About the ACR Appropriateness Criteria

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 and reviewed annually by expert panels in diagnostic imaging and interventional radiology. Each panel includes leaders in radiology and other specialties. In 2024, there are 239 Diagnostic Imaging and Interventional Radiology topics with over 1,100 variants and for our Diagnostic Imaging topics 3,900 clinical scenarios.

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 complete the online ACR permission request form .

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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.

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.


In June 2016, the Centers for Medicare & Medicaid Services (CMS) named the American College of Radiology (ACR) a “qualified Provider-Led Entity” (qPLE) approved to provide appropriate use criteria (AUC) under the Medicare Appropriate Use Criteria program for advanced diagnostic imaging. This means that medical providers can consult ACR Appropriateness Criteria® to fulfill impending Protecting Access to Medicare Act (PAMA) requirements that they consult AUC prior to ordering advanced diagnostic imaging for Medicare patients.

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.