This is the current release of the guideline.

This guideline updates a previous version: D'Orsi C, Bassett LW, Berg WA, Bohm-Velez M, Evans WP III, Farria DM, Lee C, Mendelson E, Goldstein S, Expert Panel on Women's Imaging. Breast microcalcifications. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 12 p. [17 references]

The appropriateness criteria are reviewed biennially and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

Breast microcalcifications

To evaluate the appropriateness of radiologic procedures for patients with breast microcalcifications

Women with breast microcalcifications

Utility of radiologic examinations in differential diagnosis

Literature Search Procedure

The Medline literature search is based on keywords provided by the topic author. The two general classes of keywords are those related to the condition (e.g., ankle pain, fever) and those that describe the diagnostic or therapeutic intervention of interest (e.g., mammography, MRI).

The search terms and parameters are manipulated to produce the most relevant, current evidence to address the American College of Radiology Appropriateness Criteria (ACR AC) topic being reviewed or developed. Combining the clinical conditions and diagnostic modalities or therapeutic procedures narrows the search to be relevant to the topic. Exploding the term "diagnostic imaging" captures relevant results for diagnostic topics.

The following criteria/limits are used in the searches.

1. Articles that have abstracts available and are concerned with humans.
2. Restrict the search to the year prior to the last topic update or in some cases the author of the topic may specify which year range to use in the search. For new topics, the year range is restricted to the last 5 years unless the topic author provides other instructions.
3. May restrict the search to Adults only or Pediatrics only.
4. Articles consisting of only summaries or case reports are often excluded from final results.

The search strategy may be revised to improve the output as needed.

The total number of source documents identified as the result of the literature search is not known.

Strength of Evidence Key

Category 1 - The conclusions of the study are valid and strongly supported by study design, analysis and results.

Category 2 - The conclusions of the study are likely valid, but study design does not permit certainty.

Category 3 - The conclusions of the study may be valid but the evidence supporting the conclusions is inconclusive or equivocal.

Category 4 - The conclusions of the study may not be valid because the evidence may not be reliable given the study design or analysis.

The topic author drafts or revises the narrative text summarizing the evidence found in the literature. American College of Radiology (ACR) staff draft an evidence table based on the analysis of the selected literature. These tables rate the strength of the evidence for all articles included in the narrative text.

The expert panel reviews the narrative text, evidence table, and the supporting literature for each of the topic-variant combinations and assigns an appropriateness rating for each procedure listed in the table. Each individual panel member forms his/her own opinion based on his/her interpretation of the available evidence.

More information about the evidence table development process can be found in the American College of Radiology (ACR) Appropriateness Criteria® Evidence Table Development document (see "Availability of Companion Documents" field).

Modified Delphi Technique

When the data available from existing scientific studies are insufficient, the American College of Radiology Appropriateness Criteria (ACR AC) employs systematic consensus techniques to determine appropriateness. The ACR AC panels use a modified Delphi technique to determine the rating for a specific procedure. A series of surveys are conducted to elicit each individual panelist's expert opinion of the appropriateness of an imaging or therapeutic procedure for a specific clinical scenario based on the available data. ACR staff distributes surveys to the panelists along with the evidence table and narrative. Each panelist interprets the available evidence and rates each procedure. Voting surveys are completed by panelists without consulting other panelists. The ratings are integers on a scale between 1 and 9, where 1 means the panel member feels the procedure is "least appropriate" and 9 means the panel member feels the procedure is "most appropriate". Each panel member has one vote per round to assign a rating. The surveys are collected and de-identified and the results are tabulated and redistributed after each round. A maximum of three rounds are conducted. The modified Delphi technique enables each panelist to express individual interpretations of the evidence and his or her expert opinion without excessive bias from fellow panelists in a simple, standardized and economical process.

Consensus among the panel members must be achieved to determine the final rating for each procedure. If eighty percent (80%) of the panel members agree on a single rating or one of two consecutive ratings, the final rating is determined by the rating that is closest to the median of all the ratings. Up to three voting rounds are conducted to achieve consensus.

