Purpose or Case Report: Familiarity with the American College of Radiology appropriateness criteria (ACR AC) is important to properly counsel clinicians and ensure patients receive optimal imaging evaluation. While clinicians have become increasingly aware of the ACR appropriateness criteria (AC), residents may not, often becoming involved in a case following the decision on what imaging study to perform. The purpose of this study was to assess resident knowledge of ACR AC regarding pediatric patients at a residency with training at a tertiary care children’s hospital.
Methods & Materials: Residents at a single program were given a survey with clinical narratives from ACR AC pediatric topics. Residents were asked to name the single best imaging study they would recommend for a given clinical scenario. If multiple imaging studies were indicated, residents were asked to name the highest ranked imaging study. 15 clinical narratives from 15 pediatric topics were selected.
Results: A total of 24 residents were surveyed, representing the entirety of the residency excluding a co-author. The number of correct responses was similar across all years. On average, the R1, R3, and R4 class selected the correct imaging study for 8 of 15 narratives, and the R2 class 9 of 15 narratives. 100% of residents correctly selected noncontrast computed tomography (NCCT) of the sinuses for persistent sinusitis. 100% of residents chose NCCT or magnetic resonance imaging for subacute head injury, both rated usually appropriate per the head trauma ACR AC. The work-up of fever of unknown origin, appendicitis, and scoliosis was also frequently selected correctly: 83%, 88% and 100% respectively. Only 17% of residents chose radiographs (XR) for the initial imaging of acute cervical spine trauma with at least one risk factor and reliable clinical examination and for an acute limp with nonlocalized symptoms and no concern for infection. 21% of residents selected ultrasound as the first-line imaging modality for neonatal seizures.
Conclusions: Residents may not be familiar with certain ACR AC regarding pediatric patients, even in advanced years of residency. An effort to integrate education on the ACR AC into residencies should be made, as increasing resident exposure to the ACR AC can improve the ability of residents to advise providers in clinical decision making.