ALL ACR APPROPRIATENESS CRITERIA

Question 1

WEEK 2: CERVICAL SPINE

Answer 1

WEEK 2: CERVICAL SPINE

Question 2

1

Answer 2

1

Question 3

1

Answer 3

1

Question 4

1

Answer 4

1

Question 5

1

Answer 5

1

Question 6

1

Answer 6

1

Question 7

1

Answer 7

1

Question 8

1

Answer 8

1

Question 9

1

Answer 9

1

Question 10

Cervical Neck Pain or Cervical Radiculopathy:

• NEW or increasing nontraumatic cervical or neck pain. No “red flags.” Initial imaging.
• NEW or increasing nontraumatic cervical radiculopathy. No “red flags.” Initial imaging.
• CHRONIC cervical or neck pain. Initial imaging.

Answer 10

• Radiograph
• MRI
• Radiograph

Question 11

Suspected Spine Trauma - Child:

• Child (3-16), acute cervical spine trauma, meets low risk criteria (based on PECARN or NEXUS). Initial imaging.
• Child (3-16), acute cervical spine trauma, at least one risk factor with reliable clinical examination (based on PECARN or NEXUS). Initial imaging.

Answer 11

• None

- Radiograph

Question 12

Myelopathy:

• Acute onset myelopathy. Initial imaging.
• Chronic or progressive myelopathy. Initial imaging.

Answer 12

• MRI

- MRI

Question 13

Suspected Spine Trauma:

• Age between 16-65. Suspected acute c-spine blunt trauma; imaging not indicated by NEXUS or CCR clinical criteria. Patient meets low risk criteria. Initial imaging.
• Age greater than or equal to 16. Suspected acute c-spine blunt trauma. Imaging indicated by NEXUS or CCR clinical criteria. Initial imaging.
• Age greater than or equal to 16. Suspected acute c-spine blunt trauma. Confirmed or suspected cervical spinal cord or nerve root injury, with or without traumatic injury identified on CT. Next imaging study.
• Age greater than or equal to 16. Suspected acute c-spine blunt trauma. Clinical or imaging findings suggest ligamentous injury. Next imaging study after CT.

Answer 13

• None
• CT
• MRI
• MRI

Question 14

WEEK 3: T-SPINE AND RIBS

Answer 14

WEEK 3: T-SPINE AND RIBS

Question 15

1

Answer 15

1

Question 16

1

Answer 16

1

Question 17

1

Answer 17

1

Question 18

Suspected Spine Trauma:

• Age greater than or equal to 16. Blunt trauma meeting criteria for thoracic and lumbar imaging. Initial imaging.
• Age greater than or equal to 16. Acute thoracic or lumbar injury detected on radiograph or CT. Neurological abnormalities. Next imaging study.

Answer 18

• CT

- MRI

Question 19

Suspected Spine Trauma - Child:

-Child younger than 16, suspected thoracolumbar spine trauma. Initial imaging.

Answer 19

-Radiograph

Question 20

Rib Fractures:

-Suspected rib fractures from minor blunt trauma (injury confined to ribs). Initial imaging.

Answer 20

-Radiograph

Question 21

TOS:

• NEUROGENIC TOS. Initial imaging and follow-up imaging after surgery or intervention.
• ARTERIAL TOS. Initial imaging and follow-up imaging after surgery or intervention.

Answer 21

• MRI, Radiograph

- Computed Tomography Angiography (CTA), Magnetic Resonance Angiography (MRA), Radiograph, US Doppler, UE Arteriography

Question 22

Scoliosis:

• Child. Congenital scoliosis. Initial imaging.
• Child (0-9). Early onset idiopathic scoliosis. Initial imaging.

Answer 22

• Radiograph, MRI

- Radiograph, MRI

Question 23

WEEK 3: SHOULDER

Answer 23

WEEK 3: SHOULDER

Question 24

Shoulder Pain - Traumatic:

• Traumatic shoulder pain. Any etiology. Initial imaging.
• Traumatic shoulder pain. Nonlocalized shoulder pain. Negative radiographs. Next imaging study.
• Traumatic shoulder pain. Radiographs normal. Physical examination and history consistent with dislocation event or instability. Next imaging study.
• Traumatic shoulder pain. Radiographs normal. Physical examination findings consistent with rotator cuff tear. Next imaging study.