If consensus is not reached through the modified Delphi technique, the panel is convened by conference call. The strengths and weaknesses of each imaging examination or procedure are discussed and a final rating is proposed. If the panelists on the call agree, the rating is accepted as the panel's consensus. The document is circulated to all the panelists to make the final determination. If consensus cannot be reached, "No consensus" appears in the rating column and the reasons for this decision are added to the comment sections.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Criteria developed by the Expert Panels are reviewed by the American College of Radiology (ACR) Committee on Appropriateness Criteria.

ACR Appropriateness Criteria®

Clinical Condition: Breast Microcalcifications - Initial Diagnostic Workup

Variant 1: Pleomorphic, fine, linear, branching in any distribution.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	9
US breast	4	Only after diagnostic mammographic workup demonstrates suspicious microcalcifications with an associated mass/focal asymmetry or having an extensive distribution, and an underlying invasive component is suspected.	O
Mammography short interval follow-up	1
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 2: Documentation of skin calcification.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	9
Mammography short interval follow-up	2
US breast	1		O
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 3: Milk of calcium, any distribution.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	9
Mammography short interval follow-up	2
US breast	1		O
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 4: Amorphous, single cluster.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	9
US breast	4	Only after diagnostic mammographic workup demonstrates suspicious microcalcifications with an associated mass or focal asymmetry.	O
Mammography short interval follow-up	1
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 5: Amorphous, multiple clusters, one breast.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	9
Mammography short interval follow-up	2
US breast	1		O
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 6: Amorphous, multiple bilateral clusters.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	5	If further evaluation is needed to better characterize the calcification.
Mammography short interval follow-up	2
US breast	1		O
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 7: Amorphous in a regional distribution.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	9
Mammography short interval follow-up	2
US breast	1		O
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 8: Amorphous in a linear or segmental distribution.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	9
US breast	4	Only after diagnostic mammographic workup demonstrates suspicious microcalcifications with an associated mass/focal asymmetry or having an extensive distribution and an underlying invasive component is suspected.	O
Mammography short interval follow-up	2
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 9: Course (popcorn), large rod-like, dystrophic, suture, lucent-centered, egg shell rim.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	1
Mammography short interval follow-up	1
US breast	1		O
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 10: Round or punctate, clustered.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	9
Mammography short interval follow-up	2
US breast	1		O
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 11: Round or punctate, regional.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	4	If further evaluation is needed to better characterize the calcification.
Mammography short interval follow-up	2
US breast	1		O
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 12: Punctate calcifications in a linear or segmental distribution.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	9
US breast	4	Only after diagnostic mammographic workup demonstrates suspicious microcalcifications with an associated mass/focal asymmetry or having an extensive distribution and an underlying invasive component is suspected.	O
Mammography short interval follow-up	2
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 13: Punctate and amorphous, diffuse, bilateral.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	3
Mammography short interval follow-up	2
US breast	1		O
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 14: Course heterogeneous, single cluster.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	9
US breast	4	Only after diagnostic mammographic workup demonstrates suspicious microcalcifications with an associated mass/focal asymmetry or having an extensive distribution and an underlying invasive component is suspected.	O
Mammography short interval follow-up	2
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 15: Course heterogeneous, multiple clusters, one breast.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	8
US breast	4	Only after diagnostic mammographic workup demonstrates suspicious microcalcifications with an associated mass/focal asymmetry or having an extensive distribution and an underlying invasive component is suspected.	O
Mammography short interval follow-up	2
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 16: Course heterogeneous, multiple bilateral clusters.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	3
Mammography short interval follow-up	1
US breast	1		O
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 17: Course heterogeneous, in regional distribution.

Radiologic Procedure	Rating	Comments	RRL*
Mammography diagnostic	5	If further evaluation is needed to better characterize the calcification.
US breast	4	Only after diagnostic mammographic workup demonstrates suspicious microcalcifications with an associated mass/focal asymmetry or having an extensive distribution and an underlying invasive component is suspected.	O
Mammography short interval follow-up	2
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 18: Course heterogeneous, in linear or segmental distribution.

Radiologic Procedure	Appropriateness Rating	Comments	RRL*
Mammography diagnostic	9
US breast	4	Only after diagnostic mammographic workup demonstrates suspicious microcalcifications with an associated mass/focal asymmetry or having an extensive distribution and an underlying invasive component is suspected.	O
Mammography short interval follow-up	1
MRI breast without and with contrast	1		O
PET breast	1
Tc-99m sestamibi scan breast	1
Core biopsy breast	1		NS
Fine needle aspiration breast	1		NS
Imaging localization for surgical excision breast	1		NS
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate			*Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Summary of Literature Review

Ductal carcinoma-in-situ (DCIS) represents 25%-30% of all reported breast cancers. Approximately 95% of all DCIS is diagnosed because of mammographically detected microcalcifications. Prior to the widespread use of screening mammography, DCIS, detected as a mass on physical examination, was an uncommon disease representing less than 3% of all breast cancers. Screening mammography is the only reliable tool available for the detection of breast microcalcifications and DCIS.

Breast microcalcifications are detected commonly on screening mammograms. Other initial radiologic procedures for workup of the various types of screening-detected calcifications are described below. Most breast calcifications are benign and can be classified accordingly without any additional work-up. In women with an indeterminate or higher probability of malignancy calcifications on screening studies, microfocus (0.1 mm focal spot) magnification views in orthogonal projections are useful. Interpretation using softcopy readout on 5M cathode ray tube (CRT) or liquid crystal display (LCD) monitors allows evaluation comparable to that of film. Although initial studies suggest that 3M LCD monitors may allow accurate analysis of calcifications, further studies are needed.

On magnification images, additional calcifications may be apparent, the morphology of individual calcifications can be characterized, and the distribution of calcifications can be better determined. For probably benign calcifications, short-interval follow-up with diagnostic mammography may be appropriate. In women with malignant calcifications, magnification images may be helpful in establishing the extent of disease. In cases of extensive malignant calcifications or malignant calcifications with an associated soft-tissue density, ultrasound may be useful in diagnosing an invasive component.

Currently, the role for computer-aided detection (CAD) of calcifications has not yet been determined. However, recent studies indicate that CAD can be clinically useful to avoid false negatives when used properly. CAD applied directly to full-field digital mammography (FFDM) images is comparable to CAD applied to digitized analog mammograms. CAD may improve detection of DCIS; however, due to its variable sensitivity for amorphous calcifications, CAD findings should not be used to avert call-back of suspicious calcifications.

Currently, only lossless compression (3:1 compression ratio or less) of digital mammograms is recommended for storage or transport. Although initial studies suggest compression ratios as high as 15:1 (lossy) may still allow accurate analysis of calcifications, larger studies are needed to evaluate the possible effects of data compression of >3:1 on calcification detection and analysis.

The use of magnetic resonance imaging (MRI), breast-specific gamma imaging (BSGI), positron emission mammography (PEM), and ductal lavage in evaluating clustered microcalcifications has not been established. In general, they should not be used to avoid biopsy of mammographically suspicious calcifications.

Stereotactically guided core biopsy using a variety of devices can sample areas of microcalcifications. Stereotactically guided fine needle aspiration (FNA) of microcalcifications has been shown to be inaccurate. Core biopsy specimen radiographs should be obtained to establish the presence of calcifications in the core, as is done with surgically excised specimens. Use of eleven-gauge vacuum-assisted core devices may improve the probability of obtaining calcifications compared to 14-gauge spring-loaded or 14-gauge vacuum-assisted biopsy devices. For 11-gauge vacuum biopsy, obtaining 12 samples has been shown to be optimal. For subtle residual calcification or calcifications that have been completely removed, a marker clip should be placed. The position of the marker clip in relation to the biopsy site should be documented in the report and on postbiopsy mammograms.

Summary

• Diagnostic mammographic workup (including spot magnifications views in the craniocaudal and 90 ml projections) remains the optimal initial procedure for evaluating screening-detected calcifications that are not typically benign.
• Ultrasound should only be performed if the diagnostic mammographic workup demonstrates suspicious microcalcifications with an associated mass/focal asymmetry or in cases of suspicious calcifications with an extensive distribution. This may be useful in determining the method of biopsy guidance, diagnosing invasive disease, and facilitating a single-step surgery (excision and lymph node dissection).
• Currently, short-term follow-up or biopsy of calcifications directly from screening mammography is not recommended. In addition, the utility of PEM, BSGI, or MRI for the initial evaluation of screening-detected microcalcifications has not been established.

Abbreviations

• MRI, magnetic resonance imaging
• NS, not specified
• PET, positron emission tomography
• Tc, technetium
• US, ultrasound

Relative Radiation Level Designations

Relative Radiation Level*	Adult Effective Dose Estimate Range	Pediatric Effective Dose Estimate Range
O	0 mSv	0 mSv
	<0.1 mSv	<0.03 mSv
	0.1-1 mSv	0.03-0.3 mSv
	1-10 mSv	0.3-3 mSv
	10-30 mSv	3-10 mSv
	30-100 mSv	10-30 mSv
*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as NS (not specified).

Algorithms were not developed from criteria guidelines.

The recommendations are based on analysis of the current literature and expert panel consensus.

Selection of appropriate radiologic imaging procedures for the evaluation of patients with breast microcalcifications

Relative Radiation Level (RRL)

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, both because of organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared to those specified for adults. Additional information regarding radiation dose assessment for imaging examinations can be found in the American College of Radiology (ACR) Appropriateness Criteria® Radiation Dose Assessment Introduction document (see "Availability of Companion Documents" field).

The American College of Radiology (ACR) Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those exams generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the U.S. Food and Drug Administration (FDA) have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.

An implementation strategy was not provided.

Not applicable: The guideline was not adapted from another source.

The American College of Radiology (ACR) provided the funding and the resources for these ACR Appropriateness Criteria®.

Committee on Appropriateness Criteria, Expert Panel on Women's Imaging--Breast Work Group

Panel Members: Christopher H. Comstock, MD (Co-Author); Carl D'Orsi, MD (Co-Author); Lawrence W. Bassett, MD (Panel Chair); Mary C. Mahoney, MD (Panel Vice-Chair); Lisa Bailey, MD; Lenore I. Everson, MD; Jennifer A. Harvey, MD; Phan Tuong Huynh, MD; Peter M. Jokich, MD; Roberta A. Jong, MD; Constance D. Lehman, MD, PhD; Elizabeth A. Morris, MD; Rachel Rabinovitch, MD

Not stated

This is the current release of the guideline.

This guideline updates a previous version: D'Orsi C, Bassett LW, Berg WA, Bohm-Velez M, Evans WP III, Farria DM, Lee C, Mendelson E, Goldstein S, Expert Panel on Women's Imaging. Breast microcalcifications. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 12 p. [17 references]

The appropriateness criteria are reviewed biennially and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

Electronic copies: Available in Portable Document Format (PDF) from the American College of Radiology (ACR) Web site.

Print copies: Available from the American College of Radiology, 1891 Preston White Drive, Reston, VA 20191. Telephone: (703) 648-8900.

The following are available:

• ACR Appropriateness Criteria®. Overview. Reston (VA): American College of Radiology; 2 p. Electronic copies: Available in Portable Document Format (PDF) from the American College of Radiology (ACR) Web site.
• ACR Appropriateness Criteria®. Literature search process. Reston (VA): American College of Radiology; 1 p. Electronic copies: Available in Portable Document Format (PDF) from the ACR Web site.
• ACR Appropriateness Criteria®. Evidence table development. Reston (VA): American College of Radiology; 4 p. Electronic copies: Available in Portable Document Format (PDF) from the ACR Web site.
• ACR Appropriateness Criteria®. Radiation dose assessment introduction. Reston (VA): American College of Radiology; 2 p. Electronic copies: Available in Portable Document Format (PDF) from the ACR Web site.

None available

This NGC summary was completed by ECRI on February 13, 2006. This NGC summary was updated by ECRI Institute on November 5, 2010.

Instructions for downloading, use, and reproduction of the American College of Radiology (ACR) Appropriateness Criteria® may be found on the ACR Web site .