DR CTQS TEP Meeting

Virtual Conference via Zoom

Meeting 2: July 2nd, 2019; 9:00am-12:00pm Pacific

Meeting Minutes

Project Overview:

The Centers for Medicare & Medicaid Services (CMS) has granted an award to the University of California San Francisco (UCSF) to develop a measure of computed tomography (CT) image quality and radiation safety. The project is a part of CMS’s Medicare Access & CHIP Reauthorization Act (MACRA)/Measure Development for the Quality Payment Program. The project title is “DR CTQS: Defining and Rewarding Computed Tomography Quality and Safety”. The Cooperative Agreement number is 1V1CMS331638-01-00. As part of its measure development process, UCSF convened groups of stakeholders and experts who contributed direction and thoughtful input to the measure developer during measure development and maintenance.

Project Objectives:

The goal of the project is to create a quality measure for CT to ensure image quality standards are preserved and harmful effects of radiation used to perform the tests are minimized. Radiation doses delivered by CT are far higher than conventional radiographs (x-rays), the doses are in the range known to be carcinogenic, and there is a significant performance gap across health care organizations and clinicians which has consequences for patients.  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 so that they are useful to support clinical practice. The measure will be electronically specified using electronic data stored within the Picture Archiving and Communication Systems (PACS) - the computerized systems for reviewing and storing imaging data or Radiology Information Systems (RIS).

TEP Objectives:

In its role as a measure developer, the University of California San Francisco is obtaining input from a broad group of stakeholders to develop a set of recommendations to develop a radiology quality and safety measure The proposed measure will be developed with the close collaboration of the leadership from diverse medical societies as well as payers, health care organizations, experts in safety and accreditation, and patient advocates. A well-balanced representation of stakeholders on the TEP is intended to ensure the consideration of key perspectives and obtain balanced input.

Scope of Responsibilities:

The TEP’s role is to provide input and advice to the measure developer (University of California San Francisco) related to a series of planned steps throughout the 3-year project. The specific steps will include developing and testing a risk-adjusted measure which can be used to monitor CT image quality in the context of minimizing radiation doses while maintaining acceptable image quality. The TEP will assist UCSF in conceptualizing the measure and any appropriate risk adjustment of it.  The TEP will assist UCSF with identifying barriers to implementing the proposed measure and test sites in which the developer can assess the feasibility and performance of its use. The TEP will assist UCSF with interpreting results obtained from the test sites and in suggesting modifications of the measure prior to it being incorporated into a software tool which will be made available to providers to enable them to report and monitor their performance. The TEP will provide input and advice to UCSF regarding the software tool to ensure that it is valuable for a wide range of stakeholders and CMS.

Guiding Principles:

Participation on the TEP is voluntary. Individuals participating on the TEP understand that their input will be recorded in the meeting minutes. Proceedings of the TEP will be summarized in a report that may be disclosed to the general public. If a participant has disclosed private, personal data by his or her own choice, then that material and those communications are not deemed to be covered by patient-provider confidentiality. Questions about confidentiality will be answered by the TEP organizers.

All potential TEP members must disclose any significant financial interest or other relationships that may influence their perceptions or judgment. It is unethical to conceal (or fail to disclose) conflicts of interest. However, the disclosure requirement is not intended to prevent individuals with particular perspectives or strong points of view from serving on the TEP. The intent of full disclosure is to inform the TEP organizers, other TEP members and CMS about the source of TEP members’ perspectives and how that might affect discussions or recommendations. 

All potential TEP members should be able to commit to the anticipated time frame needed to perform the functions of the TEP.

Estimated Number and Frequency of Meetings:

TEP is expected to meet three times per year either in-person or via a webinar.

Several TEP members were unable to attend the TEP meeting on July 2. To benefit from their input, an abbreviated alternative TEP meeting was held on July 30, which followed the same format as the July 2, but was compressed in time. Attendees of this session were given all of the slides that were presented at the July 2^nd TEP session and listened to a presentation that used a subset of these.

