Value-based Imaging Activities

Educational activities for referring clinicians to optimize image ordering based on evidence

Funding for these activities is made available through a grant from the Transforming Clinical Practice Initiative . The ACR R-SCAN program is one of 10 Support and Alignment Networks funded to provide technical support to over 140,000 clinicians enrolled in the initiative.

Imaging Order Simulations (IOS)

NOTICE: This activity is currently under maintenance to provide an improved user experience. If you would like to be notified when the activity becomes available, please contact us at

Test Your Knowledge

Access cases designed to test your knowledge of appropriate imaging and familiarize yourself with clinical decision support (CDS) technology that delivers evidence-based appropriate use criteria (AUC) to guide selection of the most appropriate imaging for patients  — all while earning CME.

This free activity is made up of 12 modules based on Choosing Wisely®  (CW) recommendations related to reducing or re-evaluating the use of imaging for specific indications. The CW topics are aligned with the ACR Appropriateness Criteria® (AC), which are evidence-based guidelines made available through the CareSelect™  clinical decision support platform.

Prepare for PAMA

Under the Protecting Access to Medicare Act (PAMA), CMS will require physicians and other providers to consult AUC developed by a qualified provider-led entity prior to ordering outpatient imaging services for Medicare patients. Learn more »

Features and Benefits

  • Complete one or all of the modules at your convenience
  • CME is awarded at the completion of each module
  • Discover radiation exposure information, relative cost and other information about imaging exams helpful for patient conversations   
  • Try out clinical decision support in an easy-to-navigate portal
  • Gain a better understanding of ACR Appropriateness Criteria
What Others Are Saying
“The featured clinical cases reflect highly relevant situations and provide a valuable opportunity for clinicians to review evidence-based ordering guidelines and learn about the interactive ACR Appropriateness Criteria clinical decision support tool … that can be subsequently integrated into daily practice.”

— Jason Hom, MD, Clinical Assistant Professor of Medicine, Stanford University

Value-based Imaging Podcasts

Position Yourself for Success

Position your practice for success in the transition to value-based care with brief, free podcasts that discuss strategies for image ordering and highlight how the ACR Appropriateness Criteria® supports Choosing Wisely®  recommendations. 

Features and Benefits

  • Improve ordering practices and avoid low-value imaging with evidence-based recommendations based upon the growing list of Choosing Wisely topics
  • Gain insight about how communication between radiologists and referring clinicians can improve imaging care
  • Prepare for the impending Protecting Access to Medicare Act (PAMA) requirements by using clinical decision support tools and consulting the ACR Appropriateness Criteria
  • Receive CME Credit

IOS Activities by Topic

NOTICE: This activity is currently under maintenance to provide an improved user experience. If you would like to be notified when the activity becomes available, please contact us at

Podcast Activities by Topic

Accessing and Navigating the Activities

An ACR login is required to access the activities.

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Navigating the IOS Modules

Click on the image below to view the instructions for completing the modules.

Consulting ACR Select

  1. Enter the patient age and gender.
  2. Enter the body area of interest.
  3. In the search field, enter a term to locate the indication or scenario.
  4. Click the “Display Evidence” table to view the ACR Appropriateness Criteria for some topics.
  5. Hover over the RRL (relative radiation level) to obtain radiation dose information.
  6. More details about cost and RRL are available in the explanation section for each case.

Navigating the Podcasts

  1. Click the play button on the video to listen to the podcast.
  2. When finished, click the arrows >> to proceed to the questions page.
  3. After answering all the questions, click “Submit to Complete” at the top of the page. Make sure your pop-up blocker is turned off.
  4. Complete the evaluation and download or print your certificate.

Checking Your Score

Click the four-line icon located on the right of the screen, then click on “Activity Summary” to view your score.

Hardware/Software Requirements

You can access these modules via a PC, Mac, or Linux computer using any of the following supported browsers:

  • Google Chrome
  • Mozilla Firefox
  • Microsoft Internet Explorer
  • Apple Safari 

We support the two latest versions of each of these browsers. Upon the release of a new version, we will begin supporting the newly released version and stop supporting the oldest previously supported version.

Regardless of the browser you choose, you must enable:

  • Cookies
  • Javascript
  • MP4 video playback plug-in (e.g., Microsoft Windows Media Player, Apple Quicktime)
  • Flash player (optional) 

We recommend using the latest production-level versions of these browsers. In particular, we strongly suggest using Firefox or Chrome.

Learning Objectives

Upon completion of the IOS modules, the participants should be able to:

  • Demonstrate their ability to order more appropriate imaging for the Choosing Wisely® topic (measured by the pre- and posttests conducted via R-SCAN as well as overall R-SCAN data reported to CMS).
  • Demonstrate their ability to utilize decision support tools in their practices (measured by logins to ACR Select; note that if participants use other CDS tools, this will not be tracked).
  • Analyze and use appropriateness criteria over multiple topics, resulting in educational reinforcement of the concepts of appropriateness.

