Optimizing Radiography Utilization: Multidisciplinary Expert Consensus Recommendations Endorsed by the Society of Academic Bone Radiologists, Society of Skeletal Radiology, American Society of Emergency Radiology, Orthopaedic Trauma Association, American Academy of Emergency Medicine, and American Rhinologic Society

Radiography is an excellent first-line imaging technique for a wide range of conditions. However, there is insufficient evidence-based clinical guidance for ordering radiographic examinations in certain low-yield anatomic sites. To address this issue, a three-round modified Delphi consensus study was performed with a multidisciplinary, multi-institutional expert panel to determine the appropriate utilization of radiography at 12 often low-yield anatomic sites. The expert panel comprised 34 subspecialty faculty members (16 radiologists, nine emergency medicine physicians, four orthopedic surgeons, and five otolaryngology surgeons) from 21 academic centers. They evaluated 12 anatomic sites: rib, scapula, sacrum, coccyx, sternum, sternoclavicular joint, nasal bone, mandible, facial bones, sinuses, neck soft tissue, and skull. A structured literature review across three databases was conducted to assess the utilization and diagnostic test characteristics of radiography for each anatomic site. Teams drafted consensus statements and supporting text for their respective sites and submitted these statements to the panel for iterative rounds of anonymized voting. All 58 submitted statements achieved consensus by the end of round 3 and were endorsed by six major American medical societies. This study established expert consensus recommendations for the appropriate utilization of radiography at 12 anatomic sites through a multidisciplinary and multi-institutional deliberative process.