eCQM Title

Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Facility OQR)

CMS ID

1206

eCQM Version Number

4.0.000

CBE Number

3663e

GUID

4270512c-5b41-4f79-bedf-09e1521ee3bc

Measurement Period

January 1, 2027 through December 31, 2027

Measure Steward

Alara Imaging, Inc.

Measure Developer

University of California San Francisco

Endorsed By

CMS Consensus Based Entity

Description

This measure is an episode of care measure that provides a standardized method for monitoring the performance of diagnostic computed tomography (CT) to discourage unnecessarily high radiation doses, a risk factor for cancer, while preserving image quality. This measure 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 hospital non-inpatient care settings (including emergency settings) are eligible. 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. Additional details are included in the Guidance field.

The translation software was written and will be updated and maintained by Alara Imaging, Inc. and will be accessible by creating a secure account through Alara’s website.

This Measure and related data specifications are owned by Alara Imaging, Inc. Alara Imaging, Inc. is not responsible for any use of the Measure. Alara Imaging, Inc. makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and Alara Imaging, Inc. has no liability to anyone who relies on such measures or specifications.

The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by Alara Imaging, Inc. and are subject to a license at the discretion of Alara Imaging, Inc.

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Alara Imaging, Inc. disclaims all liability for use or accuracy of any third-party code contained in the specifications.

This material includes SNOMED Clinical Terms (R) (SNOMED CT [R]) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO). All rights reserved. SNOMED CT (R), was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

CPT (TM) only Copyright 2025 American Medical Association. All rights Reserved. No fee schedules, basic unit, relative values or related listings are included in CPT (TM). AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained herein.

This material contains content from LOINC (http://loinc.org). LOINC is copyright (C) Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. LOINC (R) is a registered United States trademark of Regenstrief Institute, Inc.

Disclaimer

The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.

Alara Imaging, Inc., the University of California San Francisco, and its members and users shall not be responsible for any use or accuracy of the Measure or any code contained within the Measure. THE MEASURE AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.

Measure Scoring

Proportion

Measure Type

Intermediate Outcome

Stratification

None

Risk Adjustment

None

Rate Aggregation

None

Rationale

Diagnostic imaging using CT occurs in more than a third of acute care hospitalizations in the U.S. (Vance et al., 2013), and greater than 90 million scans are performed annually in the U.S. (IMV, 2019). There is marked observed variation in the radiation doses used to perform these exams (Smith-Bindman et al., 2019). The inconsistency in how CT exams are performed represents a significant, unnecessary, and modifiable iatrogenic health risk, as there is extensive epidemiological and biological evidence that suggests exposure to radiation in the same range as that routinely delivered by CT increases a person's risk of developing cancer (Abalo et al., 2021; Bernier et al., 2019; Berrington de Gonzalez et al., 2020; Brenner et al., 2020; Cao et al., 2022; Grant et al., 2017; Hauptmann et al., 2020, 2023; National Research Council, 2006; Hong et al., 2019; Huang et al., 2020; Meulepas et al., 2019; Sadakane et al., 2019; Sakata et al., 2019; Sugiyama et al., 2020). It is estimated that 2% (37,000) of the 1.8 million cancers diagnosed annually in the U.S. are caused by CT exams (Berrington de González et al., 2009; National Cancer Institute, 2020).

The measure focuses on reducing radiation dose in CT, an intermediate outcome directly and proportionally related to cancer prevention. As radiation dose is known to be directly related and proportional to future cancer risk (Berrington de González et al., 2009; National Research Council, 2006), any reduction in radiation exposure would be expected to lead to a proportional reduction in cancers. Research suggests that when healthcare organizations and clinicians are provided with a summary of their CT radiation doses, their subsequent doses can be reduced without changing the usefulness of these tests (Smith-Bindman et al., 2020).

On the basis of the current estimated number of CT scans performed annually in the U.S. (IMV, 2019), distribution in scan types and observed doses (Demb et al., 2017; Smith-Bindman et al., 2019), modeling of the cancer risk associated with CT at different ages of exposure (Berrington de González et al., 2009), and costs of cancer care (Dieguez et al., 2017; Mariotto et al., 2011), an estimated 13,982 cancers could be prevented among Medicare beneficiaries annually, resulting in $1.86 billion to $5.21 billion annual cost savings. These cost calculations were supported by more recent data on cancer survivorship and costs, which yielded an estimated $3.04 billion in annual costs savings to Medicare (Mariotto et al., 2020; National Cancer Institute, Office of Cancer Survivorship, 2022).

