In rectal cancer, because of the need for high-resolution anatomic detail in determining local tumor extension, imaging for local staging and restaging of the primary tumor in the pelvis is considered separately from the evaluation of distant metastatic disease in the chest, abdomen, and pelvis, often resulting in the need for a combination of modalities to fully stage the patient.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical condi…