Practice Parameters and Technical Standards

The American College of Radiology will periodically define new practice parameters 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 parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated.

Each practice parameter and technical standard has undergone a thorough consensus process in which it has been subjected to extensive review, requiring the approval of ACR leadership and collaborating society boards. The practice parameters 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 parameters and technical standards by those entities not providing these services is not authorized.

These parameters documents are educational tools designed to assist practitioners in providing appropriate radiologic care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care . For these reasons and those set forth below, the American College of Radiology cautions against the use of these parameters in litigation in which the clinical decisions of a practitioner are called into question.

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 parameters, 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 parameters 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 parameters. However, a practitioner who employs an approach substantially different from these parameters 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 parameters 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 parameters is to assist practitioners in achieving this objective.

*Iowa Medical Society and Iowa Society of Anesthesiologists v. Iowa Board of Nursing, 831 N.W.2d 826 (Iowa 2013) Iowa Supreme Court refuses to find that the ACR Technical Standard for Management of the Use of Radiation in Fluoroscopic Procedures (Revised 2008) sets a national standard for who may perform fluoroscopic procedures in light of the standard’s stated purpose that ACR standards are educational tools and not intended to establish a legal standard of care. See also, Stanley v. McCarver, 63 P.3d 1076 (Ariz. App. 2003) where in a concurring opinion the Court stated that “published standards or guidelines of specialty medical organizations are useful in determining the duty owed or the standard of care applicable in a given situation” even though ACR standards themselves do not establish the standard of care.

Introduction

The practice parameters and technical standards are developed through consensus by experts from various practice settings and radiological subspecialties. These documents are not intended to establish, imply, or reflect “best practice” guidance, but are important to understanding the basic elements in providing quality radiological care.

The documents follow a well-organized development process which requires members’ and collaborating society representatives’ active participation at each stage of drafting, reviewing, and approving. For a more complete discussion of the program, please review the Practice Parameters and Technical Standards Development Handbook.

Document Drafting

A writing committee is constituted prior to drafting or revising documents for a given year. The documents go through an iterative review process until the committee reaches consensus. Literature searches are conducted to provide supporting evidence of recommendations of the documents. The documents that are collaborative with multiple medical specialty societies result in stronger recommendations that reduce potential bias and harmonize clinical recommendations.

Document Review

After completion of the initial draft or revision of a practice parameter or technical standard document, the document undergoes “field review ”; the process where the draft document is available for any ACR member and collaborating society to provide comments. All practice parameters and technical standards must complete field review before being considered for adoption by the ACR. This is the opportunity stakeholders external to the document drafting/revision process to comment. The comments are collated by staff, and then reviewed by the Chair of the Comment Reconciliation Committee, to determine which editorial comments can be accepted, or if substantive, should be considered by the Comment Reconciliation Committee for inclusion in the final draft to be presented for adoption. When a document completes the comment reconciliation process, it is considered final and ready for approval.

For more information on the comment reconciliation process, see “Review and Approval Process” section of the Practice Parameters and Technical Standards Development Handbook.

Document Approval

The final documents are sent to the relevant collaborating societies for acknowledgement if they are going through the Council approval process. The final version of the documents that Council has adopted or adopted as amended will be sent to the collaborating societies for each society’s final approval.

Documents that are not considered part of the Medical Physics approval process or the Radiation Oncology approval process are presented to the ACR Council for approval.

Council Approval Process
Each document that has completed field review will be presented to the ACR Council on a consent calendar as a resolution in accordance with the Standard Code of Parliamentary Procedure (formerly the Sturgis Standard Code of Parliamentary Procedure by Alice Sturgis). The practice parameters and technical standards will be adopted, adopted as amended, not adopted, or referred to the Board of Chancellors for action. There may be a specific BOC action with time restriction requested by the Council. For more details, see the section “Review and Approval Process” in the Practice Parameters and Technical Standards Development Handbook.

Medical Physics Approval Process 
For Medical Physics documents that are collaborative with AAPM only, the final documents are reviewed and approved by AAPM, the Commission on Medical Physics, and the ACR Council Steering Committee and Board of Chancellors (Resolution 54 2015). For details see the section “Expedited Approval of ACR-AAPM Collaborative Medical Physics Practice Parameters and Technical Standards” in the Practice Parameters and Technical Standards Development Handbook.

Radiation Oncology Approval Process
For Radiation Oncology documents that are collaborative with radiation oncology societies only (eg, ASTRO, ABS, ARS, etc), the ACR Commission on Radiation Oncology and the ACR Commission on Medical Physics review and approve the final documents after the collaborating societies have reviewed and approved the document. Based on the recommendation of the ACR Commissions, the ACR Council Steering Committee, and the ACR Board of Chancellors reviews and approves the final document (Resolution 8 2010). For details, see the section “Process for Radiation Oncology Collaborative Practice Parameters and Technical Standards” in the Practice Parameters and Technical Standards Development Handbook.

Overall Process Timeline

The overall process to develop or revise a practice parameter or technical standard document is completed in 18 months. View timeline.