Journal of the American College of Radiology最新文献

{"title":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Female Breast Cancer Screening: 2024 Update","authors":"Aatiqah Aziz , Sonya Bhole MD","doi":"10.1016/j.jacr.2024.09.017","DOIUrl":"10.1016/j.jacr.2024.09.017","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Page 615"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634240","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":"State-Level Medicaid Reimbursement and Imaging Utilization by Medicaid and Children’s Health Insurance Program Patients","authors":"Eric W. Christensen PhD ,&nbsp;Alexandra R. Drake MPH ,&nbsp;Neil C. Davey MD ,&nbsp;Elizabeth Y. Rula PhD","doi":"10.1016/j.jacr.2024.10.009","DOIUrl":"10.1016/j.jacr.2024.10.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine if relative Medicaid-to-Medicare reimbursement rates are associated with patient imaging utilization.</div></div><div><h3>Methods</h3><div>This cross-sectional study estimated the association of diagnostic imaging utilization with the state-level Medicaid-to-Medicare reimbursement ratio (MMRR) of professional payments. State-specific reimbursement ratios were computed for each imaging modality. Logistic regression was used to estimate the likelihood of having imaging, and gamma regression was used to estimate the average number of imaging studies for those with imaging. These models were performed for each gender-modality combination controlling for patient characteristics.</div></div><div><h3>Results</h3><div>Among 48,835,765 Medicaid patients, 54.3% were women. The median MMRR was 0.82 (interquartile range [IQR]: 0.73-0.94) for CT, 0.87 (IQR: 0.76-1.01) for MR, 0.76 (IQR: 0.69-0.99) for nuclear medicine (NM), 0.85 (IQR: 0.73-1.09) for ultrasound, and 0.82 (IQR: 0.74-0.97) for radiography or fluoroscopy (XR). The probability of having imaging was 25.9% for CT, 25.9% for MR, 21.4% for ultrasound, and 31.8% for XR higher at 75th percentile of the MMRR distribution compared with the 25th percentile (<em>P</em> &lt; .001). For those with imaging, the mean number of imaging studies received was associated with 5.7% fewer studies for NM at the 75th percentile compared with the 25th percentile (<em>P</em> &lt; .001), although there was no difference for other modalities.</div></div><div><h3>Conclusions</h3><div>Medicaid payments are related to imaging utilization. A higher MMRR is associated with a substantially increased likelihood of Medicaid patients receiving CT, MR, ultrasound, and XR imaging but no difference in the amount of imaging studies received for those with imaging for these modalities.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages 530-538"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873610","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":"Has Anyone Seen Our Chief?","authors":"Jennifer Nathan MD ,&nbsp;Frank J. Lexa MD, MBA ,&nbsp;Kenneth Hite MD ,&nbsp;Candice Johnstone MD, MPH ,&nbsp;Serena Liebengood MD, MHSA","doi":"10.1016/j.jacr.2024.12.013","DOIUrl":"10.1016/j.jacr.2024.12.013","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Page 606"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900987","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":"Perceived Discrimination and Pandemic Attitudes on Cancer Screening Behaviors Among Asian American Women: A Sequential Explanatory Mixed-Methods Study","authors":"Chau D. Vo MD ,&nbsp;Bingjing Mao PhD ,&nbsp;Alexander W. Burns BS ,&nbsp;Jordan Neil PhD ,&nbsp;Nathaniel Mercaldo PhD ,&nbsp;Qi Yan MPH ,&nbsp;Yasmine Nousari BA ,&nbsp;Lauren Ballini MPH ,&nbsp;Nikki López-Suárez MD ,&nbsp;Aayan V. Khasgiwala ,&nbsp;Arlin Arias Castro MEd ,&nbsp;Kelly Irwin MD ,&nbsp;Elyse R. Park PhD, MPH ,&nbsp;Ruth C. Carlos MD, MS ,&nbsp;Efrén J. Flores MD","doi":"10.1016/j.jacr.2024.11.032","DOIUrl":"10.1016/j.jacr.2024.11.032","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to assess how pandemic-related health concerns and discrimination affected cancer screenings among Asian American women (AAW).</div></div><div><h3>Methods</h3><div>A two-phase explanatory mixed-methods study was conducted. In phase 1, a survey was distributed among AAW eligible for lung, breast, or colorectal cancer screening to assess delays during the pandemic, concerns about contracting coronavirus disease 2019 (COVID-19), barriers to care, and experiences of discrimination. In phase 2, four qualitative focus group discussions, stratified by generational status and history of delayed cancer screening, were conducted to explore a priori domains of interest on cancer screening during the pandemic and perceived discrimination. Logistic regression analyses were performed to identify factors associated with delays, followed by deductive thematic qualitative analysis.