Since the creation of the “Radiographic Highlights” series in 1982, AFP has shown its dedication to helping readers learn about and use various radiographic tools for diagnosis and management. This series of short articles led to the comprehensive “Radiologic Decision-Making” series in 1996, which provided a more detailed clinical context for various conditions such as appendicitis1 and scoliosis,2 with practical guidelines on diagnostic imaging. The radiology series is evolving yet again to match the current trend of short guideline-based articles that meet the need for condensed information at the point of care to keep pace with today's busy physician, who makes diagnostic and treatment decisions every 10 to 15 minutes in the office.
This issue of AFP marks the collaboration of the American College of Radiology (ACR) and the American Academy of Family Physicians on a series of articles based upon the ACR Appropriateness Criteria. These criteria consist of more than 160 guidelines developed by expert consensus panels in diagnostic imaging, interventional radiology, and radiation oncology. The Appropriateness Criteria were developed in 1993 when the ACR determined that there was a need for a universal, scientifically based set of imaging guidelines for radiologists and referring physicians. The Appropriateness Criteria are available on the ACR Web site at http://www.acr.org/ac, and for an annual fee, can be downloaded to a personal digital assistant for point-of-care access.
The intention of this new radiology series in AFP is to highlight some of the most clinically relevant ACR Appropriateness Criteria in the format of a clinical case, a table, and a brief narrative that puts the recommendations into perspective. Dr. Michael Bettmann, professor and vice chair for interventional services at Wake Forest University School of Medicine Department of Radiology and chair of the ACR Appropriateness Criteria Committee, is the coordinator of the series. The first article in the series is written by Dr. William Stanford, professor emeritus from the Department of Radiology at the University of Iowa.3 The article entitled “Radiologic Evaluation of Acute Chest Pain—Suspected Myocardial Ischemia” discusses various imaging modalities that might be considered in the evaluation of chest pain and suspected acute myocardial ischemia including echocardiography, radionuclide perfusion imaging, computed tomography, and magnetic resonance imaging. Using the ACR Appropriateness Criteria, Dr. Stanford discusses the strengths of each of these imaging tests and determines their applicability in the patient with chest pain.
Over the next several months, we will present additional articles based on the ACR Appropriateness Criteria that also address clinical problems common in primary care, including chronic foot pain and hematuria. We hope these will serve as informative and practical tools for the family physician and we welcome your comments on this series.