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 3 07 ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 0 0 2 10
References Study Quality
3 (21714641) 3
29 (17131307) 4
20 (17936405) 2
22 (19357536) 3
17 (19520905) 2
10 (20404381) 2
4 (21119104) 3
19 (21178639) 2
5 (21045183) 4
23 (22286927) 3
30 (22491665) 2
27 (23069269) 4
26 (23348977) 3
8 (23697514) 3
12 (23789668) 4
11 (23863051) 1
28 (23971173) 4
6 (24004119) 1
14 (24037918) 2
13 (24322569) 2
31 (25104066) 4
25 (25282284) 3
7 (25372087) 3
15 (25199624) 3
32 (25664626) 3
18 (25760561) 2
21 (26226181) 4
9 (25746779) 2
24 (26485620) 3
16 (26502000) 3
CT chest with IV contrast Usually not appropriate Strong 3 07 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 3 1 2 1 0 0 0 1
References Study Quality
3 (21714641) 3
29 (17131307) 4
20 (17936405) 2
22 (19357536) 3
17 (19520905) 2
10 (20404381) 2
4 (21119104) 3
19 (21178639) 2
5 (21045183) 4
23 (22286927) 3
30 (22491665) 2
27 (23069269) 4
26 (23348977) 3
8 (23697514) 3
12 (23789668) 4
11 (23863051) 1
28 (23971173) 4
14 (24037918) 2
13 (24322569) 2
31 (25104066) 4
25 (25282284) 3
7 (25372087) 3
15 (25199624) 3
32 (25664626) 3
18 (25760561) 2
9 (25746779) 2
24 (26485620) 3
16 (26502000) 3
CT chest without and with IV contrast Usually not appropriate Strong 3 07 ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 0 0 0 0 0 0 0 0
References Study Quality
3 (21714641) 3
29 (17131307) 4
20 (17936405) 2
22 (19357536) 3
17 (19520905) 2
10 (20404381) 2
4 (21119104) 3
19 (21178639) 2
5 (21045183) 4
23 (22286927) 3
30 (22491665) 2
27 (23069269) 4
26 (23348977) 3
8 (23697514) 3
12 (23789668) 4
11 (23863051) 1
28 (23971173) 4
6 (24004119) 1
14 (24037918) 2
13 (24322569) 2
31 (25104066) 4
25 (25282284) 3
7 (25372087) 3
15 (25199624) 3
32 (25664626) 3
18 (25760561) 2
21 (26226181) 4
9 (25746779) 2
24 (26485620) 3
16 (26502000) 3
MRI chest without IV contrast Usually not appropriate Expert Consensus 1 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 1 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 3 ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 8 2 0 1 0 1 0 0 0
References Study Quality
33 (24334433) Good
34 (24403460) 3
Radiography chest Usually not appropriate Strong 3 07 ☢ <0.1 mSv ☢ <0.03 mSv [ped] 1 1 8 2 2 1 0 0 0 0 0
References Study Quality
3 (21714641) 3
40 (3956302) 4
39 (6734291) 3
38 (3528436) 4
41 (19637354) 2
35 (20442215) 2
37 (22031728) 1
36 (23993734) 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 2 ☢☢☢ 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 ☢☢☢ 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 ☢☢☢ 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 1 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 1 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 1 ☢☢☢☢ 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 1 ☢ <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 1 ☢ <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 ☢☢☢ 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 ☢☢☢ 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 1 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 1 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 1 ☢☢☢☢ 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 ☢☢☢ 1-10 mSv 1 1 7 4 1 1 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.