Table 1. TEP Member Name, Title, and Affiliation

Name	Title	Organization
Attendees July 2, 2019
Niall Brennan, MPP	CEO	Health Care Cost Institute
Helen Burstin, MD, MPH, FACP	CEO	Council of Medical Specialty Societies
Jay Bronner, MD	President and Chief Medical Officer	Radiology Partners
Jeph Herrin, PhD	Adjunct Assistant Professor	Yale University
Matthew Nielsen, MD, MS	Professor	University of North Carolina
Debra Ritzwoller, PhD	Patient	Patient Representative
J. Anthony Seibert, PhD	Professor	University of California, Davis
Arjun Venkatesh, MD, MBA, MHS	Assistant Professor	Yale School of Medicine
Todd Villines, MD, FSCCT	Professor	University of Virginia
Kenneth Wang, MD, PhD	Adjunct Assistant Professor	University of Maryland, Baltimore
Attendees July 30, 2019
Mythreyi Bhargavan Chatfield, PhD	Executive Vice President	American College of Radiology
Tricia Elliot, MBA, CPHQ	Director, Quality Measurement	Joint Commission
Hedvig Hricak, MD, PhD	Radiology Chair	Memorial Sloan Kettering Cancer Center
Leonard Lichtenfeld, MD, MACP	Interim Chief Medical Officer	American Cancer Society, Inc.
Lewis Sandy, MD	Executive Vice President, Clinical Advancement	UnitedHealth Group
Not In Attendance
Missy Danforth	Vice President of Health Care Ratings	The Leapfrog Group
Suzanne Schrandt, JD	Patient	Patient Representative

 

Ex Officio TEP
Attendees July 2, 2019:
Mary White, ScD	Chief, Epidemiology and Applied Research Branch	Centers for Disease Control
Attendees July 30, 2019
Amy Berrington, DPhil	Branch Chief & Senior Investigator Radiation Epidemiology Branch	National Cancer Institute
CMS & CATA representatives
Janis Grady	Project Officer	CMS

 

UCSF team
Attendees
Rebecca Smith-Bindman, MD	Principal Investigator	University of California, San Francisco
Andrew Bindman, MD	Principal Investigator	University of California, San Francisco
Patrick Romano, MD, MPH	Co-Investigator	University of California, Davis
Monika Ray, PhD	Statistician	University of California, Davis
Naomi López-Solano, CCRP	Project Manager, Logistics	University of California, San Francisco
Diana Ly, MPH	Project Manager, Strategy	University of California, San Francisco

 

Technical Expert Panel Meeting

Prior to the meeting, TEP members received a copy of the agenda, presentation slides, the minutes from the first TEP meeting, honorarium documentation, and a conflict of interest form. All documents can be found on pgs. 2-45 of the TEP Meeting Packet. The meeting was conducted with the use of PowerPoint slides all of which are referenced with page numbers of where they can be found in the TEP Meeting Packet.

9:00 AM           Call meeting to order by TEP Chair                                        Dr. Burstin

Helen Burstin called the meeting to order. She noted that the meeting will last for three hours with a break at the halfway point, and will include a discussion period after each presentation.

9:02 AM           Roll Call and Updated Conflicts                                             Dr. Burstin

                        TEP Members and Ex Officio members attendance listed above.

