Appropriateness Criteria’s face-lift echoes technology shifts

The increased utilization of CT, MR, and PET imaging has prompted the American College of Radiology to revise its Appropriateness Criteria manual. Advances in technology have also enabled the ACR to use a robust search engine for its Web-based version, as well as plan for a PDA-based application.

The latest updates to the manual provide a more intuitive format that includes modality-utilization ranking tables at the top of each category and a more consistent terminology. For instance, the standard term "CT" now replaces alternative references (CAT scan, computed tomography), with the exception of "CTA" to indicate angiography scanning.

"We did not add new topics but updated 55 of the existing ones. These now include some of the more recent technologies," said Christine Waldrip, ACR appropriateness criteria program specialist.

Many of the criteria topics had not been reviewed since 1999. In some cases, panel experts only made minor editorial modifications, but in many others, they had to address the substantive evolution of imaging modalities and of the procedures that called for their application.

"PET now appears prominently in some topics for the first time. And most of the changes that took place in the last five years affecting MRI and CT technology have been addressed," Waldrip said.

Criteria updates due to changes in technology include:

• lung cancer staging and workup of solitary pulmonary nodules

• uterine cancer

• blunt chest trauma and suspected aortic injury

• acute traumas of the hand or wrist

• acute pyelonephritis

As in the past, physicians can get a full list of topics that range from cardiovascular imaging to radiation oncology. The latest version of the Appropriateness Criteria features a new Web-based search engine that allows them to conduct searches by condition or procedure.

"The search function is a new tool. Before, you just saw all the topics listed. Now, if you want to know what's the appropriate imaging procedure dealing with acute chest pain or chronic foot pain, you can put those words into the search engine and come up with the topic," Waldrip said.

The ACR has customarily looked at its criteria every three to five years. The current policy calls for more regular oversight.

"There may not be changes annually, but the guidelines will be reviewed in a more timely fashion," she said.

The ACR also announced a new PDA-based application feature for the criteria that should be available this fall.

For more information from the Diagnostic Imaging archives:

New ACR health policy chair lays out agenda

Israeli HMO adopts ACR imaging criteria

National insurer endorses ACR appropriateness criteria

Application of ACR appropriateness criteria in ER could save millions