Imaging Order Simulation

An educational activity for referring clinicians to optimize image ordering based on evidence

Funding for this activity 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.

About the Program

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

Activities by Topic

Accessing and Navigating the Activities

An ACR login is required to access the activities.

Create a free account



Navigating the 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.


Checking Your Score

Click the “Menu” icon located on the right of the case 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 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.

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 this enduring material activity for a maximum of 0.5 AMA PRA Category 1 Credits™ for each of the 12 modules. Physicians should claim only the credit commensurate with the extent of their participation in the activity. For each module, you must achieve a minimum score of 80% in three attempts to receive credit. Estimated time to complete this 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.

CME Released: August 2017
CME Expires: August 2019

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:

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


The following 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 »