The American College of Radiology Appropriateness Criteria and the Standard of Care: Concerns Resulting From Recent Case Law

The American College of Radiology Appropriateness Criteria have historically served an advisory role in guiding image ordering and lacked legal import in establishing the standard of care. However, a 2025 Ohio appellate court case permitted use of the Appropriateness Criteria at trial, challenging their conventional status. Radiologists should exercise caution when implementing protocoling workflows that bypass independent radiologist review and remain diligent in contacting ordering practitioners regarding requests for inappropriate examination types.