marcelo S. Guimaraes MD ,&nbsp;Minhaj S. Khaja MD, MBA ,&nbsp;Alexander Lam MD ,&nbsp;Jeffrey J. Siracuse MD, MBA ,&nbsp;Jason W. Pinchot MD","doi":"10.1016/j.jacr.2025.02.024","DOIUrl":"10.1016/j.jacr.2025.02.024","url":null,"abstract":"<div><div>Management of iliac artery occlusive disease encompasses a review of peripheral arterial disease (PAD) diagnosis and treatment as a whole. There are several consensus documents that provide a comprehensive review of the topic. Differentiating optimal medical, surgical, and/or endovascular approaches to treat aortoiliac occlusive disease requires recognition of the likely etiology most responsible for the clinical symptomatology. Prompt diagnosis of acute limb ischemia versus chronic limb threatening ischemia is imperative to selecting the correct treatment pathway for individual patients. This document will attempt to summarize the data and most recent clinical trials to support clinical decision-making in the treatment of aortoiliac occlusive disease.</div><div>The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages S343-S358"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACR Appropriateness Criteria® Inflammatory Ear Disease","authors":"Expert Panel on Neurological Imaging,&nbsp;Mohit Agarwal MD ,&nbsp;Amy F. Juliano MD ,&nbsp;Mari Hagiwara MD ,&nbsp;Moises Auron MD ,&nbsp;Judah Burns MD ,&nbsp;Matthew L. Bush MD, PhD, MBA ,&nbsp;Prachi Dubey MBBS, MPH ,&nbsp;Elliott R. Friedman MD ,&nbsp;Maria K. Gule-Monroe MD ,&nbsp;Benjamin W. Hatten MD, MPH ,&nbsp;Vikas Jain MD ,&nbsp;Tanya J. Rath MD ,&nbsp;Lilja B. Solnes MD, MBA ,&nbsp;M. Reza Taheri MD, PhD ,&nbsp;David Zander MD ,&nbsp;Bruno Policeni MD, MBA","doi":"10.1016/j.jacr.2025.02.026","DOIUrl":"10.1016/j.jacr.2025.02.026","url":null,"abstract":"<div><div>This document provides evidence-based guidelines for appropriateness of imaging modalities in cases of inflammatory ear disease covering acute and chronic, and uncomplicated and complicated otitis media and otitis externa in adults. Imaging recommendations for initial imaging and postoperative surveillance of cholesteatoma in adults have also been addressed. This document provides guidance for physicians in the choice of imaging while managing cases of complicated or uncomplicated inflammatory conditions of the ear, and managing initial presentation or postoperative cases of cholesteatoma.</div><div>The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages S300-S318"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACR Appropriateness Criteria® Fever Without Source or Unknown Origin-Child: 2024 Update","authors":"Expert Panel on Pediatric Imaging,&nbsp;Matthew L. Cooper MD ,&nbsp;Ramesh S. Iyer MD, MBA ,&nbsp;Sherwin S. Chan MD, PhD ,&nbsp;Dianna M.E. Bardo MD ,&nbsp;Tushar Chandra MD, MBBS ,&nbsp;Roshni A. Dasgupta MD ,&nbsp;Deborah Faccenda MD ,&nbsp;Terry L. Levin MD ,&nbsp;Sharon E. Mace MD ,&nbsp;Michael M. Moore MD ,&nbsp;Helen R. Nadel MD ,&nbsp;Cassandra M. Sams MD ,&nbsp;Gary R. Schooler MD ,&nbsp;Narendra S. Shet MD ,&nbsp;Judy H. Squires MD ,&nbsp;Sumit Pruthi MD, MBBS","doi":"10.1016/j.jacr.2025.02.029","DOIUrl":"10.1016/j.jacr.2025.02.029","url":null,"abstract":"<div><div>Fever is the most common reason for the evaluation of pediatric patients in acute care settings. Patients for whom no source of infection is identified after a thorough history, physical examination, and laboratory evaluation are classified as having fever without source. Special considerations should be taken in the evaluation of neonates and neutropenic patients as they are at higher risk of serious bacterial infection. Patients with prolonged fever lasting &gt;3 weeks who have no identifiable source of fever are classified with fever of unknown origin and represent an additional subset of febrile pediatric patients that also require special consideration. This document summarizes the relevant literature and provides expert recommendations for the selection of the initial imaging in four common clinical scenarios in pediatric patients with fever without source or unknown origin.</div><div>The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages S243-S260"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}