Conflict of interest defined as you, your spouse, your registered domestic partner, and/or your dependent children:

1. received income or payment as an employee, consultant or in some other role for services or activities related to diagnostic imaging

2. currently own, or have held in the past 12 months, an equity interest in any health care related company which includes diagnostic imaging as a part of its business

3. hold a patent, copyright, license or other intellectual property interest related to diagnostic imaging

4. hold a management or leadership position (i.e., Board of Directors, Scientific Advisory Board, officer, partner, trustee, etc.) in an entity with an interest in diagnostic imaging

5. received and cash or non-cash gifts from organizations or entities with an interest in diagnostic imaging

6. received any loans from organizations or entities with an interest in diagnostic imaging

7. received any paid or reimbursed travel from organizations or entities with an interest in diagnostic imaging

COIs were disclosed to UCSF prior to TEP meeting via paperwork. No members had new financial conflicts that precluded their participation. TEP members were also asked to verbally disclose any COIs when introducing themselves for the sake of group transparency. TEP members re-stated their affiliations and any existing conflicts. Dr. Helen Burstin stated her affiliation as the CEO of the Council of Medical Specialty Societies. She is now on the board of the Society to Improve Diagnosis in Medicine, although this is not a conflict of interest. Dr. Jay Bronner stated no new conflicts of interest. Dr. Jeph Herrin stated his affiliation with Yale University, and no new conflicts of interest. Dr. Matt Nielsen reported his affiliation with the University of North Carolina. He noted he is now the Quality Improvement Chair at AUA, however this association is not directly related to imaging. Dr. Debra Ritzwoller stated her affiliation with KP Colorado and as a patient/guardian stakeholder. Dr. Tony Seibert is a faculty member at UC Davis. His current conflicts include being a member of the Bayer Radimetrics Advisory Board, and Governor of the American Board of Radiology. Dr. Todd Villines noted a change in affiliation: previously he was at Walter Reed in Bethesda; he is now a professor at the University of Virginia. Dr. Villines reported no change in conflicts. Dr. Ken Wang noted his affiliation with the VA in Baltimore and University of Maryland. Of note, he is participating on his personal time not representing government. His conflicts include a small start-up and occasional reimbursements from Radiology Society of North America. Dr. Mary White reported her affiliation with the CDC and no conflicts of interest. Dr. Arjun Venkatesh reported no updates to conflicts of interest, but reminded the group that he works under contract with CMS for the development of hospital quality measures and quality rating systems, and also leads quality measure development for the American College of Emergency Physicians. Niall Brennan also joined the call later and stated that he had no conflicts and that he is currently the President and CEO of the Health Care Cost Institute.

July 30 Make-Up TEP

TEP members were asked to disclose any COIs when introducing themselves for the sake of group transparency. TEP members re-stated their affiliations and any existing conflicts. Dr. Hedvig Hricak is currently the Chair of the Memorial Sloan Kettering Cancer Center Department of Radiology. She disclosed her current conflict as a board member of IBA. Dr. Mythreyi Chatfield stated her affiliation with the American College of Radiology, as the Executive Vice President of Quality and Safety, and had no conflicts of interest to disclose. Tricia Elliot restated her role as the Director of Quality Measurement at The Joint Commission, and no new conflicts of interest. Dr. Leonard Lichtenfeld reminded the panel of his role as the Interim Chief Medical Scientific Officer of the American Cancer Society. He did not have any conflicts but mentioned his stock ownership in Google and noted that they have some interest in using augmented intelligence in radiology analytics. Dr. Lewis Sandy stated his affiliation with UnitedHealth Group as the Executive Vice President of Clinical Advancement, and had no conflicts of interest to disclose. Dr. Amy Berrington restated her role as the Branch Chief and Senior Investigator in the Radiation Epidemiology Branch at the National Cancer Institute, and had no conflicts of interest to disclose.

Review of goals for TEP #2 meeting:

1. Agreement on measure construct
2. Make progress on measure specification
3. Agreement on stratification approach
4. Agreement on approach to setting thresholds for image quality and radiation dose thresholds

9:15 AM           Defining the Proposed Measure                                           Dr. Patrick Romano

Presentation focused on elucidating the construction of the proposed measure. Description of the measure concept, including: balancing aspects, the numerator and denominator, inclusion and exclusion criteria, stratification and risk adjustment strategies, and possible challenges were presented to the TEP.

