For asymptomatic patients with saline implants, no imaging is recommended. If there is suspected saline implant rupture, ultrasound is usually appropriate, though saline implant rupture is often clinically evident. For asymptomatic patients with silicone implants, the FDA recommends that patients have an initial ultrasound or MRI examination without contrast 5 to 6 years after initial silicone implant surgery and then every 2 to 3 years thereafter. In a patient with silicone implants and suspect…
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AC Appropriateness Criteria® Female Infertility
Infertility is defined as the inability to conceive spontaneously after 12 months of routinely unprotected intercourse in patients <35 years of age, and after 6 months in patients ≥35 years of age. Infertility also refers to the inability to achieve a successful pregnancy based on the medical, sexual, and reproductive history; age, physical findings; diagnostic testing; the need for medical intervention; or a combination of these variables for a patient. In the United States, 13% of women 15 …
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ACR Appropriateness Criteria® Nonthrombotic Iliac Vein Lesion
Nonthrombotic iliac vein lesions (NIVLs), also referred to as a May-Thurner lesion/anatomy or Cockett syndrome, most frequently result from the left common iliac vein being compressed between the right common iliac artery and the spine. Iliac vein compression is often clinically silent, but can be associated with significant symptoms in which case it is referred to as May-Thurner syndrome. It is still unclear why some patients are asymptomatic whereas others can develop severe, debilitating symp…
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Beyond Pattern Recognition: A Gödelian Limit on Self-Validation in Radiological AI
Artificial intelligence (AI) systems increasingly match or exceed human performance in narrowly defined radiological tasks, accelerating their clinical deployment. Yet these advances obscure a fundamental limitation: AI systems cannot independently determine when their outputs are valid, clinically appropriate, or ethically actionable in real-world practice. We argue that this limitation is structural rather than temporary. Using Gödel’s incompleteness theorem as a clarifying metaphor—not a form…
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ACR Appropriateness Criteria® Chronic Foot Pain: Update 2025
Chronic foot pain is a common clinical issue that can greatly affect an individual’s quality of life. This document defines best practices for ordering imaging studies based on specific clinical scenarios, which are categorized into different variants. Each variant includes a brief description of the usefulness, advantages, and limitations of various imaging modalities. This document is the result of a comprehensive analysis of the available literature and a thorough review of best imaging pract…
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ACR Appropriateness Criteria® Abdominal Pain-Child
The range of pathology that can produce abdominal pain in children not only is broad, but can vary with age. Due to the wide differential and the inability for a child to clearly identify and describe the nature of their abdominal pain, diagnostic imaging is often needed. Various clinical scenarios are discussed for a child presenting with acute abdominal pain. Initial imaging studies that are usually appropriate or may be appropriate (based on the best available evidence or expert consensus) fo…