ACR Appropriateness Criteria ® Chronic Hip Pain

Abstract

Chronic hip pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic hip pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

A Case Study of Chronic Iliopsoas Tendinopathy and Sacroiliac Joint Dysfunction Masquerading As Pelvic Girdle Pain

“…Radiological imaging can often be beneficial if there are concerns for trauma or injury, but may not be necessary based on the history and physical examination. The American College of Radiology Appropriateness Criteria can be a useful tool when deciding which imaging to perform on a patient [ 11 ]. Laboratory testing can be used to target causes of pain to include infectious etiologies, inflammatory, or autoimmune pathologies.…”

“…It is critical to rule out infectious, reactive forms of monoarticular arthritis, or targeted joint discomfort, which can be completed from appropriate past medical history collection, physical examination, and laboratory diagnostic testing [ 10 ]. Once the area of pain has been identified, be it within a joint, extra-articular, or referred musculoskeletal discomfort, and with appropriate history collection and physical examination, radiological imaging can be performed, which can be guided by the American College of Radiology Appropriateness Criteria [ 11 ]. Once physical examination, history, and time course with pregnancy have been identified, a differential may be narrowed to PGP or pregnancy-related low back pain.…”

Intraoperative radiation exposure in hip arthroscopy: a systematic review

“…40,41 The ACR Appropriateness Criteria contain evidence-based recommendations for imaging modalities to assist providers in making the most appropriate imaging decision for patients with chronic hip pain. 42 Overall, limiting exposure to patients during the perioperative period can be achieved with careful selection of imaging modalities and modern intraoperative equipment, including the 3D C-arm, 360 degree O-arm, and intraoperative MRI. 41 21 NR 1 in 11,000 NR Salvo et al 22 NR NR 0.00838 mSV shallow dose equivalent, 0.00871 mSv lens/deep dose equivalent Schemann et al 23 0.67 NR NR SD, standard deviation; NR, not reported; FAI, femoroacetabular impingement group; ST, soft tissue group.…”

Chronic non-traumatic hip pain in adults: the role of magnetic resonance imaging

“…Criteria; imaging with conventional MRI of the pelvic and hip-is best for symptoms of widespread pain or nonspecific physical exam findings. MR arthrography of the hip is considered the imaging approach of choice if symptoms or clinical exam findings reveal intra-articular disease [3].…”