Practice Guidelines and Technical Standards

The American College of Radiology will periodically define new practice guidelines and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice guidelines and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated.

Each practice guideline and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review, requiring the approval of the Commission on Quality and Safety as well as the ACR Board of Chancellors, the ACR Council Steering Committee, and the ACR Council. The practice guidelines and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.

The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, an approach that differs from the guidelines, standing alone, does not necessarily imply that the approach was below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations on available resources or advances in knowledge or technology subsequent to publication of the guidelines. However, a practitioner who employs an approach substantially different from these guidelines is advised to document in the patient record information sufficient to explain the approach taken.

The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. It should be recognized; therefore, that adherence to these guidelines will not assure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.

ACR members can review and comment on the draft documents of the ACR Practice Guidelines and Technical Standards online. Click Here to view review and comment.

The draft guidelines or standards are placed in groups to be part of a selected field review cycle. A field review is scheduled in August, September, and October. Each cycle is three weeks in duration. Depending on the number of new or revised guidelines or standards to be reviewed and when their drafts have been completed, ACR staff divide the guidelines or standards among the four field reviews.

The guidelines or standards in a particular field review cycle are posted to the ACR website. All ACR members are invited by email to review and comment on the guidelines/standards. Reminders are sent out before each field review cycle to all Chancellors, Council Steering Committee Members, Councilors, Alternate Councilors and State Chapter Presidents. Emails are also sent as reminders to all Practice Guidelines and Technical Standards committee members and the appropriate Commissions and Accreditation Committees.

At the end of each field review cycle, the comments are collated and submitted to the Chair of the Council Steering Committee (CSC) Subcommittee with responsibility for reconciling that guideline or standard. The subcommittee chair and members meet by conference call to discuss the comments and revise the draft guideline or standard as appropriate.

For the collaborative guidelines, once the members’ comments are integrated into the draft collaborative document, the guideline must be reviewed and approved by the collaborating societies before being submitted at AMCLC.

As part of the overall reorganization of the ACR Commission and Committee structure, the Standards and Accreditation Commission (renamed the Quality and Safety Commission) was formed. It is one of eight operational commissions. The members of this commission are, to a large extent, composed of people who also serve on a specialty commission. There are eleven specialty commissions and each of these commissions has a series of operational committees, one of which is a Guidelines and Standards Committee. The chairpersons of these committees make up the membership of the Quality and Safety Commission. This guarantees a broad spectrum of specialty representation on the Commission as well as members from private practice settings and academic medical centers with a wide geographic distribution (see organizational matrix on next page).

The method for developing a practice guideline or technical standard starts with the specialty commissions or committees receiving suggestions for guidelines or standards from organizations, individual practicing radiologists, ACR State Chapters, or any other appropriate entity related to the specialty of radiology. A proposal form is submitted to the chair and vice-chair of the commission for approval.

Once approved, a draft is developed and then circulated throughout the guidelines committee for review and comment until deemed ready to submit for full member comment. If done collaboratively, a committee is formed with members of each collaborating society. The guideline is developed and then sent to the collaborative societies for review and comment.

The draft guideline or standard is available on the ACR Web site for on-line commenting during a three-week field review cycle. The ACR Web site provides access to the draft documents for all members to submit their comments online.

After each field review cycle, a Chair is appointed by the Council Steering Committee (CSC) and a subcommittee is formed. A conference call may be scheduled for a guideline/standard if comments were received during the field review. The subcommittee members include the principal drafters (drafting committee), Chairs of sponsoring Commission and Committee, Speaker, Vice-Speaker, 2-3 field review commenters, 2-3 guidelines committee members, collaborative committee members, ACR staff and legal counsel.

The revised draft from this conference call is then placed on the ACR Web site for an additional 3-week review period prior to the ACR Annual Meeting and Chapters Leadership Conference (AMCLC). If collaborative, the revised draft is sent to the collaborative society for approval. Comments are collated and provided to an assigned ACR Reference Committee to be considered as testimony at the AMCLC.

The approval process for collaborative guidelines during the AMCLC was revised in 2008. All guidelines, whether ACR only or collaborative, are treated in the same manner, allowing for testimony from the floor to be considered and draft language to be amended by the Reference Committee. The ACR also established a process to allow representatives at the AMCLC in order to provide input from the collaborating societies’ on amendments to the collaborative guidelines proposed by ACR councilors.

The guidelines or standards that are approved at the AMCLC are published in a CD format and mailed to all College Members for implementation in their practices. The effective date for guidelines or standards is October first of that year.

This process provides opportunity for input from all sectors of radiology. The chairperson of the Quality and Safety Commission is most interested in this broad participation and invites comments as well as proposals for new practice guidelines or technical standards from all members of the American College of Radiology.

ACR Practice Guidelines and Technical Standards define principles and technical parameters of radiologic and radiation oncology practice, which should generally produce, desired health care outcomes. They describe a range of acceptable approaches for the diagnosis and/or treatment of disease for most patients in most circumstances. Given differences in training, experience, and local conditions, the ACR Practice Guidelines and Technical Standards acknowledge the need for health care providers to exercise their independent medical judgment in making decisions regarding the use and specific details of any procedure.

ACR Practice Guidelines and Technical Standards are educational tools designed to provide consensus-based scientifically valid and medically credible information to assist health care providers in delivering effective, efficient, consistent and safe medical care. They may be developed jointly with other professional organizations. Used in conjunction with the ACR Appropriateness Criteria®, it is expected that the ACR Practice Guidelines and Technical Standards will increase the likelihood that appropriate procedures will be performed in a safe and acceptable manner and will help reduce unnecessary ones.

ACR Practice Guidelines and Technical Standards are intended to be living documents that are regularly reviewed and revised to reflect changes in radiologic and radiation oncology practice.

PRACTICE GUIDELINES describe recommended conduct in specific areas of clinical practice. They are based on analysis of current literature, expert opinion, open forum commentary, and informal consensus. Guidelines are not intended to be legal standards of care or conduct and may be modified as determined by individual circumstances and available resources.

TECHNICAL STANDARDS describe technical parameters that are quantitative or measurable. They often include specific recommendations for patient management or equipment specifications or settings. Technical Standards are based on analysis of current literature, expert opinion, open forum commentary, and informal consensus. Technical Standards are intended to set a minimum level of acceptable technical parameters and equipment performance and may be modified as determined by individual circumstances and available resources.