As part of its ongoing efforts to ensure safe, effective, and appropriate use of medical imaging, the American College of Radiology (ACR) identified a list of five imaging exams whose necessity should be discussed before being ordered. The list, created as part of the Choosing Wisely campaign, initiated by the American Board of Internal Medicine (ABIM) Foundation, provides evidence-based recommendations to support physicians working with patients to make wise choices about medical imaging care.

The ACR recommendations address imaging for uncomplicated headache absent specific risk factors for structural disease or injury; imaging for suspected pulmonary embolism (PE) without moderate or high pre-test probability of PE; preoperative chest x-rays without specific reasons due to patient history or physical exam; computed tomography (CT) to evaluate suspected appendicitis in children until ultrasound is considered an option; and follow-up imaging for adnexal (reproductive tract) cysts 5mm or less in diameter in reproductive-age women.

“Medical imaging exams save lives and lower health care costs by replacing more invasive surgeries, providing quicker diagnoses and allowing for fewer and shorter hospital stays,” said John A. Patti, MD, FACR, chair of the ACR Board of Chancellors. “Although imaging use is down significantly in recent years and Medicare spending on imaging is at 2003 levels, opportunities remain to ensure appropriate ordering of scans. Since greater access to medical imaging is directly tied to increased life expectancy, the ACR has identified five areas where care can be improved by providing appropriate access to meaningful imaging.”

The list, which joins those of eight other national medical specialty societies released today as part of Choosing Wisely, is the latest in a long history of ACR quality and safety efforts.