ACR guidelines Exam Questions and Answers Solved Correctly
new or increasing non traumatic cervical neck pain, no red flags. initial imaging. - Answers x-ray
new or increasing non traumatic cervical radiculopathy, no red flags. initial imaging. - Answers MRI
chronic cervical or neck pain. initial imaging. - Answers x-ray
acute onset of cervical myelopathy. initial imaging. - Answers MRI
chronic or progressive cervical myelopathy. initial imaging. - Answers MRI
16-65 yo, suspected acute cervical trauma, imaging NOT indicated by CCS/NEXUS and pt meets low risk
criteria. initial imaging. - Answers safe to NOT image
16-65 yo, suspected acute cervical trauma, imaging IS indicated by CCS/NEXUS. initial imaging. - Answers
CT
≥16 yo, suspected acute cervical trauma, confirmed or suspected cervical spinal cord or nerve root
injury, with or without traumatic injury ID'd on CT. next imaging. - Answers MRI
≥16 yo, suspected acute cervical trauma, clinical or imaging findings indicate ligamentous injury. next
imaging after CT. - Answers MRI
<16 yo, acute cervical trauma, meets low risk criteria on PECARN/NEXUS. initial imaging. - Answers safe
to NOT image
<16 yo, acute cervical trauma, ≥1 risk factor with reliable clinical exam based on PECARN/NEXUS) -
Answers x-ray
≥16 yo, blunt thoracic/lumbar trauma and meets criteria for imaging. initial imaging. - Answers CT
≥16 yo, acute thoracic or lumbar injury detected on x-ray or CT, neurologic abnormalities. next imaging.
- Answers MRI
<16 yo, suspected thoracolumbar spine trauma. initial imaging. - Answers x-ray
suspected rib fx from minor trauma (injury confined to ribs). initial imaging. - Answers chest x-ray
neurogenic TOS, initial imaging and f/u imaging after surgery or intervention - Answers MRI, chest x-ray
arterial TOS, initial imaging and f/u imaging after surgery or intervention - Answers CTA, MRA, chest x-
ray, US doppler, arteriography (any vascular study)
child, congenital scoliosis. initial imaging. - Answers x-ray of whole spine, MRI
child, early onset idiopathic scoliosis. initial imaging. - Answers x-ray, MRI
, new back pain, previously treated vertebral compression fx or multiple vertebral compression fxs. initial
imaging. - Answers CT, MRI
traumatic shoulder pain, any etiology. initial imaging. - Answers x-ray
traumatic shoulder pain, non localized shoulder pain, negative x-ray. next imaging. - Answers MRI
traumatic shoulder pain, x-ray = normal, physical exam and hx consistent with dislocation or instability.
next imaging. - Answers MR arthrography, MRI
traumatic shoulder pain, x-ray = normal, physical exam and hx consistent with rotator cuff tear. next
imaging. - Answers MRI, MR arthrography, USI
chronic shoulder pain. initial imaging. - Answers x-ray
chronic shoulder pain, suspected rotator cuff disorder or subacromial deltoid bursitis (no prior surgery),
initial x-ray = normal/inconclusive. next imaging. - Answers USI, MR arthrography, MRI
chronic shoulder pain, suspect labral pathology or shoulder instability, initial x-ray =
normal/inconclusive. next imaging. - Answers MR arthrography, MRI
chronic shoulder pain, suspect adhesive capsulitis, initial x-ray = normal/inconclusive. next imaging. -
Answers image guided anesthetic, MRI
chronic shoulder pain, suspect biceps tendon abnormality, initial x-ray = normal/inconclusive. next
imaging. - Answers USI, image guided anesthetic, MR arthrography, MRI
chronic shoulder pain, hx of prior rotator cuff repair, suspected rotator cuff disorder or subacromial sub
deltoid bursitis, initial x-ray = normal/inconclusive. next imaging. - Answers USI, MR arthrography, MRI,
CT arthrography
chronic elbow pain. initial imaging. - Answers x-ray
chronic elbow pain with mechanical sx (locking, clicking, limited ROM), suspect IA pathology (ie.
