ACR Value-Based PQI Project:
Improving the Selection of Imaging Exams
Background
The ACR Value-Based Practice Quality Improvement (PQI) Project spotlights the American College of Radiologyled Imaging 3.0 concepts and highlights the benefits of clinical decision support systems for ensuring patients
receive the most appropriate imaging exam. The project fulfills the American Board of Radiology’s Maintenance of
Certification PQI requirement. Imaging exams from the Choosing Wisely campaign are at the core of the PQI
project that engages radiologists and referring clinicians in discussions about the best use of imaging to ensure
quality patient care. The ACR Appropriateness Criteria® (AC) and ACR Select clinical decision support system are
integral project components. Soon to begin beta testing, the ACR Value-Based Radiology PQI Project will launch
for nation-wide participation at the ACR’s expanded annual meeting “ACR 2015: The Crossroads of Radiology” to
be held next May 17-21, in Washington, DC.
PQI Project’s Purpose
The project seeks to improve the appropriate selection of imaging exams by:
1. Engaging radiologists in research about the patterns of imaging exams performed by their practice,
2. Empowering radiologists with educational strategies for working with referring physicians to improve their
selection of imaging exams, and
3. Evaluating and reporting on the relative effectiveness of educational strategies.
An additional component is the analysis of national aggregate data about the potential for improving imaging exam
selection through educational opportunities for both radiologists and referring physicians. As significant national
practice data are collected, the aggregate results will provide compelling and quantifiable data for ACR members to
present to legislators and healthcare policy makers about radiologists’ important role ensuring optimal patient care
and effective management of healthcare resources.
Project Overview
The project employs the evidence-based ACR AC to evaluate the rate of appropriate versus inappropriate exams
being ordered for a specific imaging study before and after educational interventions with referring clinicians.
Project participants will have complimentary access to ACR Select. The project’s four phases include:

Recording baseline data: phase 1
Radiologists will select a study for which they experience frequent inappropriate referrals from either referring
practices or individual referrers. They will measure the prevalence of this occurrence by recording the number
of inappropriate studies (numerator) and the total number of this study type performed (denominator) over a
certain period of time. The level of exam appropriateness is determined by the ACR AC or other nationally
recognized clinical decision support criteria. The PQI participants will be granted a temporary license to access
the Web-based ACR Select product for ease of assessment and data recording.

Action plan for improvement: phase 2
A variety of educational tools will be available on the PQI project’s Web portal for developing an intervention
plan that best matches their practice environment.

Reassess and document improvement: phase 3
The participants will repeat the process described for Phase 1. The centrally collected data stored by the ACR
will allow comparison of individual practices to peer data.

Analysis: phase 4
Statistical analysis will consist of comparing the results of Phase 3 to Phase 1 to determine the effect of the
educational intervention. Practice data collected will be stored at ACR for producing national aggregate
statistics about the extent to which educational interventions improved the appropriate selection of imaging
exams. This will be in addition to individual participant statistics that will qualify the participants for
completion of the ABR’s Maintenance of Certification Part IV project
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PQI Project Choosing Wisely Topics
SUBSPECIALITY
CHEST
CHEST
CV
ED
GU
GU/NUCS
MSK/NEURO
NEURO
PEDS
PEDS
Choosing Wisely List
Avoid admission or preoperative chest xrays for ambulatory patients with
unremarkable history and physical exam.
Do not perform chest computed
tomography (CT angiography) to evaluate
for possible pulmonary embolism in
patients with a low clinical probability and
negative results of a highly sensitive Ddimer assay.
Don’t use coronary computed tomography
angiography in high-risk Emergency
Department patients presenting with acute
chest pain.
Avoid the routine use of “whole-body”
diagnostic computed tomography (CT)
scanning in patients with minor or singlesystem trauma.
Don’t perform follow-up imaging for
clinically inconsequential adnexal cysts.
Don’t perform PET, CT, and radionuclide
bone scans in the staging of early prostate
cancer at low risk for metastasis.
Don’t perform advanced imaging (eg, MRI)
of the spine within the first 6 weeks in
patients with nonspecific acute low back
pain in the absence of red flags.
Don’t order sinus computed tomography
(CT) or indiscriminately prescribe
antibiotics for uncomplicated acute
rhinosinusitis.
Computed tomography scans are not
necessary in the immediate evaluation of
minor head injuries; clinical
observation/Pediatric Emergency Care
Applied Research Network (PECARN)
criteria should be used to determine
whether imaging is indicated.
Neuroimaging (CT, MRI) is not necessary
in a child with simple febrile seizure.
Society
American College of Radiology,
American College of Physicians,
American College of Surgeons
American College of Physicians,
ACCP/ATS,
American College of Radiology
Society of Cardiovascular
Computed Tomography
American College of Surgeons
American College of Radiology
American Society of Clinical
Oncology
North American Spine Society
(NASS), American College of
Physicians, American Academy of
Family Physicians
American Academy of Allergy,
Asthma & Immunology; American
Academy of Otolaryngology —
Head and Neck Surgery Foundation
ACR Select
Pathway
Modality driven:
x-ray, chest, search
for "admit"
Coming soon
Indication driven:
chest, search for
"chest pain"
Coming soon
Indication driven:
female, pelvis, search
for "adnexal"
Indication driven:
male, pelvis, search
for "prostate"
Indication driven:
spine, search for "low
back"
Indication driven:
maxfac, search for
"sinus"
Coming soon
American Academy of Pediatrics
American Academy of Pediatrics
(Change age)
Indication driven:
head, search for
"febrile"
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