Chapter 1 – Introduction
ACR – Appropriateness Criteria
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 | |
| Jaundice | |
| 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 | |
| Hematuria |
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.
