ACR Appropriateness Criteria® Routine Chest Imaging

J Am Coll Radiol. 2023 May;20(5S):S224-S233. doi: 10.1016/j.jacr.2023.02.006.


Routine chest imaging has been used to identify unknown or subclinical cardiothoracic abnormalities in the absence of symptoms. Various imaging modalities have been suggested for routine chest imaging. We review the evidence for or against the use of routine chest imaging in different clinical scenarios. This document aims to determine guidelines for the use of routine chest imaging as initial imaging for hospital admission, initial imaging prior to noncardiothoracic surgery, and surveillance imaging for chronic cardiopulmonary disease. The American College of Radiology 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 where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Keywords: AUC; Admission chest radiograph; Appropriate Use Criteria; Appropriateness Criteria; Preoperative imaging; Routine chest radiograph; Screening chest radiograph.

Publication types

  • Review
  • Practice Guideline

MeSH terms

  • Diagnostic Imaging* / methods
  • Humans
  • Societies, Medical*
  • United States