Choosing Wisely:

Avoid other imaging tests apart from ultrasound for the initial evaluation of patients with suspected gallstone disease.

Rationale and Comments: The diagnostic workup of acute right upper quadrant pain is informed by risk factors for cholecystitis. When acute cholecystitis is suspected, the initial imaging modality of choice is ultrasound based on availability, examination time, lack of ionizing radiation, morphologic evaluation, confirmation of the presence or absence of gallstones, evaluation of bile ducts, and identification or exclusion of alternative diagnoses. When the clinical features, examination, laboratory and ultrasound findings are congruent, no further imaging is required.
Sponsoring Organizations:
  • Society of American Gastrointestinal and Endoscopic Surgeons
  • Sources:
  • Society of American Gastrointestinal and Endoscopic Surgeons and American College of Radiology guidelines
  • Disciplines:
  • Gastroenterologic
  • Surgical
  • References: • SAGES guideline for the clinical application of laparoscopic biliary tract surgery. Available at
    • Yarmish, GM et al., 2014. ACR appropriateness criteria right upper quadrant pain. Journal of the American College of Radiology : JACR, 11(3), pp.316–322.

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