</div></div><div><h3>Results</h3><div>In phase 1, of 225 participants recruited, 166 met the inclusion criteria (74%). Most participants were first-generation Americans (67%), were employed (65%), and had higher education (67% with a master’s degree or higher). Forty percent reported delays in cancer screening. Factors associated with delays included worry about contracting COVID-19 (adjusted odds ratio, 2.57; 95% confidence interval, 1.05-6.28; <em>P</em> = .038) and spreading it to family or friends (adjusted odds ratio, 5.78; 95% confidence interval, 1.50-22.3; <em>P</em> = .011). No association between discrimination and delayed cancer screening was found. In phase 2, focus group discussions (n = 19) revealed that first-generation women who delayed screening faced barriers due to a fear of infection and perceived discrimination. Perceived discrimination affected daily behaviors and sense of safety, though less so in medical settings.</div></div><div><h3>Conclusions</h3><div>Delays in cancer screening among AAW were associated with patients’ concerns about contracting and spreading COVID-19. Radiology practices can lead collaborative efforts on cancer screening campaigns that emphasize early detection and promote psychological safety.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages 539-549"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366958","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":"The Road Map for ACR Practice Accreditation for Radiology Artificial Intelligence","authors":"David B. Larson MD, MBA ,&nbsp;Mythreyi Bhargavan-Chatfield PhD ,&nbsp;Michael Tilkin MS ,&nbsp;Laura Coombs PhD ,&nbsp;Christoph Wald MD, PhD, MBA","doi":"10.1016/j.jacr.2025.02.008","DOIUrl":"10.1016/j.jacr.2025.02.008","url":null,"abstract":"<div><div>As the use of artificial intelligence (AI) continues to grow in radiology, it has become clear that its real-world performance often differs from that demonstrated in premarket testing, underscoring the need for robust quality management (QM) programs at local institutions. For decades, a key mechanism to ensure QM in radiology practices has been ACR accreditation. However, no such program currently exists for AI in radiology. As leaders of the ACR Commissions on Quality and Safety and Informatics, we are dedicated to establishing ACR accreditation for radiology AI. In this article, we outline our plan for this effort. ACR accreditation is a peer-reviewed process that evaluates radiology practices according to ACR Practice Parameters and Technical Standards, which are consensus-based guidelines aimed at improving care quality and reducing variability. ACR Practice Parameters focus on clinical aspects like patient management, and Technical Standards address the performance of imaging and treatment equipment. To support the development of this accreditation program, the ACR Recognized Center for Healthcare-AI (ARCH-AI) program has been established as a precursor to formal accreditation. ARCH-AI participants attest to meeting minimum criteria in areas such as governance, model selection, acceptance testing, monitoring, and management of locally developed models. Insights gained from ARCH-AI will inform the development of the formal accreditation program, which will culminate in ACR Council approval, currently anticipated in spring 2027. The College remains committed to fostering dialogue among members and stakeholders to ensure AI fulfills its promise of enhancing patient care safely and effectively.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages 586-592"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588409","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® Dementia: 2024 Update","authors":"Expert Panel on Neurological Imaging,&nbsp;Karl A. Soderlund MD ,&nbsp;Matthew J. Austin MD ,&nbsp;Sharona Ben-Haim MD ,&nbsp;Sammy Chu MD ,&nbsp;Jana Ivanidze MD, PhD ,&nbsp;Pallavi Joshi DO, MA ,&nbsp;Aleks Kalnins MD, MBA ,&nbsp;Maura Kennedy MD, MPH ,&nbsp;Ambar Kulshreshtha MD, PhD ,&nbsp;Phillip H. Kuo MD, PhD ,&nbsp;Joseph C. Masdeu MD, PhD ,&nbsp;Tejas Nikumbh MD ,&nbsp;Bruno P. Soares MD ,&nbsp;Ashesh A. Thaker MD ,&nbsp;Lily L. Wang MBBS, MPH ,&nbsp;Sevil Yasar MD, PhD ,&nbsp;Robert Y. Shih MD","doi":"10.1016/j.jacr.2025.02.031","DOIUrl":"10.1016/j.jacr.2025.02.031","url":null,"abstract":"<div><div>Dementia is defined by significant chronic or acquired impairment in a single domain or loss of two or more cognitive functions by brain disease or injury. It is a common chronic syndrome in adults and constitutes the fifth leading cause of death in patients &gt;65 years of age. Multiple etiologies of dementia exist, most notably Alzheimer disease, frontotemporal dementia, and dementia with Lewy bodies, as well as other neurologic diseases such as vascular dementia and normal pressure hydrocephalus. In addition to aiding clinicians in selecting the most appropriate imaging test for patients suspected of one of these dementia syndromes, this document highlights the most appropriate initial imaging tests for patients with suspected mild cognitive impairment and rapidly progressive dementia, as well as the most appropriate pre- and posttreatment imaging tests for patients undergoing therapy with antiamyloid monoclonal antibodies.</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 S202-S233"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106338","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® Renal Transplant Dysfunction: 2024 Update","authors":"Expert Panel on Urological Imaging,&nbsp;Myles T. Taffel MD ,&nbsp;Gaurav Khatri MD ,&nbsp;Andrei S. Purysko MD ,&nbsp;Ryan Avery MD ,&nbsp;Melanie P. Caserta MD ,&nbsp;Silvia D. Chang MD ,&nbsp;Alberto Diaz De Leon MD ,&nbsp;Dhakshinamoorthy Ganeshan MBBS ,&nbsp;Rajan T. Gupta MD ,&nbsp;Susie Q. Lew MD ,&nbsp;Andrej Lyshchik MD, PhD ,&nbsp;Refky Nicola DO, MSc ,&nbsp;Carl Piel Jr. DO ,&nbsp;Alp Sener MD, PhD ,&nbsp;Andrew D. Smith MD, PhD ,&nbsp;Paul Nikolaidis MD","doi":"10.1016/j.jacr.2025.02.022","DOIUrl":"10.1016/j.jacr.2025.02.022","url":null,"abstract":"<div><div>Renal transplantation remains the treatment of choice in patients with end-stage renal disease as the 5-year survival rates for the graft in renal transplant patients range from 72% to 99%. Despite improvements in graft survival related to increased efficacy of immunosuppression drugs and improvements in surgical technique, various complications do occur. Ultrasound is the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for longitudinal follow-up. Various other imaging techniques serve as complementary examinations in specific clinical settings. Angiography remains the reference standard for arterial complications and is used for nonsurgical intervention, but noninvasive CT or MR angiography could be considered prior to an invasive procedure.</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 S372-S395"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106452","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 Shoulder Pain: 2024 Update","authors":"Expert Panel on Musculoskeletal Imaging,&nbsp;Olga Laur MD ,&nbsp;Alice S. Ha MD, MS ,&nbsp;Roger J. Bartolotta MD ,&nbsp;Ryan Avery MD ,&nbsp;Cyrus P. Bateni MD ,&nbsp;Karen C. Chen MD ,&nbsp;Aleksey Dvorzhinskiy MD ,&nbsp;Jonathan Flug MD, MBA ,&nbsp;Christian S. Geannette MD ,&nbsp;Tate Hinkle MD ,&nbsp;Christopher Hogrefe MD ,&nbsp;Benjamin E. Plotkin MD ,&nbsp;Michael J. Todd MD ,&nbsp;Eric Y. Chang MD","doi":"10.1016/j.jacr.2025.02.015","DOIUrl":"10.1016/j.jacr.2025.02.015","url":null,"abstract":"<div><div>Trauma is a predominant cause of acute shoulder pain, commonly secondary to fractures (clavicle, scapula, or proximal humerus) or soft tissue injuries (typically involving the rotator cuff, acromioclavicular ligaments, or labroligamentous complex). Radiography is the imaging modality of choice for initial assessment of acute shoulder pain and identification of potential fractures. In cases where radiographs yield normal or inconclusive results, additional imaging modalities such as ultrasound, MRI, or CT of the shoulder without contrast, or MR or CT arthrography, may be useful to diagnose the underlying pathology. These modalities aid in the detection of conditions including nondisplaced fractures, tears of the labrum and rotator cuff, as well as detailed assessment of soft tissue and bony injury following glenohumeral joint dislocation. This document presents a comprehensive review of the evidence supporting or refuting the use of various imaging modalities in diagnosing acute shoulder pain.