Avoid ordering CT of the abdomen and pelvis in otherwise health emergency department (ED) patients (age <50) with known histories of kidney stones, or urolithiasis, presenting with symptoms consistent with acute uncomplicated renal colic.
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Choosing Wisely Topic: CT for Renal Colic ACR Appropriateness Criteria: CT for Renal Colic Choosing Wisely Case Review: Selecting the best imaging exam for kidney stones Podcast: A discussion on ordering imaging exams for renal colic |
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Choosing Wisely Handout: Why the doctor may not order a CT scan for kidney stones Patient-Friendly Appropriateness Criteria Summary Educational Flyer: CT Scans in the Emergency Department |
Don’t routinely order coronary CT angiography for screening asymptomatic individuals.
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Choosing Wisely Topic: CTA for Asymptomatic Patient with Low Risk of Coronary Heart Disease ACR Appropriateness Criteria: Asymptomatic Patient at Risk for Coronary Artery Disease Article: R-SCAN: Cardiac CT Angiography for Acute Chest Pain Choosing Wisely Case Review: Selecting the best imaging exam for acute chest pain |
Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.
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Choosing Wisely Topic: Admission and Pre-op Chest X-Ray ACR Appropriateness Criteria: Routine Chest Radiography Presentation: When to Image Based on Choosing Wisely® and ACR Appropriateness Criteria® — Admission and Pre-op Chest X-ray Podcast: A discussion on ordering imaging exams for preoperative chest radiography Choosing Wisely Case Review: Selecting the best imaging exam for preoperative chest radiography |
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Choosing Wisely Video: Patient Story About Unnecessary Pre-op Chest X-ray Choosing Wisely Handout: Chest X-Rays Before Surgery |
Do not perform chest CT angiography to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay.
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Educational Flyer: CT Scans in the Emergency Department Choosing Wisely Handout: When you need a CT scan to check for a blood clot in your lungs Patient-Friendly Appropriateness Criteria Summary Article: ACP Evaluation of Patients With Suspected Acute Pulmonary Embolism |
Do not recommend follow-up imaging for clinically inconsequential adnexal cysts.
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Choosing Wisely Topic: Adnexal Cyst Follow Up ACR Appropriateness Criteria: Clinically Suspected Adnexal Mass Presentation: Characterization and Follow up of Simple Ovarian Cysts Case Study: Shaping Change from Within (results of the Carle Physician Group's R-SCAN project) Podcast: A discussion on ordering imaging exams for adnexal cysts* Article: Management of Asymptomatic Ovarian and Other Adnexal Cysts Imaged at US Choosing Wisely Video: Radiologists Discuss Proceedings for Small Ovarial Cyst Article: R-SCAN: Follow-Up for Adnexal Cysts Choosing Wisely Case Review: Selecting the best imaging exam for adnexal cysts Presentation: When to Image Based on Choosing Wisely® and Society of Radiologists in Ultrasound Consensus Conference Statement |
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Choosing Wisely Handout: Imaging Tests for Ovarian Cysts |
Don’t perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis.
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Choosing Wisely Topic: Advanced Imaging for Early Prostate Cancer Staging Podcast: A discussion on ordering imaging exams for prostate cancer Article: ACR Appropriateness Criteria Prostate Cancer – Pretreatment Detection, Surveillance, and Staging Article: R-SCAN: Appropriate Imaging for Low-Risk Prostate Cancer Choosing Wisely Case Review: Selecting the best imaging exam for prostate cancer ACR Appropriateness Criteria: Prostate Cancer – Pretreatment Detection, Staging, and Surveillance Presentation: When to Image Based on Choosing Wisely® and ACR Appropriateness Criteria® — Early Prostate Cancer Staging |
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Choosing Wisely Handout: Imaging Tests for Early Prostate Cancer |
Don't recommend ultrasound for incidental thyroid nodule in low-risk patients unless the nodule meets age-based size criteria or has suspicious features.
Note: This topic is completed via upload of data entered in an Excel spreadsheet only. The spreadsheet is available below.
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Data Entry Excel Template for Incidental Thyroid Nodule Project |
Don’t perform advanced imaging (e.g. MRI) of the spine within the first 6 weeks in patients with nonspecific acute low back pain in the absence of red flags.
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Choosing Wisely Topic: Imaging for Low Back Pain ACR Appropriateness Criteria: Low Back Pain Article: R-SCAN: Imaging for Low Back Pain Flyer: ACEP-ACR Partnership Delivers Resources to Help Prepare You for the Future Podcast: A discussion on ordering imaging exams for low back pain Choosing Wisely Video: Patient with Low Back Pain Requests an MRI Order Wisely Video: Appropriate Imaging for Low Back Pain Presentation: Optimal Approach to Imaging for Low Back Pain Choosing Wisely Case Review: Selecting the best imaging exam for low back pain Presentation: When to Image Based on Choosing Wisely® and ACR Appropriateness Criteria® -- Low Back Pain |
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Patient-Friendly Appropriateness Criteria Summary Choosing Wisely Handout: Imaging for Low Back Pain ACP Health Tips - What You Can Do: Low Back Pain — English | Spanish Choosing Wisely Handout: Bed Rest and Low Back Pain |
Don’t order sinus CT or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.
