1.4: 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 – 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.