Clinical Recommendation Statement

The measure aligns with numerous evidence- and consensus-based clinical guidelines asking radiologists to track, optimize, and lower CT radiation doses, guidelines that have been written by the American College of Radiology (Kanal et al., 2017); cardiovascular imaging societies (Hirshfeld et al., 2018a, 2018b; Hirshfeld et al., 2018); Image Gently Alliance, an initiative begun by the American College of Radiology, the Radiological Society of North America, American Society of Radiologic Technologists, the American Association of Physicists in Medicine, and the Society of Pediatric Radiology, which dozens of U.S. and international organizations have joined as recently as 2020 (Image Gently Alliance, 2022); and the US Food and Drug Administration (U.S. Food and Drug Administration, 2019).

This measure has been strongly supported by a Technical Expert Panel (TEP) comprising a diverse group of clinicians, patient advocates, and leaders of medical specialty societies, payers, and healthcare safety and accrediting organizations, all of whom were engaged through every stage of measure conceptualization, development, and testing. In assessing the face validity of the measure, 100% of TEP members agreed radiation dose and global noise are relevant metrics of CT quality, that size is an appropriate method of risk adjustment, and that performance on this measure of radiation dose and image quality as specified is a representation of quality.

Improvement Notation

Decreased score indicates improvement

Reference

Reference Type: Citation

Reference Text:

Abalo, K. D., Rage, E., Leuraud, K., Richardson, D. B., Le Pointe, H. D., Laurier, D., & Bernier, M. O. (2021). Early life ionizing radiation exposure and cancer risks: Systematic review and meta-analysis. Pediatric Radiology, 51(1), 45–56. https://doi.org/10.1007/s00247-020-04803-0

Reference

Reference Type: Citation

Reference Text:

Bernier, M. O., Baysson, H., Pearce, M. S., Moissonnier, M., Cardis, E., Hauptmann, M., Struelens, L., Dabin, J., Johansen, C., Journy, N., Laurier, D., Blettner, M., Le Cornet, L., Pokora, R., Gradowska, P., Meulepas, J. M., Kjaerheim, K., Istad, T., Olerud, H., … Kesminiene, A. (2019). Cohort Profile: The EPI-CT study: A European pooled epidemiological study to quantify the risk of radiation-induced cancer from paediatric CT. International Journal of Epidemiology, 48(2), 379–381g. https://doi.org/10.1093/ije/dyy231

Reference

Reference Type: Citation

Reference Text:

Berrington de Gonzalez, A., Daniels, R. D., Cardis, E., Cullings, H. M., Gilbert, E., Hauptmann, M., Kendall, G., Laurier, D., Linet, M. S., Little, M. P., Lubin, J. H., Preston, D. L., Richardson, D. B., Stram, D., Thierry-Chef, I., & Schubauer-Berigan, M. K. (2020). Epidemiological studies of low-dose ionizing radiation and cancer: Rationale and framework for the monograph and overview of eligible studies. Journal of the National Cancer Institute. Monographs, 56, 97–113. https://doi.org/10.1093/jncimonographs/lgaa009

Reference

Reference Type: Citation

Reference Text:

Berrington de González, A., Mahesh, M., Kim, K. P., Bhargavan, M., Lewis, R., Mettler, F., & Land, C. (2009). Projected cancer risks from computed tomographic scans performed in the United States in 2007. Archives of Internal Medicine, 169(22), 2071–2077. https://doi.org/10.1001/archinternmed.2009.440

Reference

Reference Type: Citation

Reference Text:

Brenner, A. V., Sugiyama, H., Preston, D. L., Sakata, R., French, B., Sadakane, A., Cahoon, E. K., Utada, M., Mabuchi, K., & Ozasa, K. (2020). Radiation risk of central nervous system tumors in the Life Span Study of atomic bomb survivors, 1958-2009. European Journal of Epidemiology, 35(6), 591–600. https://doi.org/10.1007/s10654-019-00599-y

Reference

Reference Type: Citation

Reference Text:

Cao, C. F., Ma, K. L., Shan, H., Liu, T. F., Zhao, S. Q., Wan, Y., Jun-Zhang, & Wang, H. Q. (2022). CT scans and cancer risks: A systematic review and dose-response meta-analysis. BMC Cancer, 22(1), 1238. https://doi.org/10.1186/s12885-022-10310-2

Reference

Reference Type: Citation

Reference Text:

Demb, J., Chu, P., Nelson, T., Hall, D., Seibert, A., Lamba, R., Boone, J., Krishnam, M., Cagnon, C., Bostani, M., Gould, R., Miglioretti, D., & Smith-Bindman, R. (2017). Optimizing radiation doses for computed tomography across institutions: Dose auditing and best practices. JAMA Internal Medicine, 177(6), 810–817. https://doi.org/10.1001/jamainternmed.2017.0445

Reference

Reference Type: Citation

Reference Text:

Dieguez, G., Ferro, C., & Pyenson, B. (2017). Milliman research report: A multi-year look at the cost burden of cancer care. Milliman Research Report.