Dr. Romano noted that CT radiation doses vary widely and exposure to CT radiation has been associated with increased cancer incidence. The idea of this measure is to identify diagnostic CT scans that are performed unsafely either through the (1) utilization of excessive radiation doses or (2) having poor image quality undermining their diagnostic value. The numerator is the number of scans that “fail” on either of those two criteria. The denominator is defined as the number of diagnostic CT scans performed on adults by a clinician or group of clinicians during a reporting year. This failure rate interpretation is similar to a mortality rate where a higher proportion is worse.

Dr. Romano listed proposed exclusions, which include: CT scans done for research, for surgical or interventional procedures including diagnostic biopsies, for guidance in radiation oncology treatment, or in association with nuclear medicine tests including positron emission tomography (PET) and single photon emission tomography (SPECT); CT scans missing key data on patient age, radiation dose, image quality, or patient size (technical exclusions); whole body scans; and additionally, multiple areas scanned at the same time (but these would be treated as separate scans if possible).

It will be important to track patterns and frequency of missingness. In some cases, it may be possible to impute missing variables from available data elements. 

This measure concept gives rise to several challenges: identifying the appropriate radiation dose based on anatomic region, clinical indication, and patient size; creating an automated process to determine radiation dose and image quality in a valid and reliable way; and how to address data quality issues.

To address appropriate differences in the amount of radiation used by anatomic area and clinical indication, the UC team is proposing to stratify these characteristics. The anatomic areas and clinical indications will be combined into strata with similar dose and quality needs.  Risk adjustment will focus on body size derived from the CT scan. An “expected dose” will be estimated for each patient based on body size and assigned stratum.

Dr. Romano presented lowess plots revealing a relationship between patient size and radiation dose for some body regions. In general, the larger the patient size, the higher the radiation doses, however there are extreme outliers on both ends of this distribution including implausibly high doses. For head scans specifically, there is no clear relationship between size and dose.

This material was presented by Dr. Smith-Bindman at the July 30 make-up TEP using a subset of the slides presented on July 2.

9:30 AM           Discussion: Measure Definition                                             Dr. Burstin

Discussion of conceptualization of measure as a failure rate. There was concern that if patients are very large, they might require very high doses and that the images might still be of poor quality. This could result in a clinician failing the measure based on patient characteristics rather than provider performance. It was explained that the measure will be adjusted for patient size and that the TEP would be given additional opportunity at a later time to assess the adequacy of the adjustment.

Dr. Burstin suggested that the overall failure rate would be more useful for clinicians if it also included the component failure rates related to radiation dose and image quality.

There was a concern for using missing key data as part of the exclusion criteria as this could provide an avenue for gaming. It was noted that the degree to which this exclusion arose would be assessed at the provider level and that future consideration would be given to how to incorporate it into an assessment of the failure rate. 

This portion of the meeting concluded with the TEP endorsing the proposed approach for specifying the measure as a failure rate derived in strata defined by anatomic area and clinical indication and risk adjusted for patient size.

July 30^th 2019: The discussion of the measure composition was led by Dr. Andrew Bindman. One TEP member suggested that scans on the same patient for the same indication be considered a measure of poor quality. Dr. Bindman discussed that this was outside the current scope of the measure, but could contribute to a future radiology quality measure. TEP members endorsed the measure construct, and the stratification and risk-adjustment approach, but raised questions regarding the details of how the clinical indication categories and image quality thresholds would be defined. These questions were discussed later in the meeting.

9:45 AM           Determining Radiation Dose Thresholds                               Dr. Smith-Bindman

Dr. Smith-Bindman presented work on establishing radiation dose thresholds that will serve as the standard that radiologists will be tested against. It was shared that there are few evidence-based standards on proper radiation dose or needed image quality. A large number of publications have looked at dose specific indications, and those studies have found that doses can be reduced.

