ACR Appropriateness Criteria

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The ACR Appropriateness Criteria® (AC) 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. Employing these guidelines helps providers enhance quality of care and contribute to the most efficacious use of radiology. Learn more »

The newest ACR AC are listed below.

AC Portal

An interactive way to access the AC topics, variants, clinical scenarios, and recommendations. Use keyword filters and search features to more easily find all content.

See the complete list of ACR AC topics and ratings tables
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AC News and Announcements

  • The ACR Appropriateness Criteria® Methodology article is now available on the JACR  . This paper describes the methodology and illustrates adherence to the process in the development of the AC.
  • PAMA Implementation and Clinical Decision Support
    • AUC consult prior to ordering advanced diagnostic imaging for Medicare patients must be documented via a CMS-qualified clinical decision support mechanism (qCDSM). A list of qualified mechanisms may be found on the CMS website.
    • Without a documented consult, rendering providers will not receive Medicare payment for the procedure once the payment penalty phase of the program begins. For more information, see the ACR Clinical Decision Support page.
    • For questions about the Medicare PAMA AUC program, e-mail PAMA-AUC@acr.org.
  • For those new to the ACR Appropriateness Criteria, view our Introduction to AC module. Learn about how to get involved and earn CME.
AUC Navigator — Find qPLE sites, AUC guidance links, and priority clinical area designated AUCs
Improved Vehicle for Feedback on ACR Appropriateness Criteria
ACR AC Radiation Oncology topics have been transitioned to the American Radium Society

New and Revised Topics in 2022



In 2022, we added 7 new and 31 revised topics. The ACR Appropriateness Criteria includes 223 Diagnostic Imaging and Interventional Radiology topics with over 1060 clinical variants and 3000 clinical scenarios.

Diagnostic Imaging Updates

  1. Acute Pyelonephritis (Revised)  
  2. Ataxia-Child (New)  
  3. Central Venous Access Device and Site Selection (Revised) 
  4. Chronic Elbow Pain (Revised) 
  5. Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis, Crystalline Arthritis, or Erosive Osteoarthritis (Revised) 
  6. Chronic Hip Pain (Revised) 
  7. Chronic Shoulder Pain (Revised) 
  8. Cranial Neuropathy (Revised) 
  9. Evaluation of Nipple Discharge (Revised) 
  10. Fibroids (New) 
  11. Headache (Revised) 
  12. Hernia (New) 
  13. Imaging After Breast Surgery (New) 
  14. Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery) (Revised) 
  15. Lower Extremity Arterial Claudication-Imaging Assessment for Revascularization (Revised) 
  16. Lung Cancer Screening (Revised) 
  17. Malignant or Aggressive Primary Musculoskeletal Tumor – Staging and Surveillance (Revised) 
  18. Management of Vertebral Compression Fractures (Revised) 
  19. Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer (Revised) 
  20. Osteonecrosis (Revised) 
  21. Osteoporosis and Bone Mineral Density (Revised) 
  22. Palpable Breast Masses (Revised) 
  23. Pretreatment Detection, Surveillance, and Staging of Prostate Cancer (Revised) 
  24. Post-Treatment Follow-up of Prostate Cancer (Revised) 
  25. Right Lower Quadrant Pain (Revised) 
  26. Right Upper Quadrant Pain (Revised) 
  27. Routine Chest Imaging (Revised) 
  28. Soft Tissue Masses (Revised) 
  29. Staging and Follow-up of Esophageal Cancer (New) 
  30. Staging of Renal Cell Carcinoma (Revised) 
  31. Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot) (Revised) 
  32. Suspected Pulmonary Embolism (Revised) 
  33. Suspected Pulmonary Hypertension (Revised) 
  34. Thoracoabdominal Aneurysm or Dissection: Treatment Planning and Follow-up (New) 
  35. Workup of Noncerebral Systemic Arterial Embolic Source (New) 

Interventional Radiologic Updates

  1. Radiologic Management of Mesenteric Ischemia (Revised) 
  2. Management of Liver Cancer (Revised) 
  3. Management of Vertebral Compression Fractures (Revised) 
See new topics currently under development and under consideration
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Methodology Documents

As a qPLE, the ACR follows guidance development requirements including a balanced, multidisciplinary team involving various stakeholders in the development process. To read more about the development process, please review the information below.

  • The ACR Appropriateness Criteria® Methodology article is now available on the JACR . This paper describes the methodology and illustrates adherence to the process in the development of the AC.
Topic Development Process
Rating Round Information
Literature Search Process
Evidence Document

Additional Supporting Information

Overview
Composition of Expert Panels
Organizational Chart of AC Committees
Medical Specialty Organization Representation
Radiation Dose Assessment Introduction
Procedure Information
Standard Procedure List – AC Diagnostic Topics
Patient Age Definitions
Citation Information
Terms and Conditions

Provide Feedback

Our enhanced commenting web site allows us to better track and manage feedback coming from a variety of sources.

One focus of this site is to capture insights from stakeholders who are not directly involved in the ACR Appropriateness Criteria development and review processes. For two months after each release, the College conducts a focused commenting period to collect feedback related to the new and revised topics included in the release.

However, feedback and comments on any topic may be submitted at any time. Anyone can suggest new topics, splitting or grouping topics together, suggest new references or evidence for the expert panel to consider, ask questions or clarifications, or comment on the ACR AC process and methodology. We will do our best to provide timely responses but eventually all input will be reviewed and addressed.

Please let us know if you have any suggestions for the Review page so we can collect and address better your input and comments. . Click here to access the commenting site »

Patient Summaries

The Journal of the American College of Radiology (JACR), in collaboration with the ACR AC Patient Engagement Subcommittee, has launched Patient Summaries as a new publication category, representing an important, new initiative to have patients (laypersons) summarize AC recommendations for patients. It is anticipated the ordering physicians and radiologists will welcome these publications, as the summaries are intended to help patients understand what tests are appropriate for their situation, and are designed to help ordering physicians and radiologists better communicate the reason they are requesting, or performing, a particular imaging test. Learn more » 

Additional Information

Joint ACR ACCF Appropriate Utilization of Cardiovascular Imaging
Permission to Use ACR Appropriateness Criteria

Clinical Decision Support



ACR Select®, a digital representation of the ACR Appropriateness Criteria® for diagnostic imaging, is a module contained within CareSelect Imaging.

ACR Select is ready to incorporate into computerized ordering and EHR systems to guide providers when ordering medical imaging scans.


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Radiology Support, Communication and Alignment Network



Collaborate with radiologists and referring clinicians to improve imaging appropriateness based on Choosing Wisely topics.

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