The ACR Appropriateness Criteria® are evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. By employing these guidelines, providers enhance quality of care and contribute to the most efficacious use of radiology.

The guidelines are developed by expert panels in diagnostic imaging, interventional radiology, and radiation oncology. Each panel includes leaders in radiology and other specialties. There are 201 topics with 983 variants in the May 2014 version.

The ACR allows individuals to use the ACR Appropriateness Criteria for research, scientific, and / or informational purposes only. If you wish to use the ACR Appropriateness Criteria for other reasons, please contact the ACR at acr_ac@acr.org or 703-648-8900 for permission and licensing information. Click here for terms and conditions.

Background

During the 1990s, the ACR recognized the need to define national guidelines for appropriate use of imaging technologies. These guidelines became known as the ACR Appropriateness Criteria (ACR AC). In 1993, the ACR AC were formally introduced by K.K. Wallace, MD, (former chair of ACR Board of Chancellors) during testimony to the U.S. House Ways and Means Committee. Dr. Wallace stated that the ACR was ready to create guidelines for radiology to eliminate inappropriate utilization of radiologic services.1, 2

The ACR Task Force on Appropriateness Criteria was created and panel chairs were appointed in late 1993. In 1994, deliberations had begun to develop nationally accepted, scientifically-based guidelines to assist referring physicians in making appropriate imaging decisions for given patient clinical conditions in order to provide the College’s perspective on how to best use limited health care resources.

In creating the ACR AC, the Task Force incorporated attributes for developing acceptable medical practice guidelines used by the Agency for Healthcare Research and Quality (AHRQ) as designed by the Institute of Medicine. From the beginning, the methodology relied on a combination of evidence and when the data from scientific outcome and technology assessment studies are insufficient, expert consensus. Additionally, the methodology employs the input of physicians from other medical specialties to provide important clinical perspectives.

The AHRQ is explicit in stating its intent that scientific evidence should be used as much as possible but that judgment and group consensus will be necessary in the development of medical guidelines. The National Guidelines Clearinghouse (NGC), one of the initiatives of AHRQ, is a public resource for evidence-based clinical practice guidelines. The ACR AC topics are posted on the NGC site.

Currently, the ACR AC are the most comprehensive evidence based guidelines for diagnostic imaging selection, radiotherapy protocols, and image guided interventional procedures. They embody the best, current evidence for selecting appropriate diagnostic imaging and interventional procedures for numerous clinical conditions.

1 Cascade PN. Setting appropriateness guidelines for Radiology. Radiology 1994; 192(1):50A-54A.
2 Cascade PN. The American College of Radiology. ACR Appropriateness Criteria project. Radiology 2000; 214 Suppl:3-46.