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J Am Coll Radiol. 2014 Jun;11(6):543-51. doi: 10.1016/j.jacr.2014.02.006. Epub 2014 Apr 30.

ACR Appropriateness Criteria colorectal cancer screening.

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University of California, San Francisco, San Francisco, California. Electronic address:
University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
UMass Memorial Medical Center & UMass School of Medicine, Worcester, Massachusetts.
Inland Imaging Associates and University of Washington, Seattle, Washington.
Virginia Commonwealth University Medical Center, Richmond, Virginia.
University of South Alabama, Mobile, Alabama; American Gastroenterological Association, Bethesda, Maryland.
University of Texas MD Anderson Cancer Center, Houston, Texas, American College of Surgeons, Chicago, Illinois.
Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
Winthrop-University Hospital, Mineola, New York.
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Northwestern University, Chicago, Illinois.


Colorectal cancer is the third leading cause of cancer deaths in the United States. Most colorectal cancers can be prevented by detecting and removing the precursor adenomatous polyp. Individual risk factors for the development of colorectal cancer will influence the particular choice of screening tool. CT colonography (CTC) is the primary imaging test for colorectal cancer screening in average-risk individuals, whereas the double-contrast barium enema (DCBE) is now considered to be a test that may be appropriate, particularly in settings where CTC is unavailable. Single-contrast barium enema has a lower performance profile and is indicated for screening only when CTC and DCBE are not available. CTC is also the preferred test for colon evaluation following an incomplete colonoscopy. Imaging tests including CTC and DCBE are not indicated for colorectal cancer screening in high-risk patients with polyposis syndromes or inflammatory bowel disease. This paper presents the updated colorectal cancer imaging test ratings and is the result of evidence-based consensus by the ACR Appropriateness Criteria Expert Panel on Gastrointestinal Imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.


Appropriateness criteria; CT colonography; adenoma; barium enema; colorectal cancer; screening

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