Abstract
In the United States, health care costs are spiraling upward at an unsustainable rate.
Concurrently, medical specialties, legislatures, and the population each recognize
the need to prove that current medical practices are effective, measured by outcomes.
These forces necessitate a change in radiology's role, from emphasizing interpretation
and reporting to maintaining and demonstrating quality and value. An important part
of this task involves establishing the appropriateness of imaging tests by application
of objective data and expert opinion in an effort to optimize resource utilization
and modality selection. We explore the justifications for establishing appropriateness
use criteria, various paradigms that have been applied to their creation, inherent
limitations of appropriateness rules based on imperfect data, and challenges associated
with their widespread implementation and utilization. An appendix of key terms that
may be unfamiliar to radiologists is included for future reference.
Keywords
appropriate use criteria - clinical decision support - radiology - quality - value
