While your current CSC faced tremendous challenges, changes, and chance over the course of 2020, it has truly been our choices that have defined us. As we shifted to conducting the business of the College remotely and digitally, it has been inspirational to see the robust discussion that has traditionally defined us as a body persist, and thrive, in our new normal.

Although ACR 2020 was not our time-honored traditional Washington, D.C., gathering, the virtual Council discussion was filled with a diversity of passionate opinions. Many new voices were able to be heard for the first time. As a CSC, we have continued to look for ways to improve the structure of our Council sessions so that our members can focus on productive debate and decision-making.

We currently have a CSC workgroup focused on the processes surrounding practice parameters and technical standards (PP&TS). The workgroup will concentrate on the following:

• Reviewing the current process by which PP&TS are created, vetted, and approved
• Reviewing prior changes to that process
• Assessing whether the current process is as efficient and relevant as possible
• Suggesting changes to make the process as meaningful as possible

The PP&TS approval process is multifaceted, interdisciplinary, and collaborative. The current PP&TS Development and Revision Handbook provides details on this and the many different scenarios that may arise along the process of PP&TS formation. The simplest pathway — the creation of the ACR-only PP&TS — is composed of seven phases.

PHASE ONE: Drafting Documents During this phase, existing documents up for renewal are reviewed or ideas for new practice parameters are considered. This process prepares documents for upcoming field review.

PHASE TWO: Conducting Field Review Four cycles of three weeks each allow for ACR membership to review and comment upon the documents. These critical periods are our members’ opportunity to actively contribute to shaping the content of the PP&TS.

PHASE THREE: Reconciling Draft Documents During this phase, a CSC Subcommittee is formed for the purpose of reconciling all field comments into one congruent document.

PHASE FOUR: Informing Leadership The PP&TS are then distributed to the BOC to ensure that each relevant Commission is aware of the content and potential Council decisions at hand. Communication with appropriate collaborative societies also occurs during this phase.

PHASE FIVE: Finalizing Draft Documents Each PP&TS is assigned a resolution number and a reference committee and is then made available to membership via the online portal.

PHASE SIX: Approving the PP&TS Each PP&TS, as an individual resolution, is then discussed during the Council session at the ACR annual meeting. Reference committees deliberate on comments and prepare a final report. The Council then has the power to “adopt,” “not adopt,” or “refer” the PP&TS for additional revisions.

PHASE SEVEN: Disseminating the PP&TS At the conclusion of the annual meeting, the approved PP&TS are posted on the ACR PP&TS web pages and become effective and available for practices to use.

In review of this detailed process, there is ample space for substantive member contributions to PP&TS content during Phase Two. However, in recent years, discussion and detailed reworking of PP&TS has often shifted to Phase Six and has sometimes dominated time and energy during the annual meeting — a process that many attendees find inefficient and dissatisfying.

Through careful assessment of these phases and in looking at other alternative approval pathways — such as those used by the radiation oncology and medical physics groups — this newly formed CSC workgroup plans to introduce a proposal to improve this process. We will be working with ACR staff and other commission and committee leaders to gather a wide variety of perspectives.

Our goal is to propose a new process that preserves space for authentic and robust member contributions to the formation of PP&TS. We also hope to create a process that no longer dominates our annual meeting. This would ultimately allow our Council sessions to remain a place for spirited discussions about other critical and timely issues at hand — and preserve space for our councilors to debate and make impactful decisions. Of course, the product of this CSC workgroup will be presented to our Council for review at ACR 2021. At that time, it will be the choice of the Council that shapes the destiny of this process.

In the meantime, your CSC welcomes your ideas, comments, and input. We are honored to serve you through the current challenges — and across these new digital spaces.