The American College of Radiology Appropriateness Criteria were recently revised and translated into a new electronic format searchable online. They are also now being used as the basis for decision support logic underlying computerized radiology order entry. This article addresses some previous criticisms of the structure and output of the American College of Radiology expert panel process. Although there is certainly room for improvement, the conceptual framework and methodology underlying the appropriateness criteria are sound and do not need to be drastically altered.