ACR Lung-RADS v2022: Assessment Categories and Management Recommendations

Jared Christensen; Ashley Elizabeth Prosper; Carol C Wu; Jonathan Chung; Elizabeth Lee; Brett Elicker; Andetta R Hunsaker; Milena Petranovic; Kim L Sandler; Brendon Stiles; Peter Mazzone; David Yankelevitz; Denise Aberle; Caroline Chiles; Ella Kazerooni

doi:10.1016/j.jacr.2023.09.009

ACR Lung-RADS v2022: Assessment Categories and Management Recommendations

J Am Coll Radiol. 2024 Mar;21(3):473-488. doi: 10.1016/j.jacr.2023.09.009. Epub 2023 Oct 10.

Authors

Affiliations

¹ Vice Chair and Professor of Radiology, Department of Radiology, Duke University, Durham, North Carolina; Chair, ACR Lung-RADS Committee. Electronic address: jared.christensen@duke.edu.
² Assistant Professor and Section Chief of Cardiothoracic Imaging, Department of Radiological Sciences, University of California, Los Angeles, California.
³ Professor of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas.
⁴ Professor of Radiology Vice Chair of Quality Section Chief of Cardiopulmonary Imaging, University of Chicago, Chicago, Illinois.
⁵ Clinical Associate Professor, Radiology, Michigan Medicine, Ann Arbor, Michigan.
⁶ Chief of the Cardiac & Pulmonary Imaging Section, University of California, San Francisco, California.
⁷ Brigham and Women's Hospital, Boston, Massachusetts; Associate Professor Harvard Medical School Chief Division of Thoracic Imaging.
⁸ Instructor, Radiology, Harvard Medical School Divisional Quality Director, Thoracic Imaging and Intervention, Radiology, Massachusetts General Hospital, Boston, Massachusetts.
⁹ Associate Professor, Vanderbilt University Medical Center, Nashville, Tennessee.
¹⁰ Professor and Chair, Thoracic Surgery and Surgical Oncology, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York.
¹¹ Cleveland Clinic, Cleveland, Ohio.
¹² Professor, Icahn School of Medicine, New York, New York.
¹³ Professor of Radiology, Department of Radiological Sciences; David Geffen School of Medicine at UCLA, Los Angeles, California.
¹⁴ Professor of Radiology Director, Lung Screening Program, Atrium Health Wake Forest, Winston-Salem, North Carolina.
¹⁵ Professor of Radiology & Internal Medicine and Associate Chief Clinical Officer for Diagnostics, Michigan Medicine/University of Michigan Medical School, Ann Arbor, Michigan; Clinical Information Management, University of Michigan Medical Group.

PMID: 37820837
DOI: 10.1016/j.jacr.2023.09.009

Abstract

The ACR created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.

Keywords: CT; cyst; lung cancer; pulmonary nodule; screening.

MeSH terms

Consensus
Cysts*
Humans
Lung / diagnostic imaging
Lung Neoplasms* / diagnostic imaging
Lung Neoplasms* / therapy
Tomography, X-Ray Computed