Journal of the American College of Radiology最新文献

{"title":"ACR Appropriateness Criteria Imaging After Shoulder Arthroplasty: Updated 2026","authors":"Expert Panel on Musculoskeletal Imaging,&nbsp;Donna G. Blankenbaker MD,&nbsp;Nicholas C. Nacey MD,&nbsp;Cristy N. French MD,&nbsp;Matthew A. Frick MD,&nbsp;Ricardo D. Garza-Gongora MD,&nbsp;Steven J. Hattrup MD,&nbsp;Molly Kresin DO,&nbsp;Mary Kristin Lowry MD,&nbsp;Megan Mills MD,&nbsp;Michael G. Fox MD, MBA","doi":"10.1016/j.jacr.2026.03.008","DOIUrl":"10.1016/j.jacr.2026.03.008","url":null,"abstract":"<div><div>Shoulder arthroplasties, including partial or complete humeral head resurfacing, hemiarthroplasty, conventional total shoulder arthroplasty, and reverse total shoulder arthroplasty, are increasingly being performed for painful shoulder conditions. This document defines best practices for ordering imaging studies based on specific clinical scenarios, which are categorized into different variants. Each variant includes a brief description of the usefulness, advantages, and limitations of various imaging modalities. This document is the result of a comprehensive analysis of the available literature and a thorough review of best imaging practices for each clinical scenario.</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":"23 8","pages":"Pages 1717-1737"},"PeriodicalIF":5.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Detection to Calibration: Reframing Radiology Training in the Artificial Intelligence Era","authors":"Matthew N. DeSalvo MD","doi":"10.1016/j.jacr.2026.05.005","DOIUrl":"10.1016/j.jacr.2026.05.005","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"23 8","pages":"Pages 1593-1596"},"PeriodicalIF":5.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870482","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® Renovascular Hypertension: Update 2026","authors":"Expert Panel on Urological Imaging,&nbsp;Refky Nicola DO, MSc,&nbsp;Richard Thomas MD,&nbsp;Andrei S. Purysko MD,&nbsp;Ayaz Aghayev MD,&nbsp;Sandeep S. Hedgire MD,&nbsp;Dianne Goede MD,&nbsp;Susie Q. Lew MD,&nbsp;Timothy McClure MD,&nbsp;Sasan Partovi MD,&nbsp;Sachin S. Saboo MD,&nbsp;Akash Sharma MD, MBA,&nbsp;Venkateswar R. Surabhi MD,&nbsp;Myles T. Taffel MD,&nbsp;Bill S. Majdalany MD,&nbsp;Gaurav Khatri MD","doi":"10.1016/j.jacr.2026.02.010","DOIUrl":"10.1016/j.jacr.2026.02.010","url":null,"abstract":"<div><div>Renovascular hypertension is the most common cause of secondary hypertension and occurs in 0.5% to 5% of individuals with hypertension. This is more common in individuals who have difficulty controlling their pressure or elderly patients with end-stage kidney disease. An evaluation for renovascular hypertension is indicated if there is a high level of clinical suspicion. The primary imaging modalities for assessing renovascular hypertension are ultrasound, CT, and MRI, and these options can vary depending on the patient’s current renal status. Although ultrasound is beneficial since it uses nonionizing radiation, CT with contrast provides excellent spatial resolution. In patients with decreased renal function, MRI is a reliable alternative.</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":"23 7","pages":"Pages 1384-1404"},"PeriodicalIF":5.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Detection and Classification of Radiology Report Discrepancies Using NLP: A Tool for Resident Education and Quality Assurance","authors":"Kexin Wang BD,&nbsp;He Wang MD,&nbsp;Jinyun Wu MD,&nbsp;Ke Wang MD,&nbsp;Weipeng Liu BD,&nbsp;Yaofeng Zhang BD,&nbsp;Xiaoying Wang MD","doi":"10.1016/j.jacr.2026.03.015","DOIUrl":"10.1016/j.jacr.2026.03.015","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to develop and evaluate a natural language processing (NLP) system that automatically detects and classifies discrepancies between preliminary and final radiology reports, with the goal of enhancing resident education through structured feedback.</div></div><div><h3>Methods</h3><div>A total of 889 deidentified lumbar spine MRI reports (768 with revisions) from December 2023 to March 2024 were retrospectively analyzed. Preliminary full diagnostic reports were generated by trainee residents during daytime rotations; final reports were subsequently verified by attending radiologists remotely. Discrepancies in the diagnostic impression section were extracted using a multistep NLP pipeline: sentence segmentation, Bidirectional Encoder Representations From Transformers–based sentence matching, GPT-4-based named entity recognition, and rule-based classification into 11 correction types (missed diagnosis, misdiagnosis, missed image feature, misidentified image feature, localization error, diagnostic reasoning error, clinical query omission, severity error, confidence difference, typographic error, and terminology refinement). Ground truth was established by three radiologists. System performance was evaluated for each correction type individually using accuracy, sensitivity, specificity, and intraclass coefficient. Trends in resident and attending radiologist performance were analyzed at the report level.