ACR Appropriateness Criteria® on treatment of uterine leiomyomas.

Uterine leiomyomas (fibroids) are the most common tumors in women of reproductive age and a cause of significant morbidity in this patient population. Depending on the fibroid location, they can be the cause of a variety of symptoms, such as abnormal uterine bleeding, constipation, urinary frequency, and pain. Historically, hysterectomy has been the primary treatment option, and uterine fibroids remain the leading cause for hysterectomy in the United States. However, women who do not wish to undergo hysterectomy now have a variety of less invasive options available, including uterine artery embolization. This article discusses uterine artery embolization as well as some of the other treatment strategies for symptomatic uterine fibroids. In many situations, there may be no single best treatment option but several viable alternatives. Each option is discussed with consideration of outcomes, complications, and, when possible, cost-effectiveness. The recommendations in this article are the result of evidence-based consensus of the ACR Appropriateness Criteria® Expert Panel on Interventional Radiology.

ACR Appropriateness Criteria® on upper gastrointestinal bleeding.

Upper gastrointestinal bleeding is a significant cause of morbidity and mortality, affecting 36 to 48 per 100,000 persons annually. Aggressive resuscitation and upper endoscopy remain the cornerstones of therapy; however, in cases refractory to endoscopic diagnosis and management, radiology plays an increasingly vital and often lifesaving role, thanks to improvements in both imaging and interventional techniques. The various etiologies of upper gastrointestinal bleeding are discussed along with specific management recommendations based on an extensive literature review of current radiographic methods.

ACR Appropriateness Criteria on percutaneous catheter drainage of infected fluid collections.

Abnormal fluid collections occur throughout the body and represent a wide range of pathologies, including abscesses, pseudocysts, cysts, lymphoceles, seromas, bilomas, hematomas, urinomas, and infected neoplasms. Appropriate management often depends on clinical presentation, location, type of collection, early response to treatment, and the presence of complicating factors such as fistulas, septations, and increased viscosity. Physicians should carefully review clinical and imaging findings and make evidence-based recommendations for the best treatment, which may include antibiotics, needle aspiration, percutaneous drainage, endoscopic drainage, or surgical drainage. This paper addresses percutaneous catheter drainage and alternative treatment options for the management of fluid collections and is the result of evidence-based consensus by the ACR Appropriateness Criteria Expert Panel on Interventional Radiology.

Society of Interventional Radiology position statement on percutaneous radiofrequency ablation for the treatment of liver tumors.

Focal tumor ablation--whether applied percutanously, laparoscopically, or by means of open surgery--is an effective therapy for selected liver tumors. The choice of liver ablation as well as the choice between percutaneous and surgical approaches is dependent on tumor factors, patient factors, and other viable treatment options. Currently, the largest cumulative reported experience is with radiofrequency (RF) ablation of hepatocellular carcinoma and colorectal metastases. This document is a position statement of the Interventional Oncology Task Force and the Standards Division of the Society of Interventional Radiology regarding the use of percutaneous RF ablation for the treatment of liver tumors.

Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria.

The field of interventional oncology includes tumor ablation as well as the use of transcatheter therapies such as embolization, chemoembolization, and radioembolization. Terminology and reporting standards for tumor ablation have been developed. The development of standardization of terminology and reporting criteria for transcatheter therapies should provide a similar framework to facilitate the clearest communication among investigators and provide the greatest flexibility in comparing established and emerging technologies. An appropriate vehicle for reporting the various aspects of catheter directed therapy is outlined, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings. Methods for standardizing the reporting of outcomes toxicities, complications, and other important aspects that require attention when reporting clinical results are addressed. It is the intention of the group that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication for reporting the various aspects of transcatheter management of hepatic malignancy that will translate to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes.