Imaging Recommendations for Asymptomatic Adults

Colorectal Cancer Screening

The US Preventive Services Task Force strongly recommends colorectal cancer screening for all asymptomatic adults aged 50-75 years (USPSTF Grade A recommendation) 4
The American College of Physicians recommends multiple screening options, including colonoscopy every 10 years or annual FIT, as first-tier options (strong recommendation, moderate-quality evidence) 2
The American College of Physicians also recommends CT colonography every 5 years as an appropriate alternative for those who refuse colonoscopy and FIT (strong recommendation, low-quality evidence) 2
For adults aged 76-85 years, screening decisions should be individualized based on prior screening history, overall health status and life expectancy, and personal preferences 4, 1
Screening is generally not recommended for adults over 85 years (qualified recommendation) 1

The European Society of Cardiology recommends considering coronary artery calcium (CAC) scoring as a risk modifier in cardiovascular risk assessment of asymptomatic individuals at intermediate risk (Class IIb recommendation) 5
The American Heart Association recommends against CAC scoring in men under 40 years and women under 50 years due to very low prevalence of detectable calcium in these age groups 3
The American College of Cardiology does not recommend CT coronary angiography as a routine test in asymptomatic individuals 6, 5
The European Society of Cardiology recommends considering carotid artery ultrasound for plaque detection as a risk modifier in cardiovascular risk assessment (Class IIb recommendation) 5
The European Society of Cardiology does not recommend carotid ultrasound intima-media thickness (IMT) for cardiovascular risk assessment (Class III recommendation) 5

The American College of Cardiology does not recommend MRI or CT angiography for screening asymptomatic coronary artery disease 7, 6
The American College of Cardiology does not recommend stress echocardiography in asymptomatic individuals 6
The American College of Cardiology does not recommend myocardial perfusion imaging for asymptomatic individuals 6
The European Society of Cardiology does not recommend routine follow-up CT for patients with established coronary artery disease 5
The European Society of Cardiology does not recommend coronary CT angiography or functional imaging for ischemia in low-risk non-diabetic asymptomatic adults (Class III recommendation) 5

The European Society of Cardiology recommends considering functional imaging or coronary CTA for cardiovascular risk assessment in high-risk asymptomatic adults (with diabetes, strong family history of CAD, or when previous risk assessment tests suggest high risk) (Class IIb recommendation) 5
The American College of Physicians recommends considering earlier colorectal cancer screening starting at age 45 for African Americans (weak recommendation, very low-quality evidence) 2
Imaging studies should not be used as a substitute for appropriate risk factor assessment and management, as recommended by the American Heart Association and the European Society of Cardiology 3, 5