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Evolution of modern radiology practice
Safety initiatives, such as Image Gently and Image Wisely and the American College of Radiology Manuals on MR Safety and Contrast Media, have advanced the College's commitment to protecting patients and personnel
4 Min Read
Founded in 1923, the American College of Radiology (ACR) has been committed to quality and safety throughout its history. From its earliest days, ACR recognised the need for practice standards, careful oversight, and an unwavering focus on patient safety in radiology. Over the past century, this vision has led to the creation of a comprehensive suite of quality and safety programmes that set the ‘gold standard’ for imaging care in the United States and beyond.
Setting the foundation: Practice standards and accreditation
In the 1960s, ACR began designing programmes to define, oversee, and govern quality in imaging and radiation oncology. These early efforts laid the foundation for today’s ACR Practice Parameters and Technical Standards (PP/TS). Distinct from ACR’s accreditation programmes, the PP/TS provide an evidence-based framework outlining the training, skills, and techniques necessary for the safe and effective practice of diagnostic, interventional, and therapeutic radiology.
ACR conducted its first onsite radiology facility inspection in 1964. Then, in 1987, ACR introduced its first accreditation programme (mammography). From the start, ACR accreditation has been based on peer-reviewed requirements for personnel qualifications, image quality, equipment performance, and quality control procedures. Although accreditation was initially voluntary, in 1992, the US Congress passed the Mammography Quality Standards Act (MQSA) mandating accreditation of all US mammography facilities.
Broadening accreditation to encompass new modalities
In the 1990s and early 2000s, ACR expanded accreditation to radiation oncology, ultrasound, magnetic resonance (MR), nuclear medicine, computed tomography (CT), and positron emission tomography (PET). Using mammography accreditation as the template, these new programmes provided a mechanism for continuous quality improvement across the entire spectrum of medical imaging. In 2008, the Medicare Improvements for Patients and Providers Act (MIPPA) required accreditation of all advanced diagnostic imaging (CT, MRI, PET, and nuclear medicine) for participation in the US Medicare programme. In addition, as radiology practices have grown, ACR has responded by developing ACR Pulse. Introduced in 2024, ACR Pulse allows organisations to track their participation in ACR quality programmes across all their sites.
Appropriateness, benchmarking, and safety
The 21st century saw ACR embrace clinical decision support and performance measurement. The ACR Appropriateness Criteria (AC) were developed to reduce unnecessary imaging by guiding referring physicians and non-physician providers to choose the most appropriate imaging for a patient’s clinical condition.
Another significant development was the creation of the National Radiology Data Registry (NRDR), a collection of clinical registries (such as the Dose Index Registry and the National Mammography Database). The registries allow practices to benchmark their performance against national data. This transition beyond pass/fail accreditation to continuous, data-driven performance improvement is a hallmark of the ACR's modern quality strategy.
Safety initiatives, such as Image Gently and Image Wisely and the ACR Manuals on MR Safety and Contrast Media, have further advanced the College's commitment to protecting patients and personnel. ACR’s quality portfolio also extends to physician performance and reporting through the RadPEER programme, ImPOWER learning collaboratives, and RADS standardised reporting systems (such as the newest BI-RADS v.2025).
Artificial intelligence and international initiatives
ACR’s commitment to patient safety and quality care has continued with the application of artificial intelligence (AI) to imaging. ACR’s Data Science Institute has developed a robust platform to support and monitor AI in clinical practice, including AI Central, ARCH-AI (and its AI learning collaborative), and Assess-AI (the first national AI imaging registry). Due to the rapid pace of change associated with AI implementation, the College is now building a global AI community with an Informatics International membership and International ARCH-AI attestation programme to share best practices and lessons learned from around the world. In addition, in November 2024, the ACR launched its International Recognition Programme to recognise radiology facilities demonstrating high quality in imaging worldwide.
In conclusion, over the past century, ACR’s quality and safety programmes have transitioned from nascent professional standards to a comprehensive, data-driven system in the US and now across the globe. Evolving alongside changes in the field, ACR will continue to ensure high-quality, safe, and effective patient care remains the cornerstone of modern radiology practice now and into the future.
