ACR Appropriateness Criteria® Penetrating Trauma-Abdomen and Pelvis: Update 2026

The authors aim to update the ACR Appropriateness Criteria for imaging in cases of penetrating trauma to the abdomen and pelvis, specifically addressing the optimal imaging techniques for assessing urinary tract injuries. They recommend CT of the abdomen and pelvis with contrast and CT urography for suspected upper tract injuries, while suggesting fluoroscopic retrograde urethrography and contrast-enhanced CT for lower tract injuries, emphasizing the importance of tailored imaging protocols based on the type of trauma. The guidelines are based on a systematic review of the literature and expert consensus to ensure evidence-based recommendations.