Dr. Smith-Bindman shared information about the size of the CT dose registries at UCSF and the American College of Radiology. She pointed out that there is demonstrated empirical evidence from these registries about how dose ranges vary by anatomic area. She indicated that the empirical data from these registries can inform the dose thresholds which will become the basis of the failure rate. She showed how the mean doses varied across anatomical areas but that wide within-area variation persisted. She indicated that she thought it was likely that it would be possible to collapse categories of indications within anatomical areas based on their requiring somewhat similar doses. Dr. Smith-Bindman presented figures demonstrating the distribution of low, medium, and high doses within several anatomical areas including head, chest, and abdomen, further exhibiting the large variation of dose.

She noted that information from the planned image quality sub-study will help to further refine the dose thresholds within anatomic areas and by indication. In brief, it is anticipated that when radiologists rate the image quality of CT scans that vary in dose that at some dose threshold virtually all radiologists will rate image quality as adequate so that doses above this threshold are likely to be excessive. 

This material was presented by Dr. Smith-Bindman at the July 30 make-up TEP using a subset of the slides presented on July 2.

10:05 AM         Discussion: Radiation Dose Thresholds                                 Dr. Burstin

Issue was brought up of incomplete scans and how they fit into these thresholds.  Dr. Smith-Bindman explained that incomplete scans are excluded from measure, although the relevance of repeated scans due to incomplete scanning was noted.

TEP expressed strong support for empirical approach based on the registry data and the anticipated results from the image quality study to set radiation dose standards for anatomic areas and clinical indications collapsed into categories along the lines that were proposed (low, routine, and high).

A question was raised about physicians who have specialty practices focused on patients with a narrower range of indications, and whether this will result in a lower failure rate than radiologists with a broader practice. Dr. Smith-Bindman explained that in general, every CT scan performed will be assessed and compared with the specific anatomical area and indication category, and will contribute to the overall failure rate. Having fewer indications represented in a practice should not bias the measure as the comparison is within a stratum. She also noted that there are a few indications with very clear guidelines for imaging and that specialists that focus on these areas may have lower failure rates because they are meeting those standards. She noted that lung cancer screening for example, has clearly defined radiation dose targets because CMS requires reporting to the ACR dose registry for this specific category, and the systems for standardizing radiation dose and meeting these thresholds are already in place for this indication. A radiologist working exclusively within the narrow category of lung cancer screening may be better able to manage the less complex task than those who need to manage CT scans for multiple indications. However, she added that while this might be true in theory it may not be the case in practice.  For kidney stones, there are also guidelines recommending the use of low doses, yet the UCSF data registry suggests that most physicians still use doses for this category that are not following the guidelines. Thus specialty physicians who do a lot of renal stone CT may not in the end have a lower failure rate.  

Action: TEP members had been surveyed prior to the meeting about their opinions as to which CT scans within specified anatomic areas had clinical indications that required doses that were higher or lower than routine. The TEP requested that the survey results be shared with all TEP members so as to develop a shared understanding of any changes that were made based on their input.

July 30^th 2019: The discussion of Radiation Dose Thresholds was led by Dr. Bindman. A question was brought up by the TEP regarding as to whether dose thresholds would be determined on the basis of dose per protocol chosen for a diagnosis or dose per indication for the CT scan. Dr. Bindman clarified that this measure is examining dose per indication because the choice of which protocol to use is a discretionary decision made by the clinician performing the test which has implications for the safety and quality of the test. Adjusting for the choice of protocol would be an over-adjustment given the goal is to minimize dose but preserve image quality for a clinical indication for a CT scan. 

There was discussion of the possibility of gaming the indications to provide clinicians performing CT scans to have higher thresholds of acceptable dosing or more latitude in the image quality. Dr. Bindman acknowledged that some clinicians might try to find a way to game how they are evaluated but said that the use of information on clinical indications coded at the time of test ordering in combination with information on what test was billed for after performing the test should minimize the opportunity for gaming. He reminded TEP members that CMS applies high penalty for fraud related to false billing.

