Shifts in technology drive ACR's guideline changes

The increased utilization of CT, MR, and PET imaging has prompted the American College of Radiology to revise its Appropriateness Criteria manual. Advances in technology enable the ACR to use a robust search engine for its Web-based version. A PDA-based application is also in the works.

The latest updates to the manual provide a more intuitive format overall. This includes the modality utilization ranking tables at the top of each category and a more consistent terminology. The standard term "CT," for example, replaces alternative references such as CAT scan and computed tomography, said Christine Waldrip, appropriateness criteria program specialist.

"We did not add new topics but updated 55 of the existing ones. These now include some of the more recent technologies," Waldrip said.

A few examples of indications that reflect technology advances are lung cancer staging and workup of solitary pulmonary nodules, uterine cancer, blunt chest trauma and suspected aortic injury, acute trauma of the hand or wrist, and acute pyelonephritis.

Many topics had not been reviewed since 1999. In some cases, only minor editorial modifications were made. But in many others, panel experts had to address the substantive evolution that has affected imaging modalities and their applications.

"CT urography has revolutionized the workup of hematuria, stone disease, and renal cancer staging in many practices. These changes are reflected now in the guidelines," said Dr. Peter L. Choyke, chief of the molecular imaging program at the National Cancer Institute and chair of the Appropriateness Criteria's urology panel.

FDG-PET wasn't even on the list for many illnesses five years ago, and now it is considered a reasonable diagnostic method in many conditions, Choyke said.

A PDA-based version will be launched soon. It's logical, Choyke said, to migrate to handheld devices, which can be updated every day.