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ACR Releases Revised Appropriateness Criteria

The American College of Radiology (ACR), Reston, Va, updated its Appropriateness Criteria in June 2010. In addition to including seven new topics and updates to past topics, the ACR has also revised the way it advises clinicians about radiation exposure levels and categorizing appropriateness levels.

New Topics

There are seven completely new topics in the revised 2010 edition of the Appropriateness Criteria (listed in box).

In addition, there are a total of 28 topics that have been revised by their respective expert panels. The revised topics range from ?Sudden Onset of Cold, Painful Leg,? reviewed by the vascular panel, to ?Chronic Chest Pain?High Probability of Coronary Artery Disease? from the cardiac panel. In some cases, the topic?s name has been revised also.

Panels that review the criteria for each topic are comprised of experts from radiology as well as the relevant medical specialty societies and leading clinicians in the field.

David Kurth, MPH, director of guidelines, standards, and appropriateness criteria at the ACR, said that its goal is to review all topics in 2-year cycles and update topics as needed. If not reviewed within 2 years, the topic is pulled off the ACR?s Web site and is not included in the latest full release.

?When people go to the Web site, they?re getting the most up-to-date content,? said Kurth. The full criteria are disseminated exclusively through digital content systems, allowing physicians to get the latest best practices.

New Radiation Level Descriptions

Because of increased attention to radiation exposure, the ACR has also revised the way it describes relative radiation level (RRL) information of appropriate exams.

In the former method, the ACR used descriptive categories of ?high,? ?medium,? ?low,? ?minimum,? and ?none.? The latest version now includes the iconic black and yellow radiation symbols. The more symbols, the higher the RRL to the patient.

The intent of the new RRL description is to give ordering physicians an easier way to compare appropriate exams. Should the physician be presented with a choice of two relatively appropriate exams for the same symptoms, they can now easily choose the exam that has fewer symbols.

Another revision is that the appropriateness rating scale was revised to include categories: In the past, the scale was only defined digitally, from ?1? to ?9,? with the higher digits indicating the exam is most appropriate. With the new release, 1, 2, or 3 is additionally defined as ?usually not appropriate?; 4, 5, or 6 is defined as ?may be appropriate?; and 7, 8, or 9 is defined as ?usually appropriate.?

Previously, there were questions as to the difference between a ?7? appropriateness rating and an ?8? rating, for example. With the new categories, physicians can order a less expensive or a lower RRL exam and still feel confident that either a ?7? or an ?8? is ?usually appropriate? to order.

For more detailed information, visit the ACR?s Web site at www.acr.org.

—Tor Valenza