ACR Appropriateness Criteria: an Update

Cindy Schultz, PhD*

*Owner, Monarch Medical Writing, LLC, Yorktown Heights, NY

Address correspondence to: Cindy Schultz, PhD, Email:

Disclosure statement: The author reports having no significant financial or advisory relationships with corporate organizations related to this activity.



Overutilization of medical imaging is a growing concern among clinicians, regulators, and the public, both in terms of healthcare spending and patient exposure to ionizing radiation. Limiting imaging examinations to those deemed appropriate is an important mechanism for minimizing costs and patient exposure. Developed initially during the 1990s, the American College of Radiology Appropriateness Criteria® (ACR AC) are the most comprehensive and official set of guidelines available to assist referring physicians and other imaging providers in making the most appropriate imaging or treatment decision for a specific clinical condition. Based on a combination of evidence and expert consensus, the ACR AC are continually updated by a panel of radiologist and nonradiologist experts from each clinical area. The ACR AC currently provides an appropriateness score for various imaging modalities for 176 different diagnostic imaging and interventional radiology topics, and are available via several online, searchable applications. Implementation of appropriate use criteria such as the ACR AC will soon be required in order to receive reimbursement for advanced imaging services such as magnetic resonance imaging, computed tomography, positron emission tomography, and nuclear medicine imaging studies; such a requirement is currently on track to be mandated as of January 1, 2020. Therefore, it is critical that all radiologists, referring physicians, radiology residents, and radiologic technologists become familiar with the ACR AC.

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