Upon completion of the podcasts, the participants should be able to:

  • Understand successful communication practices with radiologists/referring physicians related to ordering imaging;
  • Demonstrate understanding of image ordering best practices; and
  • Apply evidence-based recommendations into image ordering decision-making.

CME Information

Accreditation Statement

The American College of Radiology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

The American College of Radiology designates these enduring material activities for a maximum of 0.5 AMA PRA Category 1 Credits™ for each of the 12 IOS modules and for each of the 10 podcasts. Physicians should claim only the credit commensurate with the extent of their participation in the activity. For each module or podcast, you must achieve a minimum score of 80% in three attempts to receive credit. Estimated time to complete each educational activity is 30 minutes.

Only physicians are eligible to be awarded AMA PRA Category 1 Credit™. The AMA defines physicians as those individuals who have obtained an MD, DO, or equivalent medical degree from another country.

All other participants in this CME activity may receive a Certificate of Participation that documents participation in an activity designated for AMA PRA Category 1 Credits™. For the purposes of recertification, other certification boards may award equivalent Continuing Education (CE) credit when presented with a Certificate of Participation from an activity that was designated for AMA PRA Category 1 Credit™. ACR suggests that learners check with their licensing board to ensure they accept reciprocity with AMA Category 1 Credit™.

Imaging Order Simulations

CME Released: August 2017
CME Expires: August 31, 2019

Value-Based Imaging Podcasts

CME Released: June 2015
CME Expires: May 31, 2021

How to Claim CME Credit

After completing all cases/questions, click the Submit to Complete button located at the top right of the screen to access a brief survey prior to receiving your certificate. Make sure your browser’s pop-up blocker is turned off.

Once the survey is completed, click the View/Print Certificate button to open your certificate and print and/or save it as a PDF. Return to the IOS/podcast page at any time using the Activities by Topic links above (you may need to log in with your ACR account again) and click on View/Print Certificate to print or save your certificate.

ACR Disclosure Policy/Conflict of Interest

In compliance with ACCME requirements and guidelines, the ACR has developed a policy for review and disclosure of potential conflicts of interest, and a method of resolution if a conflict does exist. The ACR maintains a tradition of scientific integrity and objectivity in its educational activities. In order to preserve this integrity and objectivity, all individuals participating as planners, presenters, moderators, and evaluators in an ACR educational activity or an activity jointly sponsored by the ACR must appropriately disclose any financial relationship with a commercial organization that may have an interest in the content of the educational activity.


The following faculty indicated that they have no relevant financial relationships related to the presentation of this material:

Imaging Order Simulations:
Marc H. Willis, DO
Karla A. Sepulveda, MD
L. Alexandre Frigini, MD
Christie M. Lincoln, MD
Melissa M. Chen, MD

Appropriate Imaging Podcasts:
Marcia Javitt, MD / Author
Amnon Amit, MD / Author
Robert Shih, MD / Author 
Matthew Denny, MD / Author
Carole Dennie, MD, FRCPC / Author
Philip Wells, MD, FRCPC, MSc / Author
Max Wintermark, MD / Author
Jason Hom, MD / Author
Maura Ryan, MD / Author
Elizabeth Powell, MD, MPH / Author
Laura Hayes, MD / Author
Bryan Philbrook, MD / Author
Francine Jacobson, MD, MPH / Author
Angela Bader, MD, MPH / Author
Steven Eberhardt, MD / Author
Thomas M. Schroeder, MD / Author
Marta E. Heilbrun, MD, MS / Author
Troy Madsen, MD / Author
Prasad Shankar, MD / Author
Rebecca S. Cornelius, MD, FACR / Author
Robert Ellis, MD, FAAFP / Author
Amanda Corey, MD, FACR / Author
Mia Minen, MD, MPH
Sean Necessary, MD


The following IOS reviewers indicated that they have no relevant financial relationships related to the presentation of this material:

Saurabh Agarwal, MD
Frank Berkowitz, MD
Stephen Brown, MD
Steven Chmielewski, MD
Ramesh Iyer, MD
Ann Jay, MD
Amar Shah, MD
Paul Thacker, MD
Antonio Westphalen, MD
Stefan Zimmerman, MD
Rebecca Zuurbier, MD


ACR staff have indicated that they have no relevant financial relationships related to this educational activity.

Need assistance?

Click on the Support button within the activity to submit a help request or email

Clinical Decision Support Resources


Learn more about the requirement that referring providers consult appropriate use criteria prior to ordering advanced diagnostic imaging for Medicare patients.

Get informed today »

Practice Toolkit


Use the downloadable materials and resources to build awareness of radiology and to answer patient questions about medical imaging and treatment.

Practice Toolkit »