In the late 1950s, the ACR organizational approach to policy-making was established. This approach begins with the recognition of the importance of ACR Chapters, which elect representatives (councilors) who meet annually at the Council meeting. Each chapter may have a councilor (and an alternate councilor) for every hundred ACR members in their chapter. Each year the ACR Council convenes with the primary purpose of debating and approving ACR policies. This activity is critical as the policies establish the priorities and practice standards regarding a large variety of issues. The Council meeting is an exciting and busy meeting, where many resolutions are debated during four reference committee hearings before final decisions on the resolutions are made before the full Council. Much like organizations which coalesce before the U.S. Congress, various chapters collaborate in caucuses to focus on the four days of formal Council meetings.
Currently, the Council has 312 members representing ACR chapters, the branches of the military and other federal agencies and radiology subspecialty societies.
In order to organize the Council meeting and to maintain activities during the year between Council meetings, the Council elects a speaker and vice speaker who serve as its leaders for two-year terms. The speaker and vice speaker are assisted in their work by the Council Steering Committee (CSC). The CSC is both elected and appointed. The CSC is representative of the entire Council according to its diversity, geographic distribution, radiologic subspecialty, gender, and practice patterns. In addition to organizing the annual Council meeting, the Council leadership and the Steering Committee represent the Council throughout the year, providing communication pathways both to and from the state chapters and interacting with the Board of Chancellors.