Reference

Reference Type: Citation

Reference Text:

Grant, E. J., Brenner, A., Sugiyama, H., Sakata, R., Sadakane, A., Utada, M., Cahoon, E. K., Milder, C. M., Soda, M., Cullings, H. M., Preston, D. L., Mabuchi, K., & Ozasa, K. (2017). Solid cancer incidence among the Life Span Study of Atomic Bomb Survivors: 1958-2009. Radiation Research, 187(5), 513–537. https://doi.org/10.1667/RR14492.1

Reference

Reference Type: Citation

Reference Text:

Hauptmann, M., Byrnes, G., Cardis, E., Bernier, M. O., Blettner, M., Dabin, J., Engels, H., Istad, T. S., Johansen, C., Kaijser, M., Kjaerheim, K., Journy, N., Meulepas, J. M., Moissonnier, M., Ronckers, C., Thierry-Chef, I., Le Cornet, L., Jahnen, A., Pokora, R., … Kesminiene, A. (2023). Brain cancer after radiation exposure from CT examinations of children and young adults: Results from the EPI-CT cohort study. The Lancet Oncology, 24(1), 45–53. https://doi.org/10.1016/S1470-2045(22)00655-6

Reference

Reference Type: Citation

Reference Text:

Hauptmann, M., Daniels, R. D., Cardis, E., Cullings, H. M., Kendall, G., Laurier, D., Linet, M. S., Little, M. P., Lubin, J. H., Preston, D. L., Richardson, D. B., Stram, D. O., Thierry-Chef, I., Schubauer-Berigan, M. K., Gilbert, E. S., & Berrington de Gonzalez, A. (2020). Epidemiological studies of low-dose ionizing radiation and cancer: Summary bias assessment and meta-analysis. Journal of the National Cancer Institute. Monographs, 56, 188–200. https://doi.org/10.1093/jncimonographs/lgaa010

Reference

Reference Type: Citation

Reference Text:

Hirshfeld, J. W., Ferrari, V. A., Bengel, F. M., Bergersen, L., Chambers, C. E., Einstein, A. J., Eisenberg, M. J., Fogel, M. A., Gerber, T. C., Haines, D. E., Laskey, W. K., Limacher, M. C., Nichols, K. J., Pryma, D. A., Raff, G. L., Rubin, G. D., Smith, D., Stillman, A. E., Thomas, S. A., … Wann, L. S. (2018a). 2018 ACC/HRS/NASCI/SCAI/SCCT Expert consensus document on optimal use of ionizing radiation in cardiovascular imaging: Best practices for safety and effectiveness: A report of the American College of Cardiology task force on expert consensus decision pathways. Journal of the American College of Cardiology, 71(24), e283–e351. https://doi.org/10.1016/j.jacc.2018.02.016

Reference

Reference Type: Citation

Reference Text:

Hirshfeld, J. W., Ferrari, V. A., Bengel, F. M., Bergersen, L., Chambers, C. E., Einstein, A. J., Eisenberg, M. J., Fogel, M. A., Gerber, T. C., Haines, D. E., Laskey, W. K., Limacher, M. C., Nichols, K. J., Pryma, D. A., Raff, G. L., Rubin, G. D., Smith, D., Stillman, A. E., Thomas, S. A., … Wann, L. S. (2018b). 2018 ACC/HRS/NASCI/SCAI/SCCT Expert consensus document on optimal use of ionizing radiation in cardiovascular imaging—Part 1: Radiation physics and radiation biology. Journal of the American College of Cardiology, 71(24), 2811–2828. https://doi.org/10.1016/j.jacc.2018.02.017

Reference

Reference Type: Citation

Reference Text:

Hirshfeld, J. W., Ferrari, V. A., Bengel, F. M., Bergersen, L., Chambers, C. E., Einstein, A. J., Eisenberg, M. J., Fogel, M. A., Gerber, T. C., Haines, D. E., Laskey, W. K., Limacher, M. C., Nichols, K. J., Pryma, D. A., Raff, G. L., Rubin, G. D., Smith, D., Stillman, A. E., Thomas, S. A., … Wiggins, B. S. (2018). 2018 ACC/HRS/NASCI/SCAI/SCCT Expert consensus document on optimal use of ionizing radiation in cardiovascular imaging—Part 2: Radiological equipment operation, dose-sparing methodologies, patient and medical personnel protection. Catheterization and Cardiovascular Interventions, 92(2), 222–246. https://doi.org/10.1002/ccd.27661

