Leave It to a Medical Student to Bring the ACR Appropriateness Criteria to Your Smart Device!

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? As front-line primary care providers, we need to order the correct test when we see our patients to avoid callbacks, canceled appointments, frustrated patients, and radiologists. 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. We previously favorably reviewed the web app called Rads Consult

The Rads Consult web app 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 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 in the app.

When I was assisting a resident in the clinic this week on determining the proper test to order for a patient, I again consulted the non-mobile-friendly ACR website to find the answer and remained frustrated that a dedicated app was non-existent. I stumbled upon the app called ACR Criteria in the Apple App Store. Designed by a medical student, the ACR Criteria app has no official relationship to the ACR, but provides a mobile-friendly web app of the entire ACR Criteria including the 2020 updates! The app provides (for most, but not all criteria) the Evidence Table, Lit Search, and Narrative and Rating Table for each criteria.

Evidence-based medicine

The ACR Criteria app contains a mobile-friendly representation of the AC content from the ACR website. The criteria are grouped by section and clicky on a particular criteria pulls up a list of the Evidence Table, Lit Search, and Narrative and Rating Table. Selecting from the list pulls up the actual PDF from the ACR. 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 for a given clinical condition.

What providers would benefit from this App?

Students, residents, mid-levels, primary care and emergency medicine, radiologists, nurses, any provider who orders radiographic studies.

Price

o Free.

Likes

o ACR criteria in an app

o Contains links to the actual ACR documents via PDFs

o Includes Evidence Table, Lit Search, Narrative and Rating Table for each AC

Dislikes

o Very basic interface with no additional information about app creator, use

o Some links do not work; requires internet access for content

o Not available for Android

Overall

The ACR Criteria app is great for a medical student to produce, but falls short of a polished app with the official seal and approval of the ACR. The app has some faulty links but does contain the recent 2020 updates. The app author is providing something that the ACR should be (at least for iOS). The app is much faster than trying to navigate the ACR website but still is not exactly what primary care providers need for using these criteria at the point of care. It lacks some of the polish of Rad Consult but provides the basic information using a native app shell (though still needs internet connectivity to pull down the PDFs). Will definitely keep using this app, but hope the ACR will eventually put out their own app for all to use. 

Overall Score

o 4.0 stars

User Interface

o 3.5 stars

Very basic, lacks easy to navigate categories, but search function helps. 

Multimedia Usage

o 4.0 stars

Contains all of the current AC PDFs, but requires internet access to link to them. Some links do not work.

Price

o 5.0 stars

App is free.

Real-World Applicability

o 4.5 stars

Although far from perfect, it gets the job done. I definitely can see providers using this app in clinics, on the wards, in urgent care/ER settings to help select the best test for a given condition. Rads Consult remains an excellent alternative, however, and provides some additional materials as well as polish despite being a true web app. Hopefully, the ACR will someday produce their own dedicated AC app.

Device Used For Review

o iPhone 11 Pro running iOS 13.5.1     

Available for iOS. Not available for Android devices at this time.

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.