Which imaging study should I order?

Today at morning report, we discussed the resources available to a general internist when deciding which imaging study to order. Besides a phone call to your friendly radiology colleague, one of the most helpful resources is the American College of Radiology’s Appropriateness Criteria.  These evidence-based guidelines were developed and are periodically updated by a panel of expert radiologists (last update November 2015). The guidelines include numerical “appropriateness” scores (1-3 usually not appropriate, 4-6 may be appropriate, 7-9 usually appropriate) for individual modalities in specific clinical settings. They also include literature review and suggestions for clinical variations (i.e. pregnancy, contrast allergy). A useful resource when deciding whether or not to send your patient through the tube of truth!

Example appropriateness criteria for jaundice with acute abdominal pain:

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American College of Radiology. ACR Appropriateness Criteria®. Available at https://acsearch.acr.org/list. Accessed 11/23/2015.