Reference

Reference Type: Citation

Reference Text:

Hong, J. Y., Han, K., Jung, J. H., & Kim, J. S. (2019). Association of exposure to diagnostic low-dose ionizing radiation with risk of cancer among youths in South Korea. JAMA Network Open, 2(9), e1910584. https://doi.org/10.1001/jamanetworkopen.2019.10584

Reference

Reference Type: Citation

Reference Text:

Huang, R., Liu, X., He, L., & Zhou, P. K. (2020). Radiation exposure associated with computed tomography in childhood and the subsequent risk of cancer: A meta-analysis of cohort studies. Dose-Response, 18(2), 1559325820923828. https://doi.org/10.1177/1559325820923828

Reference

Reference Type: Citation

Reference Text:

Image Gently Alliance. (2022). Strategic Agenda 2022–2027. http://www.imagegently.org/Portals/6/IGA%20Strategic%20Plan%201_10_22.pdf

Reference

Reference Type: Citation

Reference Text:

IMV. (2019). IMV 2019 CT Market Outlook Report. https://imvinfo.com/product/2019-ct-market-outlook-report/

Reference

Reference Type: Citation

Reference Text:

Kanal, K. M., Butler, P. F., Sengupta, D., Bhargavan-Chatfield, M., Coombs, L. P., & Morin, R. L. (2017). U.S. diagnostic reference levels and achievable doses for 10 adult CT examinations. Radiology, 284(1), 120–133. https://doi.org/10.1148/radiol.2017161911

Reference

Reference Type: Citation

Reference Text:

Mariotto, A. B., Enewold, L., Zhao, J., Zeruto, C. A., & Yabroff, K. R. (2020). Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiology, Biomarkers & Prevention, 29(7), 1304–1312. https://doi.org/10.1158/1055-9965.EPI-19-1534

Reference

Reference Type: Citation

Reference Text:

Mariotto, A. B., Yabroff, K. R., Shao, Y., Feuer, E. J., & Brown, M. L. (2011). Projections of the cost of cancer care in the United States: 2010–2020. Journal of the National Cancer Institute, 103(2), 117–128. https://doi.org/10.1093/jnci/djq495

Reference

Reference Type: Citation

Reference Text:

Meulepas, J. M., Ronckers, C. M., Smets, A. M. J. B., Nievelstein, R. A. J., Gradowska, P., Lee, C., Jahnen, A., van Straten, M., de Wit, M-C. Y., Zonnenberg, B., Klein, W. M., Merks, J. H., Visser, O., van Leeuwen, F. E., & Hauptmann, M. (2019). Radiation exposure from pediatric CT scans and subsequent cancer risk in the Netherlands. Journal of the National Cancer Institute, 111(3), 256–263. https://doi.org/10.1093/jnci/djy104

Reference

Reference Type: Citation

Reference Text:

National Cancer Institute (2020). Cancer Statistics. https://www.cancer.gov/about-cancer/understanding/statistics

Reference

Reference Type: Citation

Reference Text:

National Cancer Institute Office of Cancer Survivorship. (2022). Statistics and Graphs. https://cancercontrol.cancer.gov/ocs/statistics

Reference

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Reference Text:

National Research Council. (2006). Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. National Academies Press. https://doi.org/10.17226/11340

Reference

Reference Type: Citation

Reference Text:

Sadakane, A., French, B., Brenner, A. V., Preston, D. L., Sugiyama, H., Grant, E. J., Sakata, R., Utada, M., Cahoon, E. K., Mabuchi, K., & Ozasa, K. (2019). Radiation and risk of liver, biliary tract, and pancreatic cancers among atomic bomb survivors in Hiroshima and Nagasaki: 1958-2009. Radiation Research, 192, 299–310. https://doi.org/10.1667/RR15341.1

Reference

Reference Type: Citation

Reference Text:

Sakata, R., Preston, D. L., Brenner, A. V., Sugiyama, H., Grant, E. J., Rajaraman, P., Sadakane, A., Utada, M., French, B., Cahoon, E. K., Mabuchi, K., & Ozasa, K. (2019). Radiation-related risk of cancers of the upper digestive tract among Japanese atomic bomb survivors. Radiation Research, 192, 331–344. https://doi.org/10.1667/RR15386.1

