American College of Radiology
ACR Appropriateness Criteria®

Lung Cancer Screening

Variant 1: Lung cancer screening. Patient 55 to 80 years of age and 30 or more packs per year smoking history and currently smoke or have quit within the past 15 years.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT chest without IV contrast screening Usually appropriate Strong ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 0 0 2 10
References Study Quality
16 (26502000) 3
24 (26485620) 3
9 (25746779) 2
21 (26226181) 4
18 (25760561) 2
32 (25664626) 3
15 (25199624) 3
7 (25372087) 3
25 (25282284) 3
31 (25104066) 4
13 (24322569) 2
14 (24037918) 2
6 (24004119) 1
28 (23971173) 4
11 (23863051) 1
12 (23789668) 4
8 (23697514) 3
26 (23348977) 3
27 (23069269) 4
30 (22491665) 2
23 (22286927) 3
5 (21045183) 4
19 (21178639) 2
4 (21119104) 3
10 (20404381) 2
17 (19520905) 2
22 (19357536) 3
20 (17936405) 2
29 (17131307) 4
3 (21714641) 3
CT chest with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 3 1 2 1 0 0 0 1
References Study Quality
16 (26502000) 3
24 (26485620) 3
9 (25746779) 2
18 (25760561) 2
32 (25664626) 3
15 (25199624) 3
7 (25372087) 3
25 (25282284) 3
31 (25104066) 4
13 (24322569) 2
14 (24037918) 2
28 (23971173) 4
11 (23863051) 1
12 (23789668) 4
8 (23697514) 3
26 (23348977) 3
27 (23069269) 4
30 (22491665) 2
23 (22286927) 3
5 (21045183) 4
19 (21178639) 2
4 (21119104) 3
10 (20404381) 2
17 (19520905) 2
22 (19357536) 3
20 (17936405) 2
29 (17131307) 4
3 (21714641) 3
CT chest without and with IV contrast Usually not appropriate Strong ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 0 0 0 0 0 0 0
References Study Quality
16 (26502000) 3
24 (26485620) 3
9 (25746779) 2
21 (26226181) 4
18 (25760561) 2
32 (25664626) 3
15 (25199624) 3
7 (25372087) 3
25 (25282284) 3
31 (25104066) 4
13 (24322569) 2
14 (24037918) 2
6 (24004119) 1
28 (23971173) 4
11 (23863051) 1
12 (23789668) 4
8 (23697514) 3
26 (23348977) 3
27 (23069269) 4
30 (22491665) 2
23 (22286927) 3
5 (21045183) 4
19 (21178639) 2
4 (21119104) 3
10 (20404381) 2
17 (19520905) 2
22 (19357536) 3
20 (17936405) 2
29 (17131307) 4
3 (21714641) 3
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 2 1 1 0 0 0 0 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 1 1 1 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Moderate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 8 2 0 1 0 1 0 0 0
References Study Quality
34 (24403460) 3
33 (24334433) Good
Radiography chest Usually not appropriate Strong ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 8 2 2 1 0 0 0 0 0
References Study Quality
36 (23993734) 3
37 (22031728) 1
35 (20442215) 2
41 (19637354) 2
38 (3528436) 4
39 (6734291) 3
40 (3956302) 4
3 (21714641) 3
Variant 2: Lung cancer screening. Patient 50 years of age or older and 20 or more packs per year history of smoking and one additional risk factor (ie, radon exposure or occupational exposure or cancer history or family history of lung cancer or history of COPD or history of pulmonary fibrosis).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT chest without IV contrast screening May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv 5 5 1 0 1 1 5 3 1 1 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 5 3 0 2 1 0 0 1 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 0 0 0 0 0 0 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 8 3 0 1 0 0 0 0 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 2 0 1 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 8 3 0 0 1 0 0 0 0
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 7 5 1 0 0 0 0 0 0
Variant 3: Lung cancer screening. Patient younger than 50 years of age or patient older than 80 years of age or patient any age with less than 20 packs per year history of smoking and no additional risk factor (ie, radon exposure or occupational exposure or cancer history or family history of lung cancer or history of COPD or history of pulmonary fibrosis).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography chest Usually not appropriate Expert Consensus ☢ <0.1 mSv ☢ <0.03 mSv [ped] 3 3 5 1 3 1 1 0 0 1 0
CT chest with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 7 3 0 1 0 0 0 1 0
CT chest without and with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 1 0 0 0 0 0 1 0
MRI chest without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 9 3 0 0 0 0 0 0 0
MRI chest without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 2 0 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 9 2 1 0 0 0 0 0 0
CT chest without IV contrast screening Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 7 4 1 1 0 0 0 0 0
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.