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Choosing Wisely Topic: CT for Uncomplicated Rhinosinusitis ACR Appropriateness Criteria: Sinonasal Disease Podcast: A discussion on ordering imaging exams for rhinosinusitis Article: R-SCAN: Imaging for Uncomplicated Acute Rhinosinusitis Choosing Wisely Case Review: Selecting the best imaging exam for rhinosinusitis Presentation: When to Image Based on Choosing Wisely® and the ACR Appropriateness Criteria® |
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Patient-Friendly Appropriateness Criteria Summary Choosing Wisely Handout: Treating Sinusitis — English | Spanish |
Follow evidence-based guidelines for pediatric headache imaging.
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ACR Appropriateness Criteria: Pediatric Headache Clinical Decision Algorithms: General, Sinus, and Trauma Headache - PDF Version | PPT Version |
Don’t do imaging for uncomplicated headache.
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Choosing Wisely Topic: Imaging for Uncomplicated Headaches ACR Appropriateness Criteria: Headache Order Wisely Video: Appropriate Imaging for Headache Presentation: When to Image Based on Choosing Wisely® and ACR Appropriateness Criteria® — Uncomplicated Headache Article: R-SCAN: Imaging for Headache |
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Choosing Wisely Handout: Imaging Tests for Headaches — English | Spanish |
CT scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network criteria should be used to determine whether imaging is indicated.
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Choosing Wisely Topic: CT for Minor Pediatric Head Injury ACR Appropriateness Criteria: Head Trauma – Child Article: R-SCAN: Imaging for Pediatric Minor Head Trauma Case Study Video: CTs for Pediatric Patients With Minor Head Trauma – Implementing PECARN Article: Identification of Children at Very Low Risk of Clinically-Important Brain Injuries After Head Trauma Flyer: ACEP-ACR Partnership Delivers Resources to Help Prepare You for the Future Podcast: A discussion on ordering imaging exams for pediatric head trauma Article: Optimizing Communication With Parents on Benefits and Radiation Risks in Pediatric Imaging Choosing Wisely Video: Request for CT After Pediatric Head Injury Presentation: ACR Appropriateness Criteria – Head Trauma Choosing Wisely Case Review: Selecting the best imaging exam for minor head trauma (pediatric) Presentation: When to Image Based on Choosing Wisely® and ACR Appropriateness Criteria® — Minor Pediatric Head Trauma |
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Patient-Friendly Appropriateness Criteria Summary Website Resource: Think A-Head and Image Gently™ Choosing Wisely Handout: CT Scans for Children with Head Injuries — English | Spanish A Shared Decision Making Tool for Discussing CT Head Injury with Patients Choosing Wisely Handout: Brain Scans for Head Injuries — English | Spanish |
Avoid CT scans of the head in emergency department patients with minor head injury who are at low risk based on validated decision rules.
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Choosing Wisely Topic: CT for Adult Minor Head Trauma ACR Appropriateness Criteria: CT for Adult Minor Head Trauma Choosing Wisely Case Review: Selecting the best imaging exam for minor head trauma (adult) Presentation: CT for Adult Minor Head Trauma - When to Image Based on Choosing Wisely® and ACR Appropriateness Criteria® Podcast: A discussion on ordering imaging exams for adult minor head trauma Article: The Canadian CT Head Rule for patients with minor head injury Article: Computed Tomography Use for Adults with Head Injury |
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Patient-Friendly Appropriateness Criteria Summary A Shared Decision Making Tool for Discussing CT Head Injury with Patients Choosing Wisely Handout: Brain Scans for Head Injuries — English | Spanish Choosing Wisely Handout: Do you need a CT scan for a head injury? |
Neuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure.
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Choosing Wisely Topic: Advanced Imaging for Pediatric Febrile Seizures ACR Appropriateness Criteria: Seizures - Child Podcast: A discussion on ordering imaging exams for pediatric seizures Article: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure Choosing Wisely Case Review: Selecting the best imaging exam for pediatric febrile seizures Article: R-SCAN: Imaging for Pediatric Simple Febrile Seizures Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure Presentation: When to Image Based on Choosing Wisely® and ACR Appropriateness Criteria® - Febrile Seizure Article: Optimizing Communication With Parents on Benefits and Radiation Risks in Pediatric Imaging |