The American College of Radiology published its 2026 update to the Appropriateness Criteria for diffuse lung disease in August. It covers three scenarios: initial imaging when diffuse lung disease is suspected, imaging when a patient with known disease has a suspected acute exacerbation or deterioration, and surveillance of known disease without acute change.
The document uses the RAND/UCLA appropriateness method with GRADE-adapted evidence review, and relies on expert consensus where the literature is thin. It places imaging within multidisciplinary discussion, which remains the standard for diagnosing and monitoring interstitial lung disease.
The record does not list the individual appropriateness ratings for each procedure, so the specific recommendations need to be read in the full document. What the update signals is that surveillance and acute deterioration are now treated as distinct questions from initial diagnosis, which is worth reflecting in request vetting and protocol choice.
- Read the full 2026 document before changing local interstitial lung disease protocols.
- Vet requests by scenario: suspected disease, acute deterioration of known disease, or stable surveillance.
- Ask requesting clinicians which of the three questions they are asking.
- Feed imaging findings into the multidisciplinary meeting rather than issuing a stand-alone diagnosis.
- Compare with previous CT at every surveillance scan, since change over time is the key finding.
Why it matters
The right scan for a suspected new interstitial lung disease is not necessarily the right scan for a patient who is deteriorating.
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