A Promising Start but Incomplete App for Radiologists from the ACR

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? 

Much of this information is explicitly geared to radiologists. Still, primary care providers may be called on to help interpret guidelines for patients and those working in urgent/emergency/hospital medicine very likely may have to help treat patients with contrast reactions. 

The American College of Radiology (ACR) has published numerous guidelines on proper imaging and has a dedicated website to their 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 web app called Rads Consult. The Rads Consult web 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 recs 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 their website or in the Rads Consult app. Their new app called ACR Guidance provides important content on 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 in the app.

Evidence-based medicine

The ACR Guidance app contains content from the ACR website on the topics of contrast reaction, TI-RADS thyroid imaging classification system, and incidental adrenal masses. References for these are available online on the ACR website. Although the ACR recs are largely expert opinion based, they remain the standard of care. Use of this app will help to ensure patients receive the proper imaging follow-up studies and avoid unnecessary imaging, unnecessary radiation exposure, and potentially life-saving treatment of contrast reactions.

What providers would benefit from this app?

Students, residents, radiologists, nurses, any staff provider who orders the radiographic studies covered in the app and/or treats patients with contrast reactions.

Price

o Free.

Likes

  • 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)

Dislikes

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

Overall

The ACR Guidance app is disappointing in its lack of comprehensiveness. The app includes information on three somewhat disparate topics: contrast reaction calculator/guide, TI-RADS graphic for thyroid imaging abnormalities, and a paper on incidental adrenal masses. Only the contrast reaction section is fully downloaded with the app; the other two sections require an internet connection. The ACR still needs an app that captures all of their guidance and guidelines in one app. See our previous review of Rads Consult web app/website for an app that brings the ACR criteria to primary care providers and radiologists alike. 

Overall Score

o 3.5 stars

User Interface

o 4.0 stars

Simple to use interface but all of the content should be on the app and not require internet access. 

Multimedia Usage

o 3.5 stars

Currently the app contains three resources/topics and two of the three require internet access to link to the ACR website to view. The app does include the entire ACR contrast manual.

Price

o 5.0 stars

App is free.

Real-World Applicability

o 3.5 stars

A nice to have app for radiologists, but doesn’t appear essential at this point as the contents are too limited and two of the three resources require internet access. The contrast reaction card may be worth the download since it doesn’t require internet access and could potentially save a life. Hopefully, the ACR will add additional content to the app over time.

Device Used For Review

o iPhone 11 Pro running iOS 13.3.     

Available for iOS and Android devices.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.