Knowledge of ACR Thoracic Imaging Appropriateness Criteria® among Trainees: One Institution's Experience

Rationale and Objectives: Providing evidence-based appropriate imaging potentially increases diagnostic yield and prevents unnecessary imaging. The American College of Radiology's (ACR) evidence-based Appropriateness Criteria (R) (ACR-AC) were developed to provide imaging guidelines given various clinical scenarios. The goal of this study was to evaluate the knowledge level of the appropriate thoracic imaging study to be performed, given a clinical scenario. Methods: An online survey comprising 20 multiple-choice questions was developed on the basis of excerpts from the ACR-AC for thoracic imaging. The survey was piloted and invitations were sent out to resident trainees in radiology (n = 32), medicine (n = 119), and surgery (n = 40) and to pulmonary and critical medicine fellows (n = 16). Results: Sixty-nine trainees (33%) completed the survey. The trainees among those who completed the survey included 14(20%) in radiology, 32 (46%) in medicine, eight (12%) in surgery, and 15(22%) in pulmonary and critical medicine. Of the 69 trainees, most were male (n = 47 [68%]), aged 25 to 35 years (n = 65 [94%]), and in postgraduate years 1 to 3 (n = 44[64%]). The overall median and percentage number of correct responses were 13 (interquartile range [IQR], 11-15) and 65% (n = 44), respectively. As would be expected, radiology residents performed better, with a median number of correct responses of 15 (IQR, 11-16) compared to 10 (IQR, 9-12) for medicine trainees, nine (IQR, 9-12) for surgery trainees, and 13 (IQR, 12-15) for pulmonary and critical medicine trainees. There was an increase in the median number of correct responses with years of training, ranging from 10 for postgraduate year 1 to 12 for postgraduate year 6. Conclusions: This study shows an opportunity to increase the awareness of the ACR-AC. Increasing the awareness of the ACR-AC among trainees will likely increase their use in practice and ultimately improve patient care.