Faculty Bibliography

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. 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.

This white paper describes splenic and nodal incidental findings found on CT and MRI. Recommendations for management are included. This represents the third of 4 such papers from the ACR Incidental Findings Committee II, which used a consensus method based on repeated reviews and revisions and a collective review and interpretation of relevant literature. Topics include descriptions of appearances of several types of splenic lesions and, the importance of size and distribution of lymph nodes. Flowcharts are provided for reference.

The presence of a paratracheal air collection in the setting of acute trauma may indicate a wide array of etiologies. When a paratracheal air collection is found in a trauma patient, the possibility of tracheal or esophageal rupture must be considered. Tracheal diverticulae are most frequently found incidentally during autopsy, with an incidence of approximately 1%. We present a case of an incidental tracheal diverticulum in a patient with a recent history of motor vehicle accident with chest and neck trauma.

Spontaneous pneumomediastinum (SPM) is a fairly uncommon condition in which free air is present in the mediastinum, often in young patients without injury or serious underlying pulmonary disease. We present a case of SPM in a 36-year-old man with no pertinent medical history who presented with chest pain after a 3-h flight. To the best of our knowledge, this is the first known case in radiology literature of SPM caused by increased intra-alveolar pressure secondary to increased altitude.

We present the CT and clinical findings in a 21-year old male who presented to the emergency department following bystander trauma during the rescue effort of the World Trade Center disaster.