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iMedicalApps: ACR Guidance

One of the steepest learning curves in residency education is deciding what imaging tests to order for patients.

Should I order an x-ray first or go straight to computed tomography (CT) or magnetic resonance imaging (MRI)? Do I order contrast? How do I handle an incidental finding when I get back the initial imaging report? What is the best management strategy for contrast reactions?

The American College of Radiology (ACR) has published numerous guidelines on proper imaging and has a dedicated website to the organization’s Appropriateness Criteria (AC). These criteria are available free of charge to non-members but can be daunting to navigate via a mobile device. No true dedicated ACR app exists for the AC from the ACR or an independent third party.

We previously favorably reviewed the Rads Consult web app, which contains the entire ACR recommendations for virtually every diagnosis/radiographic imaging scenario. The app includes access to the actual ACR PDFs from within the web app. Users can access the ACR recommendations via symptom/diagnosis, imaging modality, or body system modalities.

Finally, the app contains additional ACR and expert opinion on common radiology questions/answers, incidental findings, and more. The ACR has recently released an app that provides guidance on several, but far from all, of the areas available on ACR website or in the Rads Consult app. This new app, called ACR Guidance, provides important content on the management of contrast reactions, the recently released TI-RADS thyroid imaging abnormalities system, and how to approach incidental findings of adrenal masses. Unfortunately, only those three topics are currently included.


  • Interface is easy to use with three easily identifiable sections
  • Contrast reaction subsection includes built-in calculator for peds dosing
  • Includes entire ACR contrast reaction manual on device (but not easy to find)


  • Two-thirds of the app content requires an internet connection
  • ACR TI-RADS graphic not viewable in landscape mode
  • Simply a lack of content for an app from a major specialty organization

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Last Updated January 31, 2020