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ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update.

Publication ,  Journal Article
Expert Panel on Gastrointestinal Imaging, ; Kambadakone, AR; Santillan, CS; Kim, DH; Fowler, KJ; Birkholz, JH; Camacho, MA; Cash, BD; Dane, B ...
Published in: J Am Coll Radiol
November 2022

This document focuses on imaging in the adult and pregnant populations with right lower quadrant (RLQ) abdominal pain, including patients with fever and leukocytosis. Appendicitis remains the most common surgical pathology responsible for RLQ abdominal pain in the United States. Other causes of RLQ pain include right colonic diverticulitis, ureteral stone, and infectious enterocolitis. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of the experts. The ACR 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 in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

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Published In

J Am Coll Radiol

DOI

EISSN

1558-349X

Publication Date

November 2022

Volume

19

Issue

11S

Start / End Page

S445 / S461

Location

United States

Related Subject Headings

  • United States
  • Societies, Medical
  • Pregnancy
  • Nuclear Medicine & Medical Imaging
  • Magnetic Resonance Imaging
  • Humans
  • Female
  • Evidence-Based Medicine
  • Diagnosis, Differential
  • Appendicitis
 

Citation

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Expert Panel on Gastrointestinal Imaging, ., Kambadakone, A. R., Santillan, C. S., Kim, D. H., Fowler, K. J., Birkholz, J. H., … Carucci, L. R. (2022). ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update. J Am Coll Radiol, 19(11S), S445–S461. https://doi.org/10.1016/j.jacr.2022.09.011
Expert Panel on Gastrointestinal Imaging, Laura R., Avinash R. Kambadakone, Cynthia S. Santillan, David H. Kim, Kathryn J. Fowler, James H. Birkholz, Marc A. Camacho, et al. “ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update.J Am Coll Radiol 19, no. 11S (November 2022): S445–61. https://doi.org/10.1016/j.jacr.2022.09.011.
Expert Panel on Gastrointestinal Imaging, Kambadakone AR, Santillan CS, Kim DH, Fowler KJ, Birkholz JH, et al. ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update. J Am Coll Radiol. 2022 Nov;19(11S):S445–61.
Expert Panel on Gastrointestinal Imaging, Laura R., et al. “ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update.J Am Coll Radiol, vol. 19, no. 11S, Nov. 2022, pp. S445–61. Pubmed, doi:10.1016/j.jacr.2022.09.011.
Expert Panel on Gastrointestinal Imaging, Kambadakone AR, Santillan CS, Kim DH, Fowler KJ, Birkholz JH, Camacho MA, Cash BD, Dane B, Felker RA, Grossman EJ, Korngold EK, Liu PS, Marin D, McCrary M, Pietryga JA, Weinstein S, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update. J Am Coll Radiol. 2022 Nov;19(11S):S445–S461.
Journal cover image

Published In

J Am Coll Radiol

DOI

EISSN

1558-349X

Publication Date

November 2022

Volume

19

Issue

11S

Start / End Page

S445 / S461

Location

United States

Related Subject Headings

  • United States
  • Societies, Medical
  • Pregnancy
  • Nuclear Medicine & Medical Imaging
  • Magnetic Resonance Imaging
  • Humans
  • Female
  • Evidence-Based Medicine
  • Diagnosis, Differential
  • Appendicitis