American College of Radiology
ACR Appropriateness Criteria®

Colorectal Cancer Screening

Variant 1: Colorectal cancer screening. Average-risk individual. Age greater than or equal to 50 years. Initial screening, then follow-up every 5 years after initial negative screen.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT colonography Usually appropriate ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 0 1 2 12
Fluoroscopy barium enema double-contrast May be appropriate ☢☢☢ 1-10 mSv 5 5 0 1 1 4 2 6 1 0 0
MR colonography May be appropriate O 0 mSv O 0 mSv [ped] 4 4 0 1 4 6 1 3 0 0 0
Fluoroscopy barium enema single-contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 5 1 4 4 1 0 0 0 0
Variant 2: Colorectal cancer screening. Moderate-risk individual. First-degree family history of cancer or adenoma. Initial screening, then follow-up every 5 years after initial negative screen.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT colonography Usually appropriate ☢☢☢ 1-10 mSv 9 9 0 0 0 0 1 1 0 3 10
Fluoroscopy barium enema double-contrast May be appropriate ☢☢☢ 1-10 mSv 5 5 0 2 2 3 1 6 1 0 0
MR colonography May be appropriate O 0 mSv O 0 mSv [ped] 4 4 0 1 4 7 1 2 0 0 0
Fluoroscopy barium enema single-contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 5 2 3 5 0 0 0 0 0
Variant 3: Colorectal cancer detection. Moderate-risk individual. Average-risk individual after positive fecal occult blood test (FOBT) or positive fecal immunochemical test indicating a relative elevation in risk.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT colonography Usually appropriate ☢☢☢ 1-10 mSv 9 9 0 0 1 0 0 0 1 4 9
Fluoroscopy barium enema double-contrast May be appropriate ☢☢☢ 1-10 mSv 5 5 0 2 1 5 6 2 0 0 0
MR colonography May be appropriate O 0 mSv O 0 mSv [ped] 4 4 0 3 4 6 0 2 0 0 0
Fluoroscopy barium enema single-contrast Usually not appropriate ☢☢☢ 1-10 mSv 2 2 5 3 4 3 0 0 0 0 0
Variant 4: Colorectal cancer screening. High-risk individual. Hereditary nonpolyposis colorectal cancer; ulcerative colitis or Crohn colitis.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT colonography Usually not appropriate ☢☢☢ 1-10 mSv 3 3 0 6 6 3 0 1 0 0 0
Fluoroscopy barium enema double-contrast Usually not appropriate ☢☢☢ 1-10 mSv 2 2 3 7 0 3 1 1 0 0 0
MR colonography Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 3 5 2 4 0 1 0 0 0
Fluoroscopy barium enema single-contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 10 4 0 1 0 0 0 0 0
Variant 5: Colorectal cancer screening. Average-, moderate-, or high-risk individual after incomplete colonoscopy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT colonography Usually appropriate ☢☢☢ 1-10 mSv 9 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy barium enema double-contrast May be appropriate ☢☢☢ 1-10 mSv 6 n/a 0 0 0 0 0 0 0 0 0
Fluoroscopy barium enema single-contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 3 4 1 7 0 0 0 0 0
MR colonography Usually not appropriate O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.