</div></div><div><h3>Results</h3><div>The NLP system achieved high accuracy (0.983-0.999), sensitivity (0.977-1.000), and specificity (0.900-1.000) for each of the 11 correction types, with strong interrater reliability (intraclass correlation coefficient &gt; 0.75). Most common corrections were misdiagnosis (504 of 768 [65.6%]) and missed diagnosis (356 of 768 [46.4%]). Residents showed significant variability in error rates, especially in missed diagnosis (range, 11.1%-59.1% across 16 residents) and misdiagnosis (range, 24.0%-71.1% across 16 residents). Attending radiologists exhibited marked heterogeneity in correction patterns (n = 6; individual workload range, 95-187 reports; median, 159 reports), with significant variability across all major error types (<em>P</em> &lt; .001 for missed diagnosis [20.6%-82.0%], misdiagnosis [31.4%-66.7%], localization error [15.8%-54.7%], and terminology refinement [3.2%-36.7%]).</div></div><div><h3>Conclusions</h3><div>The NLP-based discrepancy tracking system accurately identifies and classifies report modifications, enabling scalable, targeted feedback for radiology residents. Variability among residents and attending radiologists highlights the need for individualized training and standardized review practices.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"23 7","pages":"Pages 1293-1305"},"PeriodicalIF":5.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617263","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":"Shifts in Urbanicity-Based Access to Radiotracers for Neuroendocrine Tumors","authors":"Cindy X. Yuan MD, PhD,&nbsp;Kylie C. Long BS,&nbsp;Elizabeth Y. Rula PhD,&nbsp;Eric W. Christensen PhD","doi":"10.1016/j.jacr.2026.03.017","DOIUrl":"10.1016/j.jacr.2026.03.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the effect of newer radiotracers—⁶⁸Ga-DOTATATE/DOTATOC and ⁶⁴Cu-DOTATATE—compared with ¹¹¹In-pentetreotide on geographic access to radiotracers for patients with neuroendocrine tumors (NETs).</div></div><div><h3>Methods</h3><div>This retrospective study (2014-2023) used claims from a 5% sample of Medicare fee-for-service beneficiaries. Claims for ¹¹¹In-pentetreotide (Octreoscan, Curium US LLC, Boston, MA), ⁶⁸Ga-DOTATATE/DOTATOC (gallium), and ⁶⁴Cu-DOTATATE (copper) were extracted for all beneficiaries with NET. Distance traveled was based on the patient and facility ZIP codes. All claims for ¹⁸F-fluorodeoxyglucose were used as a proxy for PET/CT access. Distances traveled were compared across radiotracers, urbanicity, and time periods.</div></div><div><h3>Results</h3><div>There were 245,775 claims that met selection criteria. Gallium’s initial market share was 33.8% in 2017 and peaked at 90.9% in 2020. Copper’s initial market share was 21.0% in 2021 and increased to 40.6% in 2023, with greater penetration among patients from small or rural areas. When gallium was the only PET-based NET radiotracer (2017-2020), patients from small or rural areas traveled 134.9 miles further for gallium versus Octreoscan (<em>P</em> = .001). One-third of this difference can be explained by differences in access to PET/CT, as the incremental distance traveled by patients from small or rural areas for ¹⁸F-fluorodeoxyglucose over Octreoscan was 43.7 miles. After copper was introduced (2021-2023), the metropolitan or micropolitan––small or rural difference closed and was mostly indistinguishable from the effect of the distribution of PET capabilities.</div></div><div><h3>Conclusions</h3><div>Octreoscan utilization expectedly declined with the introduction of PET-based radiotracers, likely due to their clinical superiority, with greater penetration of copper in small or rural areas. Copper reduced distance traveled by patients with NETs given its comparable diagnostic accuracy and greater geographical availability compared with gallium.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"23 7","pages":"Pages 1235-1243"},"PeriodicalIF":5.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791394","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 Pancreatic Neuroendocrine Tumors","authors":"Expert Panel on Gastrointestinal Imaging,&nbsp;Joseph H. Yacoub MD,&nbsp;Motoyo Yano MD, PhD,&nbsp;Kevin J. Chang MD,&nbsp;Emily Bergsland MD,&nbsp;Priya R. Bhosale MD,&nbsp;Brooks D. Cash MD,&nbsp;Victoria Chernyak MD, MS,&nbsp;Ayushi Gupta MD,&nbsp;Julie Hallet MD, MSc,&nbsp;Jason Halpern MD,&nbsp;Michael Magnetta MD,&nbsp;Craig F. Noronha MD,&nbsp;Tamer Refaat MD, PhD, MS,&nbsp;Elena K. Korngold MD","doi":"10.1016/j.jacr.2026.02.012","DOIUrl":"10.1016/j.jacr.2026.02.012","url":null,"abstract":"<div><div>Accurate staging and appropriate follow-up imaging of pancreatic neuroendocrine tumors (PNET) are essential for guiding management and optimizing outcomes. This document provides evidence-based recommendations for the imaging evaluation of patients with PNET across six clinical variants: