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.

2012 Draft ACR Practice Guidelines and Technical Standards

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This is the final of four field review cycles for the guidelines and standards that will be presented at the 89th Annual Meeting and Chapter Leadership Conference, April 21-25, 2012, in Washington, DC.

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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.

The ACR process for developing a practice guideline or technical standard starts with the specialty commissions or committees receiving suggestions from organizations, individual ACR practicing radiologists, radiation oncologists, or medical physicists, ACR State Chapters, or other appropriate entities. A proposal form is completed and submitted to the chair and vice-chair of the Commission on Quality and Safety for approval.

If the proposal is approved, the relevant guidelines committee (as determined by the sponsoring Specialty Commission) drafts the document. If the document is drafted in collaboration with one or more medical specialty societies, the committee will also include members from each society. After the committee is satisfied with the initial draft, the document is circulated among the relevant commissions, committees, and societies for review and comment. The comments are collated and the draft is finalized by the drafting committee.

Then all of the draft practice guidelines and technical standards are posted on the ACR web site for on-line commenting (this is called field review). On average, 30 – 40 documents may be reviewed in one year. To ensure members have adequate time to review the documents, the documents are placed into one of four scheduled field reviews. A field review may have eight or more documents up on the web for review, depending on the total number being reviewed in the year. Each field review period lasts three weeks. Any ACR member may comment during this three-week period. The comments are collated by staff after each field review cycle.

A "subcommittee" is formed and a Chair is appointed by the Council Steering Committee (CSC). The Chair reviews the comments from the field review and determines if there are sufficient changes required to the document that would necessitate a conference call. The subcommittee members usually include the principal drafters (drafting committee), Chairs of sponsoring Commission and Guideline committee or Collaborative Committee, Speaker, Vice-Speaker, two or three field review commenters, two or three guidelines committee members, collaborative committee members, ACR staff, collaborative committee staff, and legal counsel. The comments are adopted or rejected during the call and the final draft is circulated to ensure accuracy and completeness. If the practice guideline or technical standard is collaborative with another society, the draft is sent to that society for written approval of the collaboration.

The final draft from this conference call is then placed on the ACR Web site prior to the ACR Annual Meeting and Chapters Leadership Conference (AMCLC).

The practice guidelines / technical standards are submitted as resolutions to be considered for adoption as policy by the ACR at the AMCLC. All practice guidelines / technical standards are treated in the same manner, allowing for testimony from the floor to be considered during the open session of the Reference Committees. The ACR allows representatives from the collaborating societies’ to provide input at the AMCLC on amendments to the collaborative guidelines proposed by ACR councilors.

The practice guidelines / technical standards that are approved at the AMCLC are published on the ACR website and in a CD format, which is mailed to ACR members to facilitate the adoption / implementation in their practices. The effective date for new and revised practice guidelines and technical standards is October first of the year in which they are adopted.

This process provides opportunity for input from all sectors of the ACR. The Chair of the Commission on Quality and Safety encourages this broad participation and invites comments as well as proposals for new practice guidelines / technical standards from all members of the American College of Radiology.

In May 2010, the ACR Council adopted a Resolution that modifies the way that Radiation Oncology Collaborative guidelines may be developed, revised, and adopted. This new process is under development and is expected to take time to perfect before full implementation.

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.