Sheng Alexander Y, Castro Alexandra, Lewiss Resa E
Boston University Medical Center, Boston, Massachusetts.
University of Pittsburgh, Pittsburgh, Pennsylvania.
J Am Coll Radiol. 2016 Feb;13(2):131-6. doi: 10.1016/j.jacr.2015.08.026. Epub 2015 Oct 21.
With the overall rise in the use of medical imaging over the past two decades, overutilization has become a major concern. The ACR Appropriateness Criteria (AC) are an evidence-based, web-based, peer-reviewed resource designed to assist clinicians in making the most appropriate imaging decisions. In this literature review, the authors assess the current knowledge, utilization, and education of the AC among undergraduate and graduate medical education trainees and practicing physicians in both radiologic and nonradiologic specialties.
A comprehensive literature search was completed using the PubMed, Cochrane, and MedEdPORTAL databases with the query "American College of Radiology Appropriateness Criteria." Articles written in English and published from 1993, the year when the AC were introduced, to present were included for review. Retrieved articles were reviewed for relevance.
The published literature is sparse. A review suggests a low rate of incorporation of the AC into clinical practice. Formal training in appropriate imaging ordering practices in both undergraduate and graduate medical education is lacking. The several studies targeting the use of the AC demonstrate that educational interventions increase awareness of the criteria as a decision tool.
The low rate of incorporation of the AC into clinical practice may reflect the lack of formal training in appropriate imaging order practices, specifically in the use of the AC, in both undergraduate and graduate medical education. The integration of the AC into decision support may reduce overutilization, but this has not been fully studied. Greater integration of the AC into medical training would require more universal physician buy-in to use the AC as a resource to optimize imaging utilization. This further requires sustained efforts to improve the "user-friendliness" of the AC and maximization of collaboration with nonradiology specialties in the development of the AC.
在过去二十年中，随着医学成像使用的总体增加，过度使用已成为一个主要问题。美国放射学会适宜性标准（AC）是一个基于证据、基于网络且经过同行评审的资源，旨在帮助临床医生做出最恰当的成像决策。在这篇文献综述中，作者评估了本科和研究生医学教育培训学员以及放射科和非放射科专业执业医师对AC的当前认知、使用情况和教育情况。
使用PubMed、Cochrane和MedEdPORTAL数据库，以“美国放射学会适宜性标准”为检索词完成了全面的文献检索。纳入了1993年（AC推出之年）至目前发表的英文文章进行综述。对检索到的文章进行相关性审查。
已发表的文献稀少。一项综述表明AC纳入临床实践的比例较低。本科和研究生医学教育中缺乏关于恰当成像医嘱开具实践的正规培训。针对AC使用情况的几项研究表明，教育干预可提高对该标准作为决策工具的认识。
AC纳入临床实践的比例较低，可能反映出本科和研究生医学教育中缺乏关于恰当成像医嘱开具实践的正规培训，特别是在AC的使用方面。将AC整合到决策支持中可能会减少过度使用，但这尚未得到充分研究。要将AC更多地整合到医学培训中，需要更多医生普遍认可将AC作为优化成像使用的资源。这进一步需要持续努力提高AC的“用户友好性”，并在AC的制定过程中最大限度地加强与非放射科专业的合作。
