As part of its ongoing efforts to ensure safe, effective and appropriate use of medical imaging, the American College of Radiology (ACR) identified a list of five imaging exams whose necessity should be discussed before being ordered. The list, created as part of the Choosing Wisely® campaign, initiated by the American Board of Internal Medicine (ABIM) Foundation, provides evidence-based recommendations to support physicians working with patients to make wise choices about medical imaging care.

The ACR Recommendations Address: 

  1. Imaging for uncomplicated headache absent specific risk factors for structural disease or injury
  2. Imaging for suspected pulmonary embolism (PE) without moderate or high pre‐test probability of PE
  3. Pre-operative chest X‐rays without specific reasons due to patient history or physical exam  
  4. Computed Tomography (CT) to evaluate suspected appendicitis in children until ultrasound is considered an option
  5. Follow‐up imaging for adnexal (reproductive tract) cysts 5cm or less in diameter in reproductive-age women

“Medical imaging exams save lives and lower health care costs by replacing more invasive surgeries, providing quicker diagnoses and allowing for fewer and shorter hospital stays. Although imaging use is down significantly in recent years and Medicare spending on imaging is at 2003 levels, opportunities remain to ensure appropriate ordering of scans. Since greater access to medical imaging is directly tied to increased life expectancy, the ACR has identified five areas where care can be improved by providing appropriate access to meaningful imaging,” said John A. Patti, MD, FACR, chair of the ACR Board of Chancellors.  

As part of Choosing Wisely, the ACR has also joined Consumer Reports to distribute patient-friendly resources for consumers and physicians to engage in important conversations regarding these medical imaging exams. The ACR’s list was developed after many months of careful consideration and review of existing professional guidelines and published evidence, by a task force of expert physicians drawn from ACR membership.

The list, which joins those of eight other national medical specialty societies released today as part of Choosing Wisely, is the latest in a long history of ACR quality and safety efforts. ACR Appropriateness Criteria help doctors prescribe the best imaging exam for a patient’s condition and reduce unnecessary scans. ACR facility accreditation programs set stringent physician, equipment and personnel standards and remain the Gold Standard in imaging quality assurance. The College co-founded the Image Wisely and Image Gently initiatives and established the national Dose Index Registry to help lower radiation dose from imaging exams. The ACR also co-founded radiologyinfo.org to provide patients with accessible, practical information on imaging scans and radiation therapy. 

“We urge providers to review the ACR’s list of five things and incorporate this information into their decision making. We also recommend that providers take advantage of other existing ACR quality and safety programs to help ensure the best imaging care possible. Basing policies on current evidence and use of existing ACR quality and safety tools can make efficient use of health care dollars and keep medical imaging safe, effective and accessible,” said Dr. Patti.