Introduction to the ACR Appropriateness Criteria

Donna Magid, MD, M.Ed

"What to Request When”

The American College of Radiology (ACR) supports an Appropriateness Criteria (AC) site, which is a valuable reference for students endeavoring to fathom what imaging study might be desirable under which clinical circumstances, and why. This site ranks possible imaging alternatives (plain film aka radiography; CT, US, MRI, etc.) from 9 (best choice) to 1 (least appropriate) for a number of constantly reviewed and updated clinical scenarios.   Site is at


For example: Patients with known HIV often present with acute respiratory illness, which can represent a wide spectrum of HIV-specific or organ-specific diseases. Patient susceptibility is also varied depending on geographic location/exposure/travel, CD4 cell count, status of antiretroviral treatment, and other individual modifying factors. The ACR AC category “Acute Respiratory Illness in HIV-positive Patient” therefore is further subdivided into variants such as: “cough, chest pain and fever”; “negative or equivocal chest radiograph”; “Positive chest radiograph with confluent opacities”. “Positive chest radiograph, infection other than PCP suspected”, “Positive chest radiograph, noninfectious disease suspected (i.e., neoplasm)”. For each of these modified scenarios, there may be differences in how useful or appropriate various imaging modalities may be. After each clinical situation variant is presented, with imaging suggestions ranked, there is a brief Expert Panel discussion summarizing current experience with the entities in question, how laboratory or other evidence may redirect decisions in another direction, a brief overview of radiation risks for each choice, other succinct useful information, and a bibliography. While this is not the most lively of documents (editorial opinion), habitually referring to it when making imaging decisions will greatly enhance your clinical progress, keep you aware of rapidly evolving change in imaging state-of-the-art, and benefit your patients. (Please note the ability to access this site from mobile devices, below). The following is from the ACR AC Home page at

                                   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 by expert panels in diagnostic imaging, interventional radiology, and radiation oncology. Each panel includes leaders in radiology and other specialties. There are currently 169 topics with over 850 variants in the June 2010 version.

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 contact the ACR at This email address is being protected from spambots. You need JavaScript enabled to view it. or 703-648-8900 for permission and licensing information. Click here for terms and conditions.

ACR Appropriateness Criteria® Search Engine

  • This search engine allows you to search for clinical conditions found within the ACR Appropriateness Criteria® documents.

Click here to use our ACR Appropriateness Criteria® Search Engine

Anytime, Anywhere™ Application for Mobile Devices Now Available

In collaboration with Skyscape, the ACR has developed the Anytime, Anywhere™ application for mobile devices as an alternative solution to radiology benefit management companies or computerized physician order entry systems that do not contain the ACR Appropriateness Criteria® guidance. This application provides instant, point-of-care access to all of the ACR Appropriateness Criteria®, which can be directly downloaded on to the iPhone, Blackberry, Palm, or other PDAs, smart phones or mobile devices. The content includes topics from expert panels in breast, cardiac, gastrointestinal, musculoskeletal, neurologic, thoracic, urologic, pediatric, vascular, and women’s imaging, as well as interventional radiology and radiation oncology.

Diagnostic Imaging Topics

  • Breast Imaging
  • Cardiac Imaging
  • Gastrointestinal Imaging
  • Musculoskeletal Imaging
  • Neurologic Imaging
  • Pediatric Imaging
  • Thoracic Imaging
  • Urologic Imaging
  • Vascular Imaging
  • Women's Imaging
  • Interventional Radiology Topics
  • Interventional Radiology

ACR Appropriateness Criteria® Supporting Documentation

The documents listed below explain the process and methods used in developing and revising the ACR AC topics.


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 services1, 2.

Relative Radiation Level Information

  • An explanation of how the ACR AC assesses patient radiation exposure for various diagnostic procedures using "relative radiation levels".

Procedure Contrast Information

  • A definition of terms for contrast usage in the ACR AC procedures.
  • A document that contains the copyright notice, the disclaimer, warranty information and the use agreement statement for the ACR"