Measure title: Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults
Measure description: This measure provides a standardized method for monitoring the performance of diagnostic CT to discourage unnecessarily high radiation doses, a risk factor for cancer, while preserving image quality. It is expressed as a percentage of CT exams that are out-of-range based on having either excessive radiation dose or inadequate image quality relative to evidence-based thresholds based on the clinical indication for the exam. All diagnostic CT exams of specified anatomic sites performed in inpatient, outpatient and ambulatory care settings are eligible (and evaluated accordingly by the Physician, Inpatient, and Outpatient measures). This eCQM requires the use of additional software to access primary data elements stored within radiology electronic health records and translate them into data elements that can be ingested by this eCQM.
Reporting time period: One calendar year
Measure score: Proportion, where lower score = better quality
Data elements:
1. CT Dose and Image Quality Category (LOINC code 96914-7): Derived from ICD and CPT® codes from the test order; reflects the anatomical area, radiation dose, and image quality requirements of the underlying reason for imaging
2. Calculated CT Size-Adjusted Dose (LOINC code 96913-9): Derived from image pixel data and DICOM data from the exam
3. Calculated CT Global Noise (LOINC code 96912-1): Reflects the image quality; calculated on image pixel data
4. Birthdate (LOINC code 21112-8)
Data sources: EHR and Radiology electronic systems (RIS and PACS)
Initial population: all CT exams in adults performed in specified settings (which vary by the reporting level: inpatient, outpatient, clinician).
Denominator Statement: CT exams in the initial population that have a CT category, size-adjusted radiation dose value, and image noise value.
Denominator Exclusions: CT exams with CT category = full body.
Numerator Statement: CT exams with a size-adjusted radiation dose or image noise value greater than CT category-specific thresholds.
Numerator exclusions: None.
Dose Threshold: Coming soon
Noise Threshold: Coming soon
Stratification: The measure is stratified by CT category.
Risk-adjustment: As larger patients require more radiation to penetrate tissue and achieve image quality, the measure adjusts radiation dose by patient size using the patient’s mid-scan axial or coronal diameter, so as not to unfairly penalize providers who care for larger patients