Answer 24

• Radiograph
• MRI
• MR arthrography, MRI
• MRI, MR arthrography, US

Question 25

Shoulder Pain - Atraumatic: - Atraumatic shoulder pain. Initial imaging. - Atraumatic shoulder pain. Suspected rotator cuff disorders (tendinosis tear, calcific tendinitis). Initial radiographs normal or inconclusive. Next imaging study. - Atraumatic shoulder pain. Suspected labral tear and instability. Initial radiographs normal or inconclusive. Next imaging study.

Answer 25

- Radiograph - MRI, US - MR arthrography, MRI

Question 26

WEEK 3: ELBOW, WRIST, HAND

Answer 26

WEEK 3: ELBOW, WRIST, HAND

Question 27

Chronic Wrist Pain: - Chronic wrist pain. With or without prior injury. Best initial study. - Chronic wrist pain. Routine radiographs normal or nonspecific. Persistent symptoms. Next study. - Chronic wrist pain. Radiographs normal or nonspecific. Suspect carpal tunnel syndrome. Next study.

Answer 27

- Radiograph - MRI - None (US and MRI may be appropriate)

Question 28

Acute Hand/Wrist Trauma: - Acute blunt or penetrating trauma to the hand or wrist. Initial imaging. - Suspect acute hand or wrist trauma. Initial radiographs negative or equivocal. Next imaging study. - Acute wrist fracture on radiographs. Suspect wrist tendon or ligament trauma. Next imaging study.

Answer 28

- Radiograph - MRI, Radiograph (after 10-14 days of initial), CT - MR arthrography, MRI, CT arthrography, US

Question 29

WEEK 5: L-SPINE

Answer 29

WEEK 5: L-SPINE

Question 30

Suspected Spine Trauma: - Age greater than or equal to 16. Blunt trauma meeting criteria for thoracic or lumbar imaging. Initial imaging. - Age greater than or equal to 16. Acute thoracic or lumbar spine injury detected on radiographs or CT. Neurologic abnormalities. Next imaging study.

Answer 30

- CT | - MRI

Question 31

Suspected Spine Trauma - Child: | -Child, younger than 16 years of age, suspected thoracolumbar spine trauma. Initial imaging.

Answer 31

-Radiograph

Question 32

LBP: - Acute LBP with or without radiculopathy. No red flags. No prior management. Initial imaging. - Subacute or chronic LBP with or without radiculopathy. No red flags. No prior management. Initial imaging. - Subacute or chronic LBP with or without radiculopathy. Surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of optimal medical management. Initial imaging. - LBP with suspected cauda equina syndrome. Initial imaging. - LBP with history of prior lumbar surgery and with or without radiculopathy. New or progressing symptoms or clinical findings. Initial imaging. - LBP with or without radiculopathy. One or more of the following; low velocity trauma, osteoporosis, elderly individual, or chronic steroid use. Initial imaging. - LBP with or without radiculopathy. One or more of the following; suspicion of cancer, infection, or immunosuppression. Initial imaging.

Answer 32

- None - None - MRI - MRI - Radiograph, MRI - Radiograph, MRI, CT - MRI

Question 33

WEEK 5: PELVIS AND HIP

Answer 33

WEEK 5: PELVIS AND HIP

Question 34

Acute Hip Pain - Suspected Fracture: - Acute hip pain. Fall or minor trauma. Suspected fracture. Initial imaging. - Acute hip pain. Fall or minor trauma. Negative radiographs. Suspect fracture. Next imaging study.

Answer 34

- Radiograph | - MRI, CT

Question 35

Chronic Hip Pain: - Chronic hip pain. Initial imaging. - Chronic hip pain. Radiographs negative. Suspect extra-articular noninfectious soft-tissue abnormality, such as tendonitis. - Chronic hip pain. Radiographs negative. Suspect impingement. - Chronic hip pain. Radiographs negative. Suspect labral tear with or without clinical findings consistent with or suggestive of impingement. - Chronic hip pain and low back, pelvic, or knee pathology. Want to exclude hip as the source. Radiographs negative or showing mild OA.

