Applicability of American College of Radiology appropriateness criteria in a general internal medicine clinic.

Abstract

The American College of Radiology (ACR) Appropriateness Criteria for Imaging and Treatment Decisions are intended to help radiologists and referring physicians use imaging procedures appropriately and cost-effectively, but these criteria have not undergone empirical testing. To assess how readily the ACR appropriateness criteria can be applied to clinical practice, we retrospectively examined their applicability in a general ambulatory care setting. From all requests during an 8-month period for noninterventional CT, sonography, MR imaging, and nuclear medicine imaging procedures received from a general internal medicine clinic, we excluded cases for which relevant clinic notes were unavailable or incomplete. Three experienced radiologists classified cases by consensus, using data from radiology requests and clinic notes. Cases were classified as a "complete match" if the features matched a clinical condition and variant included in the ACR appropriateness criteria; as a "partial match" if the features matched a clinical condition but did not match all features of a variant; or as "unmatched." Of 316 cases, there were 202 complete matches (64%) and 37 partial matches (12%). Of the 77 unmatched cases (24%), 14 pertained to asymptomatic patients. The ACR appropriateness criteria could be applied to 76% of the imaging procedure requests that we received from a general internal medicine clinic. These results suggest that the ACR appropriateness criteria can be applied to diagnostic imaging in a general ambulatory-care setting.