“The concept of appropriateness as applied to healthcare, balance risk, and benefit of a treatment, test or procedure in the context of available resources for an individual patient with specific characteristics. Appropriateness criteria provide guidance to supplement the clinician's judgment as to whether a patient is a reasonable candidate for a given treatment, test, or procedure.”1
In 1993, the American College of Radiology Appropriateness Criteria (ACR AC) was established to develop medical practice guidelines for a variety of radiology and radiation oncology topics. This process necessitated practice guidelines that are valid, reliable/reproducible, applicable, flexible, clear and are derived from a multidisciplinary process. Scientific evidence is emphasized but judgment and group consensus are essential in medical guideline development.
The ACR Appropriateness Criteria® are derived from a panel of surgical, medical, and radiation oncologists representing both academic and private practice settings. The ACR AC are not competitive, but rather complementary to existing guidelines such as those of the American Society for Clinical Oncology and the National Comprehensive Cancer Network.
In this issue of the American Journal of Clinical Oncology, the ACR AC statement for postradical prostatectomy irradiation is published.2 This topic (as is true for all ACR AC studies) was chosen because of the prevalence of the condition, the variability of practice, the relative cost, the potential for morbidity/mortality, and the potential for improved care. Preparation of this manuscript consisted of multiple phases to include a literature search of peer-reviewed medical journals, a narrative text summarizing the literature, an evidence table based on the analysis of the selected literature (these tables rate the strength of the evidence for each article included in the narrative text) and an intensive review of the narrative text, evidence table, and supporting literature by the expert panel. Finally, the appropriate ratings for each of these specific questions were determined using a modified Delphi method, which is an anonymous voting process to illicit each panelist's interpretation of the evidence based on the available data.
The ACR Appropriateness Criteria® for radiation oncology include multiple topics other than prostate cancer (Table 1). The ACR AC process incorporates the expertise and hard work of multiple individuals to include the current chair and vice-chair of the ACR Appropriateness Criteria (Doctors Michael A. Bettmann and Peter Johnstone) and the ACR staff to include Christine Waldrip and David O'Brien.
We hope that the ACR Appropriateness Criteria® for prostate cancer and other radiation oncology topics prove beneficial to you and your clinical practice.
2. Rossi CJ, Merrick GS, Hsu IJ, et al. ACR Appropriateness Criteria Expert Panel on Radiation Oncology—prostate. Postradical prostatectomy irradiation in prostate cancer. Am J Clin Oncol
. In press.