</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 S36-S47"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106458","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":"Female Representation in Integrated Interventional Radiology Residency: Trends, Underrepresentation, and Modest Growth Over Five Years","authors":"Emily R. Hunt BS ,&nbsp;Sophie Vo BS ,&nbsp;Andrea Benson BS ,&nbsp;Sherron Thomas BS ,&nbsp;Harika Dabbara BS ,&nbsp;Rebecca T. Le MD","doi":"10.1016/j.jacr.2024.12.008","DOIUrl":"10.1016/j.jacr.2024.12.008","url":null,"abstract":"<div><h3>Objective</h3><div>Women remain a minority of trainees in interventional radiology (IR) since the residency’s inception in 2014. Similar phenomena have been observed in other surgical specialties. Our study aims to quantify changes in female trainee representation in integrated IR over a 5-year period from the 2018-2019 to 2022-2023 academic years and to compare with trends in other specialties.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of survey data collected from the National Graduate Medical Education database. The eight selected specialties, including IR, were chosen due to qualitative similarities with IR training or due to less than 30% female trainee representation in 2018-2019. In these data, gender was categorized as male or female. Percentage of female trainees in each specialty was collected in the study period. Analysis was conducted using analysis of variance, linear regression, and Tukey honest significant difference (<em>P</em> &lt; .05).</div></div><div><h3>Results</h3><div>In the 5-year study period, female representation in integrated IR residency grew by 16.6% at a mean relative growth rate of 4.0% annually. By 2022-2023, integrated vascular surgery residency had the highest female trainee representation (38.4%), whereas integrated IR had the second lowest (22.4%), ahead of orthopedic surgery (20.4%).</div></div><div><h3>Discussion</h3><div>Despite observed growth, female trainee representation in integrated IR lags behind other procedural and radiology specialties. Our analysis emphasizes the need for continued recruitment of female applicants to bolster gender parity. Supporting known ongoing initiatives like female mentorship programs and developing new strategies to support female interest in IR should be a priority for the field.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 5","pages":"Pages 593-599"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878838","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® Staging and Follow-up of Anal Cancer","authors":"Expert Panel on Gastrointestinal Imaging,&nbsp;Natally Horvat MD, PhD ,&nbsp;Peter S. Liu MD ,&nbsp;Kathryn J. Fowler MD ,&nbsp;James H. Birkholz MD ,&nbsp;Brooks D. Cash MD ,&nbsp;Bari Dane MD ,&nbsp;Cathy Eng MD ,&nbsp;Avinash R. Kambadakone MD ,&nbsp;Elena K. Korngold MD ,&nbsp;Jason A. Pietryga MD ,&nbsp;Tamer Refaat MD, PhD, MS ,&nbsp;Cynthia S. Santillan MD ,&nbsp;Devaki Shilpa Surasi MD ,&nbsp;Sarah Woolsey MD, MPH ,&nbsp;David H. Kim MD","doi":"10.1016/j.jacr.2025.02.018","DOIUrl":"10.1016/j.jacr.2025.02.018","url":null,"abstract":"<div><div>This document aims to provide recommendations on the role of imaging in the diagnosis of squamous cell anal cancer, focusing on its use in locoregional and systemic assessment during initial staging, posttreatment evaluation, and surveillance. For initial locoregional staging, MRI of the pelvis and FDG-PET/CT are usually appropriate to complement clinical and digital rectal examinations, because they offer additional information regarding locoregional tumor invasion and nodal metastases. For metastatic disease assessment, which is rare in the initial presentation and commonly associated with recurrence—with lymph nodes, liver, and lungs being the most common sites of disease—CT and FDG-PET/CT are usually appropriate for detecting distant nodal metastases and other sites of metastatic disease. MRI of the abdomen may be appropriate as a problem-solving tool, particularly in assessing small or indeterminate liver lesions. For patients who have completed locoregional treatment, most typically achieve clinical complete response; consequently, few require surgery unless there is persistent disease or recurrence. The role of posttreatment imaging assessment is still debatable; however, in cases in which surgery is indicated, MRI and FDG-PET/CT are usually appropriate for assessing local tumor invasion and nodal metastases.</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 in which 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 S396-S404"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106451","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}