Answer 35

- Radiograph - MRI, US - MRI, MR arthrography, CT arthrography - MR arthrography, CT arthrography - MRI, image-guided anesthetic +/- corticosteroid injection

Question 36

Imaging After Total Hip Arthroplasty: - Follow-up of the asymptomatic patient with a total hip arthroplasty. - Total hip arthroplasty, trochanteric pain; suspect abductor injury or trochanteric bursitis.

Answer 36

- Radiograph | - Radiograph, MRI, US

Question 37

WEEK 5: KNEE

Answer 37

WEEK 5: KNEE

Question 38

Chronic Knee Pain: - Adult or child greater than or equal to 5. Chronic knee pain. Initial imaging. - Adult or child greater than or equal to 5. Chronic knee pain. Initial knee radiograph negative or demonstrates joint effusion. Next imaging study. - Adult or child greater than or equal to 5. Chronic knee pain. Initial knee radiograph demonstrates osteochondritis dissecans (OCD), loose bodies, or history of cartilage/meniscal repair. Next imaging study.

Answer 38

- Radiograph - MRI - MRI

Question 39

Acute Trauma to the Knee: - Adult or child greater than or equal to 5. Fall or acute twisting trauma to the knee. No focal tenderness, no effusion, able to walk. Initial imaging. - Adult or child greater than or equal to 5. Fall or acute twisting trauma to the knee. One or more of the following; focal tenderness, effusion, inability to bear weight. Initial imaging. - Adult or skeletally mature child. Fall or acute twisting trauma to the knee. No fracture seen on radiographs. Suspect occult fracture or internal derangement. Next study.

Answer 39

- None - Radiograph - MRI

Question 40

Acutely Limping Child Up to Age 5: - Child up to age 5. Acute limp. Nonlocalized symptoms. No concern for infection. Initial imaging. - Child up to age 5. Acute limp. Pain. Localized symptoms. No concern for infection. Initial imaging.

Answer 40

- Radiograph tibia/fibula | - Radiograph

Question 41

WEEK 6: FOOT/ANKLE

Answer 41

WEEK 6: FOOT/ANKLE

Question 42

Acute Trauma to the Ankle: - Adult or child 5 years or older. Acute trauma to the ankle or acute trauma to the ankle with persistent pain for more than 1 week but less than 3 weeks. No exclusionary criteria present. Initial imaging. Patient meets the requirements for evaluation by Ottowa Ankle Rules (+ talus or calcaneus) - Adult or child 5 years or older. Acute trauma to the ankle. No exclusionary criteria present. Patient meets the requirements for evaluation by the Ottowa Ankle Rules which are negative. Initial imaging. - Adult or child 5 years or older. Acute trauma to the ankle. Exclusionary criteria present. Patient does not meet requirements for evaluation by the Ottowa Ankle Rules. Initial imaging.

Answer 42

- Radiograph - None - Radiograph

Question 43

Acute Trauma to the Foot: - Adult or child 5 years or older. Acute trauma to the foot. Ottowa Rules can be evaluated without exclusionary criteria. Ottowa Rules are negative. No suspected abnormalities in regions not evaluated by the Ottowa Rules. Initial imaging. - Adult or child 5 years or older. Acute trauma to the foot. Ottowa Rules can be evaluated without exclusionary criteria. Ottowa Rules are positive. Initial imaging. - Adult or child 5 years or older. Acute trauma to the foot. Ottowa Rules can be evaluated without exclusionary criteria. Ottowa Rules are negative. Suspected pathology in an anatomical area not addressed by Ottowa Rules. Initial imaging.

Answer 43

- None - Radiograph, Radiograph w/ WB - Radiograph, Radiograph w/ WB

Question 44

Chronic Ankle Pain: - Chronic ankle pain. Initial imaging. - Chronic ankle pain. Ankle radiographs normal, suspected osteochondral lesion. Next imaging study. - Chronic ankle pain. Ankle radiographs normal, suspected tendon abnormality. Next imaging study. - Chronic ankle pain. Ankle radiographs normal, pain of uncertain etiology. Next imaging study.

Answer 44

- Radiograph - MRI - MRI, US - MRI

Question 45

Chronic Foot Pain: - Chronic foot pain. Unknown etiology. Initial imaging. - Chronic plantar heel pain. Radiographs negative. Clinical concern includes plantar fasciitis or plantar fascia tear. Next imaging study.

Answer 45

- Radiograph | - US, MRI