CMS-funded Computed Tomography Quality Measure

In 2018, CMS established a cooperative agreement with the University of California San Francisco (UCSF) to develop an electronic clinical quality measure (eCQM) to monitor diagnostic CT performance to discourage unnecessarily high radiation doses while preserving adequate image quality. 

The initial award focused only on the development of a measure for the Merit-based Incentive Payment System (physician quality program). 

Later, and with CMS encouragement, UCSF developed complementary measures for the Hospital Inpatient Quality Reporting Program and Hospital Outpatient Quality Reporting Program to ensure incentives were aligned across doctors and hospitals. 

UCSF developed the quality measure following rigorous scientific standards

The development of the physician measure was guided by a Technical Expert Panel of esteemed members. Later, to advise the development of the hospital measures, a separate but overlapping expert panel was formed with more hospital representatives.

Why CMS funded this quality measure

Utilization of CT has grown considerably in recent decades, with over 93 million CT exams performed in the US in 2023 (IMV; 2023). While CT provides numerous benefits, there is considerable variation in the radiation doses used for CT; doses are frequently higher than needed for diagnosis, and there is no current oversight. Patients can get a dose 10x higher (Smith-Bindman, BMJ 2019) at one hospital versus another for the same type of exam. This had led to a 600% increase in population exposure to ionizing radiation, a known risk factor for cancer, over the last 15-20 years. This variation in radiation dose is unacceptable and constitutes a profound quality issue, and the sheer number of exams performed – with many peoples receiving multiple CT exams – makes this an urgent patient safety priority. Exposure to CT radiation is estimated to cause at least 2% (36,000) of the 1.8 million cancers diagnosed annually in the US (Berrington de Gonzalez 2009, NCI Cancer Statistics 2020), and optimizing radiation doses can make a meaningful difference in reducing cancer-related morbidity, mortality, and costs.

The goal of the measure is to provide a framework where health care organizations and clinicians can assess their doses, compare them to benchmarks, and take corrective action to lower them while preserving the quality of images to support clinical practice.


IMV 2023 CT Market Outlook Report,