One TEP member questioned whether the use of broad categories to assess dose and quality would be too broad to allow physicians to understand the areas they need to improve. Dr. Smith-Bindman discussed the potential to incorporate granular feedback of performance within the different anatomical area/clinical indication stratum so that clinicians could learn from their assessments and have information to allow them to improve over time.

10:30 AM         Quick Recess                                                                                                 

10:40 AM         Study to Automate Assessment of CT Image Quality           Dr. Andy Bindman

Presentation began with Dr. Bindman’s explanation that image quality is a balancing measure to radiation dose. He introduced challenges in establishing an assessment of image quality, namely, radiologists’ assessments of image quality are in free text reports and not easily accessed. Potential surrogates include (1) image noise measures or (2) machine learning, but it is not currently known how either relate to radiologist judgement of quality.

For the image noise approach, Dr. Bindman explained that as radiation dose decreases, image noise increases creating a “quantum mottle” similar to when a television picture becomes blurry. Global image noise is a single measure of noise that summarizes the image quality of a single CT scan. The second approach the UC team is exploring relies on artificial intelligence (AI) to automate the assessment of image quality. A computer would first be trained on images and provided with information on the radiologists’ assessment of image quality. In this way, the computer would “learn” how radiologists arrived at that assessment.

Dr. Bindman introduced the planned quality sub-study to compare radiologists’ assessment of image quality as gold-standard against global noise derived from CT scan and AI reading of image quality. In judging whether the images are adequate, the radiologists will be provided with information on the clinical indication for the CT scan. He introduced study design alongside how participants will review cases online using MD.Ai. He explained that the analysis of the study will compare the agreement in the radiologists’ rating of image with (1) global noise, and (2) a computer assessment done using AI. Depending on the results of the study, the UC team may recommend that either global noise or AI be used to automate assessment of image quality when calculating the failure rate.  In addition, the sub-study will be used as previously described by Dr. Smith-Bindman to identify a radiation dose threshold above which radiologists are virtually unanimous (e.g. >95%) in rating image quality as adequate for the anatomical area and clinical indication. Dr. Bindman noted that the study will be conducted in fall 2019. The next planned TEP meeting in September will provide members with additional details on the planned study and the TEP meeting anticipated for late winter/early spring 2020 will be used to share results of the image quality sub-study.

This material was presented by Dr. Bindman at the July 30 TEP using a subset of the slides presented on July 2.

10:50 AM         Discussion: Study to Automate Assessment of CT Image Quality    Dr. Burstin

Concerns were raised about validity of using radiologists’ ratings of image quality as gold standard, when the reliability of reviewers is unknown. Many radiologists read for multiple facilities at one time, so they are accustomed to reading images of varying quality. Radiologists’ view of what is an acceptable image has changed over time, particularly as software has emerged to improve the adequacy of what may have previously been considered an inadequate image. Dr. Smith-Bindman explained that reliability will be assessed as a component of the image quality sub-study. It is anticipated that there will be 20-30 readings per test case which should provide an ability to develop a clear sense of how reproducible radiologists’ opinions of quality are. The UC team expects that by including radiologists from a wide variety of settings that the study will provide an empirically derived reference standard. 

Question was brought up about whether signal will be reviewed, and how patient motion will affect measure. Dr. Smith-Bindman explained that patient motion is outside the scope of this project, but that such events would presumably be random across providers so that it should not have a disproportionate effect on any particular clinician or clinician group being evaluated. The UC sub-study will explore the value of including information on signal. 

Construct of gold standard received approval from TEP but concerns were raised about the durability of the measure and the “moving target” nature of what is viewed as adequate image quality. What is set as the gold standard today may not be the gold standard later. Dr. Burstin noted that this could be a concern due to the measure being used for payment. However, the TEP members acknowledged that this concern may be premature without yet knowing results of the study.