osteocartilaginous body, osteochondral lesion, synovial abnormality), x-ray = normal. next imaging. -
Answers MRI, MR arthrography, CT
chronic elbow pain, suspect occult stress fx or other bone abnormality, x=ray = normal. next imaging. -
Answers MRI, CT
chronic elbow pain, suspect chronic epicondylitis/tendon repair, x-ray = normal. next imaging. - Answers
USI, MRI
chronic elbow pain, suspect MCL/LCL tear, x-ray = normal. next imaging. - Answers USI, MRI, MR
arthrography, CT
chronic elbow pain, suspect nerve abnormality, x-ray = normal. next imaging - Answers USI, MRI
new or increasing non traumatic cervical neck pain, no red flags. initial imaging. - Answers x-ray
new or increasing non traumatic cervical radiculopathy, no red flags. initial imaging. - Answers MRI
chronic cervical or neck pain. initial imaging. - Answers x-ray
acute onset of cervical myelopathy. initial imaging. - Answers MRI
chronic or progressive cervical myelopathy. initial imaging. - Answers MRI
16-65 yo, suspected acute cervical trauma, imaging NOT indicated by CCS/NEXUS and pt meets low risk
criteria. initial imaging. - Answers safe to NOT image
16-65 yo, suspected acute cervical trauma, imaging IS indicated by CCS/NEXUS. initial imaging. - Answers
CT
≥16 yo, suspected acute cervical trauma, confirmed or suspected cervical spinal cord or nerve root
injury, with or without traumatic injury ID'd on CT. next imaging. - Answers MRI
≥16 yo, suspected acute cervical trauma, clinical or imaging findings indicate ligamentous injury. next
imaging after CT. - Answers MRI
<16 yo, acute cervical trauma, meets low risk criteria on PECARN/NEXUS. initial imaging. - Answers safe
to NOT image
<16 yo, acute cervical trauma, ≥1 risk factor with reliable clinical exam based on PECARN/NEXUS) -
Answers x-ray
≥16 yo, blunt thoracic/lumbar trauma and meets criteria for imaging. initial imaging. - Answers CT
≥16 yo, acute thoracic or lumbar injury detected on x-ray or CT, neurologic abnormalities. next imaging.
- Answers MRI
<16 yo, suspected thoracolumbar spine trauma. initial imaging. - Answers x-ray
suspected rib fx from minor trauma (injury confined to ribs). initial imaging. - Answers chest x-ray
neurogenic TOS, initial imaging and f/u imaging after surgery or intervention - Answers MRI, chest x-ray
arterial TOS, initial imaging and f/u imaging after surgery or intervention - Answers CTA, MRA, chest x-
ray, US doppler, arteriography (any vascular study)
child, congenital scoliosis. initial imaging. - Answers x-ray of whole spine, MRI
child, early onset idiopathic scoliosis. initial imaging. - Answers x-ray, MRI
, new back pain, previously treated vertebral compression fx or multiple vertebral compression fxs. initial
imaging. - Answers CT, MRI
traumatic shoulder pain, any etiology. initial imaging. - Answers x-ray
traumatic shoulder pain, non localized shoulder pain, negative x-ray. next imaging. - Answers MRI
traumatic shoulder pain, x-ray = normal, physical exam and hx consistent with dislocation or instability.
next imaging. - Answers MR arthrography, MRI
traumatic shoulder pain, x-ray = normal, physical exam and hx consistent with rotator cuff tear. next
imaging. - Answers MRI, MR arthrography, USI
chronic shoulder pain. initial imaging. - Answers x-ray
chronic shoulder pain, suspected rotator cuff disorder or subacromial deltoid bursitis (no prior surgery),
initial x-ray = normal/inconclusive. next imaging. - Answers USI, MR arthrography, MRI
chronic shoulder pain, suspect labral pathology or shoulder instability, initial x-ray =
normal/inconclusive. next imaging. - Answers MR arthrography, MRI
chronic shoulder pain, suspect adhesive capsulitis, initial x-ray = normal/inconclusive. next imaging. -
Answers image guided anesthetic, MRI
chronic shoulder pain, suspect biceps tendon abnormality, initial x-ray = normal/inconclusive. next
imaging. - Answers USI, image guided anesthetic, MR arthrography, MRI
chronic shoulder pain, hx of prior rotator cuff repair, suspected rotator cuff disorder or subacromial sub
deltoid bursitis, initial x-ray = normal/inconclusive. next imaging. - Answers USI, MR arthrography, MRI,
CT arthrography
chronic elbow pain. initial imaging. - Answers x-ray
chronic elbow pain with mechanical sx (locking, clicking, limited ROM), suspect IA pathology (ie.
osteocartilaginous body, osteochondral lesion, synovial abnormality), x-ray = normal. next imaging. -
Answers MRI, MR arthrography, CT
chronic elbow pain, suspect occult stress fx or other bone abnormality, x=ray = normal. next imaging. -
Answers MRI, CT
chronic elbow pain, suspect chronic epicondylitis/tendon repair, x-ray = normal. next imaging. - Answers
USI, MRI
chronic elbow pain, suspect MCL/LCL tear, x-ray = normal. next imaging. - Answers USI, MRI, MR
arthrography, CT
chronic elbow pain, suspect nerve abnormality, x-ray = normal. next imaging - Answers USI, MRI
