Patient-Friendly Summary of the ACR Appropriateness Criteria: Radiologic Management of Venous Thromboembolism-Inferior Vena Cava Filters

Deep vein thrombosis is caused by blood clots in the veins in the legs. These can travel to the lungs, causing pulmonary embolism (PE). These conditions are referred to as venous thromboembolism (VTE). VTE is usually treated with anticoagulants (medicines that decrease blood clotting). It may also be appropriate to put a permanent or retrievable device within the inferior vena cava (IVC) to stop the clot from going into the lungs. A retrievable IVC is usually appropriate when the use of anticoagulants may cause too high a risk of bleeding. A permanent IVC may be appropriate. In cases of acute VTE with a clot in calf veins below the knee (which has a lower risk for PE), observation with serial imaging tests is usually appropriate. Anticoagulation may also be appropriate if there is severe pain with the calf vein clot or if the patient is bedridden or has an underlying malignancy. In individuals who have chronic VTE, anticoagulation is usually appropriate. In select patients who develop high pressures within the lung arteries due to chronic VTE and PE, an operation to remove the clots from the lungs or a procedure to open the artery in the lungs by inflating a balloon may be appropriate. A permanent or retrievable IVC may also be appropriate. In people at high risk for VTE (for example, those with major trauma), anticoagulation and using a device that automatically compresses the legs to keep blood flow moving is usually appropriate. Retrievable IVC or surveillance may also be appropriate. See the full appropriateness criteria for this topic at https://acsearch.acr.org/docs/69342/Narrative

Patient Friendly Summary of the ACR Appropriateness Criteria: Acute Mental Status Change, Delirium, and New Onset Psychosis

Changes in mental status can be caused by a variety of factors, including intoxication, infection, stroke, bleeding, tumor, fluid, trauma or brain injury, and inflammation. This can show up as changes in behavior, alertness, agitation, confusion, and seizures. When there is high suspicion of bleeding, stroke, infection, or tumor or if the individual has extremely high blood pressure, CT or MRI without intravenous (IV) contrast may be the initial examination. If the examination without contrast does not show the cause, follow-up CT or MRI performed with IV contrast may help if a tumor or an infection is suspected. If an individual has a known infection, tumor, recent bleeding, or recent acute stroke and his or her condition is getting worse, it may be appropriate to have CT or MRI of the head without IV contrast or MRI of the head with and without contrast. When the reason for mental state change is known, for example, intoxication, and the cause is not thought to be due to trauma, it may be appropriate to have MRI of the head without and with IV contrast. For individuals whose mental state is getting worse even with treatment or is getting worse without a cause, MRI or CT of the head without IV contrast and MRI of the head without or with IV contrast are usually appropriate. For an individual with new delirium (disturbed state of mind), CT of the head without IV contrast is usually appropriate. For an individual with new psychosis (disconnection from reality), CT or MRI of the head without IV contrast or MRI of the head without and with IV contrast may be appropriate. Clinical version, ACR Appropriateness Criteria® Acute Mental Status Change, Delirium, and New Onset Psychosis https://acsearch.acr.org/docs/3102409/Narrative

Patient-Friendly Summary of the ACR Appropriateness Criteria Imaging After Total Knee Arthroplasty

Knee replacement, or total knee arthroplasty, is the most common joint replacement procedure in the United States. Most patients do not require any imaging after discharge other than the x-rays at the first postoperative follow-up appointment

ACR appropriateness criteria jaundice

A fundamental consideration in the workup of a jaundiced patient is the pretest probability of mechanical obstruction. Ultrasound is the first-line modality to exclude biliary tract obstruction. When mechanical obstruction is present, additional imaging with CT or MRI can clarify etiology, define level of obstruction, stage disease, and guide intervention. When mechanical obstruction is absent, additional imaging can evaluate liver parenchyma for fat and iron deposition and help direct biopsy in cases where underlying parenchymal disease or mass is found. Imaging techniques are reviewed for the following clinical scenarios: (1) the patient with painful jaundice, (2) the patient with painless jaundice, and (3) the patient with a nonmechanical cause for jaundice. 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. rights reserved

Patient-Friendly Summary of the ACR Appropriateness Criteria: Nontraumatic Chest Wall Pain

The 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

Patient-Friendly Summary of the ACR Appropriateness Criteria: Prostate Cancer-Pretreatment Detection, Surveillance, and Staging

Regular screening is recommended for men beginning about age 55. The first sign of cancer comes from either a blood test for a protein specific to prostate cancer (PSA) or by a digital examination of the prostate through the rectum to assess enlargement or firmness. Neither of these is perfectly accurate. Suspicion of cancer warrants additional testing

Patient-Friendly Summary of the ACR Appropriateness Criteria: Crohn Disease

Crohn disease (CD) is a chronic condition caused by inflammation of the bowel. The small bowel, the colon, or both can be involved. Individuals may have periods with frequent flare-ups and periods of remission. CD is usually diagnosed by colonoscopy along with clinical symptoms, laboratory tests, and imaging. Imaging is helpful to evaluate the extent of involvement on initial diagnosis, to evaluate for residual inflammation, or to monitor response to treatment. For individuals without a prior diagnosis of CD or individuals with known CD with a suspected flare-up, CT abdomen and pelvis with intravenous (IV) contrast, CT enterography, or MR enterography is usually appropriate. For enterography, whether done under CT or MR, the individual has to consume approximately 1 to 1.5 L of a special liquid to help fill the small bowel. For individuals with known CD under surveillance or monitoring for treatment, MR enterography is preferred because of its lack of radiation dose. Other imaging tests may be appropriate including MRI abdomen and pelvis without and with IV contrast when an individual is acutely ill and cannot tolerate a large volume of liquid to drink. CT abdomen and pelvis without IV contrast, fluoroscopy small-bowel follow-through, and MRI abdomen and pelvis without IV contrast can be performed in different situations but yield less information than CT enterography or MR enterography. See the full appropriateness criteria for this topic at https://acsearch.acr.org/docs/69470/Narrative/

Patient-Friendly Summary of the ACR Appropriateness Criteria: Suspected Upper-Extremity Deep Vein Thrombosis

The 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