July 30^th 2019: The discussion of the Study to Automate Assessment of CT Image Quality was led by Dr. Bindman. Concerns were expressed by the TEP about the resources needed to implement the automated assessment mechanisms, and the potential for added burden on physician groups. Dr. Bindman acknowledged the potential complexity which along with physician burden would be tested as a part of this project. Results would be shared with TEP so that they could provide additional input. Dr. Bindman also mentioned that some of the logistics for executing the work would fall to whoever takes on the role of measure steward and that this role would be discussed with TEP members at upcoming meetings as well. 

11:10 AM         Alpha Testing of Proposed Measure                                     Dr. Smith-Bindman

Dr. Smith-Bindman reported on initial findings from alpha testing which uses surrogate thresholds for dose assessments. The goal of alpha testing is to demonstrate the degree to which the measure can be calculated from data that providers submit regarding their CT scans. Dr. Smith-Bindman pointed out that the UC CT International Dose Registry was not created with this purpose in mind but that it provides a good testing ground for evaluating the plausibility of the proposed approach. As a first test (alpha), the UC team has used the UC Dose Registry to execute a series of steps that will be needed to do measure reporting. This includes aggregating the data into clinician groups, excluding examination types that are not included in calculating the measure, categorizing CT scans into anatomic area/clinical indication strata, comparing observed doses to risk-adjusted doses, and assessing failure rate by clinician group.

The UC team determined the observed radiation dose for each eligible scan within anatomically defined strata, calculated the patient size associated with each CT and modeling a failure rate based on either the top 10% or the top 25% as a failure.

The UC team learned from alpha testing that a little more than 20% of CT scans in the registry would be excluded because they were done for research, in conjunction with nuclear scans, in association with radiation oncology treatments or in support of procedures. Another 10% were excluded due to missing information. For the remainder, the UC team was able to derive observed radiation doses and to calculate expected radiation doses based on anatomic area and patient size. The UC team also demonstrated how an assessment of performance could be done with these data.

Future alpha testing will incorporate clinical indication into the assessment of radiation thresholds. Subsequent beta testing will allow the UC team to: (a) replicate this testing in a diverse sample, (b) test our capacity to aggregate physicians based on TINs, (c) incorporate image quality into calculation of failure rate, and (d) evaluate the burden of reporting on clinicians.

11:30 AM         Discussion: Alpha Testing                                                       Dr. Burstin

Question was raised about how the UC team proposes to determine the clinical indication for the CT scan. TEP members were informed that the UC team plans to use type of CT scan and billing codes for this and that TEP members will be given more detail about this about an upcoming TEP meeting.

Questions were raised about how UC team will use body circumference to risk adjust. Concern raised about how we will do this with scans where it is hard to see body circumference or outline, such as cardiac scans. TEP members were informed that UC team has experience in calculating patient size from CT scans within the UC CT International Dose Registry. Some of these preliminary results were shown in Dr. Romano’s presentation at this meeting and more detail will be presented on this at a subsequent TEP meeting. A suggestion was made to include size as a predictor in the image quality sub-study. The UC team agreed that this was a good idea and would be done.

11:50 AM         Wrap up and Next Steps                                                        Dr. Bindman

Dr. Bindman thanked TEP members for their time and contributions, expressed the UC team’s intention to reflect on feedback with its CMS partners and develop a plan to address advice from the panel. Dr. Bindman indicated that plans were underway to hold the next TEP meeting in September or October of this year. That meeting is expected to be a webinar and the topics will include more detail on the image quality sub-study as well as plans for the beta testing component of the project. A UC team member will be following up with TEP members for their availability. Finally, TEP members were reminded of optional honorarium and how to submit paperwork to receive the funds.

12:00 PM         Adjourn                                                                                   Dr. Burstin

 

In-person meeting materials/appendix