The American College of Radiology has updated its Appropriateness Criteria for diffuse lung disease for 2026. These are evidence-based, expert-panel guidelines on which imaging to use for specific clinical scenarios, revised using GRADE methods and the RAND/UCLA appropriateness method.
The update covers three situations a radiologist and referring team meet repeatedly: initial imaging of suspected diffuse lung disease, imaging of a suspected acute exacerbation or deterioration in confirmed disease, and surveillance of confirmed disease without acute change. High-resolution CT and multidisciplinary discussion remain central to diagnosis and monitoring.
The practical value is in protocol selection and in guiding referrers to the right test for the right scenario. Read the full criteria before updating local protocols, as the detailed scenario-by-scenario recommendations are where the changes sit.
- The 2026 update covers initial imaging, suspected acute exacerbation, and surveillance of diffuse lung disease.
- High-resolution CT and multidisciplinary discussion remain central to diagnosis and monitoring.
- Recommendations are graded using GRADE and the RAND/UCLA appropriateness method.
- Use them to match imaging to the clinical scenario and to steer referrers.
- Consult the full criteria before revising local protocols.
Why it matters
Appropriateness criteria drive which scan is ordered and reimbursed, so an updated version changes day-to-day protocolling and referral advice.
Don't overread it
This is an appropriateness guideline, not new outcome data; it standardises imaging selection rather than reporting a new effect.
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