Introduction to the American College of Radiology Appropriateness Criteria® Review Series

Abstract

As Chair and Vice-Chair of the American College of Radiology (ACR) Appropriateness Criteria® Thoracic Imaging panel, we are honored to provide this introduction to a new Journal of Thoracic Imaging (JTI) series devoted to a concise review of selected Appropriateness Criteria topics in Thoracic Imaging. The Appropriateness Criteria have been in existence for more than a decade. Since their inception, the Appropriateness Criteria have served as a unique resource to radiologists and clinicians. The purpose of the Appropriateness Criteria is to provide evidence-based criteria regarding the appropriateness of specific imaging tests for precise clinical indications. The Appropriateness Criteria have been produced using a well-delineated and reproducible two-step process. The first step consists of a focused review of current literature on the specific topic, with the development of an evidence table, referenced narrative, and ratings table (with relevant imaging modalities and suggested ratings/treatments). The second step is consensus building, using a modified Delphi technique (an anonymous voting process). Both of these steps require extensive participation by the expert panel. Each topic is reviewed annually or biannually.1 Thanks to the constantly updated reviews, it has become clear over the years that some topics should be retired and that new clinically relevant topics should be generated. This is a formidable strength of the process: it ensures routine review of the criteria and revision when important new data emerge. Criteria are developed to as great an extent as possible on sound clinical data rather than on individual or collective opinions. Overall, the intent is to provide information that is both scientifically accurate and practical. As stated by the ACR, the intended main users of the individual Appropriateness Criteria are clinicians who request imaging examinations of their patients. In this way, the Appropriateness Criteria provide guidance as to the appropriateness of specific imaging modalities for particular clinical situations. As radiologists play an important consultative role to clinicians in the appropriate use of imaging studies, it is also important for radiologists to be familiar with these criteria. Toward this end, and to promote greater visibility of these published criteria, the ACR and JTI have joined together to provide a series of concise reviews of the recently updated or new Appropriateness Criteria topics that are highly relevant to the JTI readership. This is an immensely valuable opportunity, for which the ACR Appropriateness Criteria® Thoracic Imaging expert panel is extremely grateful. Each Appropriateness Criteria topic has been drafted by a chest radiologist with expertise in the clinical area and has subsequently been extensively vetted by a panel of specialists, with added representation as necessary from the American College of Chest Physicians and the Society of Thoracic Surgeons. The inaugural publication for this Web-exclusive series, “Chronic Dyspnea, Suspected Pulmonary Origin,” drafted by Debra S. Dyer, MD, can be found in the Web version of this issue of the Journal at www.thoracicimaging.com.2 We enthusiastically invite the readers of JTI to learn more about the ACR through this and future summary articles in upcoming issues. For those readers who are interested in more detailed information, the complete ACR Appropriateness Criteria® are also available at www.acr.org/ac.