local staging, staging for metastatic disease, surveillance postresection, follow-up after treatment of liver-dominant and non-liver dominant disease, and follow-up of untreated disease. Contrast-enhanced CT is usually appropriate in most scenarios and commonly used as the first-line imaging modality in assessing tumor size, locoregional extent, vascular involvement, and metastatic spread. MRI is also usually appropriate, particularly for liver evaluation. MRI with hepatobiliary contrast agents and diffusion-weighted imaging improves detection and characterization of liver metastases, especially in liver-dominant disease. DOTATATE PET/CT is usually appropriate for staging and treatment planning in patients with suspected or known metastatic disease. FDG-PET/CT is reserved for select cases, such as high-grade tumors.</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":"23 7","pages":"Pages 1445-1461"},"PeriodicalIF":5.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vibe Coding in Radiology: Claude Code and ChatGPT Codex Leading to the Rise of the Radiologist-Developer","authors":"Kaustav Bera MD,&nbsp;Leonardo Kayat Bittencourt MD, PhD,&nbsp;Nikhil Ramaiya MD,&nbsp;Sree Harsha Tirumani MD","doi":"10.1016/j.jacr.2026.04.008","DOIUrl":"10.1016/j.jacr.2026.04.008","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"23 7","pages":"Pages 1283-1288"},"PeriodicalIF":5.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719080","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":"Toward Safer Tissue Acquisition in Peripheral Lung Nodule Evaluation","authors":"Jacob Schwartz MD, MPH,&nbsp;Irene Riestra MD,&nbsp;Uzair K. Ghori MD,&nbsp;Otis B. Rickman DO,&nbsp;Abesh Niroula MBBS","doi":"10.1016/j.jacr.2026.01.026","DOIUrl":"10.1016/j.jacr.2026.01.026","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"23 7","pages":"Pages 1225-1226"},"PeriodicalIF":5.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097544","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":"Geographic Analysis of Digital Breast Tomosynthesis Availability in High- and Low-Deprivation Areas","authors":"Cassie Deshong BA,&nbsp;Elizabeth Stoeckl MD,&nbsp;Oyinloye Jose MD,&nbsp;Angela Kristo MD,&nbsp;Manlu Liu BA,&nbsp;Amelia Wagner BA,&nbsp;Ian A. Weissman DO,&nbsp;Efren J. Flores MD,&nbsp;Anand K. Narayan MD, PhD,&nbsp;Victoria L. Mango MD,&nbsp;Randy C. Miles MD, MPH","doi":"10.1016/j.jacr.2026.04.010","DOIUrl":"10.1016/j.jacr.2026.04.010","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the association between zip code-level neighborhood deprivation and availability to digital breast tomosynthesis (DBT) at FDA-accredited breast imaging facilities.</div></div><div><h3>Methods</h3><div>Area Deprivation Index (ADI) values were obtained from the University of Wisconsin Neighborhood Atlas, which ranks zip code-level socio-economic disadvantage across the United States. Classification of high-disadvantage and low-disadvantage zip codes was dichotomized (high ≥ 97th national ADI percentile, low ≤ 3rd ADI percentile). Among FDA-accredited breast imaging facilities, a random sample was obtained, stratified by ADI values. DBT availability, out-of-pocket DBT fees, transportation assistance, availability of DBT educational resources, appointment availability, and flexible scheduling offerings was obtained from each facility.</div></div><div><h3>Results</h3><div>Among 220 facilities sampled, 91.8% (202 of 220) reported DBT availability. There was no observed difference in overall DBT, after-hour evening, and transportation service availability between facilities in low- and high-deprivation areas. Of facilities reporting DBT fees (n = 77), the median cost was $250, with no significant difference in average fees across ADI zip codes. A higher proportion of facilities in low-deprivation areas, however, offered DBT services on weekends compared with those in high-deprivation areas (50% versus 23.1%, <em>P</em> &lt; .001). Compared with high-deprivation areas, facilities in low-deprivation areas also more frequently significantly offered online scheduling.</div></div><div><h3>Conclusion</h3><div>Most breast imaging facilities in both high- and low-deprivation areas offer DBT, with comparable availability rates across neighborhoods. Addressing cost concerns, offering online scheduling and expanding weekend appointment availability may represent key opportunities to improve DBT utilization across sociodemographic groups.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"23 7","pages":"Pages 1228-1234"},"PeriodicalIF":5.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Friendly Summary of the ACR Appropriateness Criteria®: Chylothorax Treatment Planning: 2026 Update","authors":"Avani Shinde,&nbsp;Alexander Lam MD","doi":"10.1016/j.jacr.2026.03.001","DOIUrl":"10.1016/j.jacr.2026.03.001","url":null,"abstract":"","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"23 7","pages":"Page 1465"},"PeriodicalIF":5.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}