The American College of Radiology (ACR) Task Force on Appropriateness Criteria was established in 1993 and began to develop scientifically-based guidelines to assist referring physicians in making appropriate imaging decisions for a given patient clinical condition in order to provide the College’s perspective on how to best use limited health care resources.

The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines that have been developed to assist healthcare providers in making the most appropriate imaging decision for a clinical condition. There are 230 topics with over 1,100 variants in the 2017 release. Use of the guidelines will enhance quality of care and contribute to the most efficacious use of imaging.

The guidelines offer advice on the appropriateness of imaging examinations for specific clinical conditions.  The imaging is stratified from a score of 9 for the most appropriate imaging examination to 1 for the least appropriate imaging modality.  The guidelines also take radiation exposure into account.  The suggested imaging is supported by validated scientific evaluation of the current literature and is accompanied by narrative and reference sections.

The guidelines were developed by experts working on panels with committee members representing diagnostic imaging, interventional radiology, radiation oncology, and other medical specialties pertinent to the clinical condition.

There is a process of annual review of selected guideline and revisions are performed on a regular basis. Hence, static images of the guidelines were not provided as they will not adequately reflect any revisions made.  Links provided will allow for inclusion of any updates made to the specific Appropriateness guideline you are reviewing.

ACR Imaging Appropriateness Clinical Scenarios

Not all clinical scenarios have dedicated ACR Appropriateness guidelines.  Some common clinical scenarios will be presented in this e-Book.  Some of these clinical conditions have unique ACR Guidelines associated with them.  Table 1.1 highlights the ACR Guidelines that are available for some of the clinical conditions that will be discussed.

Body Region ACR Appropriateness Criteria Guideline
Brain and Spine Headache – Sudden – Severe
Cerebrovascular Ischemia
Low Back Pain
Breast Breast Cancer Screening
Palpable Breast Mass
Cardiovascular Acute Pain – Suspected Aortic Dissection
Dyspnea – Suspected Cardiac Cause
Chest Acute Pain – Suspected Pulmonary Embolism
Radiologically Detected Solitary Pulmonary Nodule
Acute Respiratory Illness in Immunocompetent Patient
Chronic Dyspnea – Suspected Pulmonary Origin
Gastrointestinal / Abdominal Right Lower Quadrant Pain – Suspected Appendicitis
Left Lower Quadrant Pain – Suspected Diverticulitis
Suspected Bowel Obstruction
Liver Lesion – Initial Imaging Characterization
Gynecological / Obstetric Assessment of Adnexal / Pelvic Mass
Assessment of Fetal Well Being
Second and Third Trimester Bleeding
Head and Neck Neck Mass / Adenopathy
Invasive Infected Fluid Collections
Management of Inferior Vena Cava Filters
MSK Acute Hand and Wrist Trauma
Acute Shoulder Pain
Acute Knee Pain
Acute Hip Pain
Acute Ankle Trauma
Chronic Extremity Joint Pain
Pediatric Suspected Non-Accidental Trauma
Urinary Tract Infection
Vomiting in Infants up to 3 Months of Age
Urologic Acute Flank Pain – Suspected Urolithiasis
Acute Scrotal Pain, Without Trauma
Indeterminate Renal Mass

Table 1.1 ACR Appropriateness Criteria Guidelines Pertinent to the current Curriculum

For More Information:

ACR Appropriateness Criteria Guidelines – https://acsearch.acr.org/list

This is a tabulation of all of the current guidelines with a search tool provided to expedite finding the most relevant information for your clinical situation.


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Undergraduate Diagnostic Imaging Fundamentals Copyright © 2017 by Brent Burbridge is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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