Reference

Reference Type: Citation

Reference Text:

Smith-Bindman, R., Chu, P., Wang, Y., Chung, R., Lopez-Solano, N., Einstein, A. J., Solberg, L., Cervantes, L. F., Nelson, T. R., Boswell, W., Delman, B. N., Duong, P-A., Goode, A. R., Kasraie, N., Lee, R. K., Neill, R., Pahwa, A., Pike, P., Roehm, J., …Miglioretti, D. L. (2020). Comparison of the effectiveness of single-component and multicomponent interventions for reducing radiation doses in patients undergoing computed tomography: A randomized clinical trial. JAMA Internal Medicine, 180(5), 666–675. https://doi.org/10.1001/jamainternmed.2020.0064

Reference

Reference Type: Citation

Reference Text:

Smith-Bindman, R., Wang, Y., Chu, P., Chung, R., Einstein, A. J., Balcombe, J., Cocker, M., Das, M., Delman, B. N., Flynn, M., Gould, R., Lee, R. K., Nelson, T. R., Schindera, S., Seibert, A., Starkey, J., Suntharalingam, S., Wetter, A., Wildberger, J. E., & Miglioretti, D. L. (2019). International variation in radiation dose for computed tomography examinations: Prospective cohort study. BMJ, 364, k4931. https://doi.org/10.1136/bmj.k4931

Reference

Reference Type: Citation

Reference Text:

Sugiyama, H., Misumi, M., Brenner, A., Grant, E. J., Sakata, R., Sadakane, A., Utada, M., Preston, D. L., Mabuchi, K., & Ozasa, K. (2020). Radiation risk of incident colorectal cancer by anatomical site among atomic bomb survivors: 1958-2009. International Journal of Cancer, 146(3), 635–645. https://doi.org/10.1002/ijc.32275

Reference

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Reference Text:

U.S. Food and Drug Administration. (2019). White Paper: Initiative to reduce unnecessary radiation exposure from medical imaging. Food and Drug Administration. https://www.fda.gov/radiation-emitting-products/initiative-reduce-unnecessary-radiation-exposure-medical-imaging/white-paper-initiative-reduce-unnecessary-radiation-exposure-medical-imaging

Reference

Reference Type: Citation

Reference Text:

Vance, E. A., Xie, X., Henry, A., Wernz, C., & Slonim, A. D. (2013). Computed tomography scan use variation: Patient, hospital, and geographic factors. The American Journal of Managed Care, 19(3), e93–e99.

Definition

CT Dose and Image Quality Category: reflects the type of exam performed based on body region and clinical indication. Each CT Dose and Image Quality Category has a specific set of dose and image quality (global noise) thresholds.

Calculated CT Size-Adjusted Dose: reflects the total radiation dose received during CT, risk-adjusted by patient size. The Calculated CT Size-Adjusted Dose thresholds vary by the CT Dose and Image Quality Category.

Calculated CT Global Noise: reflects the image quality of the CT. The Calculated CT Global Noise thresholds vary by the CT Dose and Image Quality Category.

Guidance

The level of aggregation for this eCQM is the facility. A parallel eCQM measures CT exams aggregated at the level of the clinician or clinician group. A single CT exam may be simultaneously measured in both the Merit-based Incentive Payment System (MIPS) and one of the hospital reporting programs (inpatient or outpatient); however, a single exam cannot be measured in both the inpatient and outpatient hospital quality reporting programs.

TRANSLATION SOFTWARE

As a radiology measure, the measure derives standardized data elements from structured fields within both the electronic health record (EHR) and the radiology electronic clinical data systems, including the Radiology Information System (RIS) and the Picture Archiving and Communication System (PACS). Primary imaging data including Radiation Dose Structured Reports and image pixel data are stored in the PACS in Digital Imaging and Communications in Medicine (DICOM) format, a universally adopted standard for medical imaging information. Because of limitations in their specifications and format, eCQMs cannot currently access and consume elements from these radiology sources in their original DICOM formats. Thus, translation software was developed to transform primary data into a format that the eCQM can consume. This eCQM requires the use of additional software (translation software) to access the primary data elements that are required for measure computation and translate them into data elements that can be ingested by this eCQM. The purpose of this translation software is to access and link these primary data elements with minimal site burden, assess each CT exam for eligibility based on initial population criteria, and generate the three data elements mapped to a clinical terminology for eCQM consumption: CT Dose and Image Quality Category, Calculated CT Size-Adjusted Dose, and Calculated CT Global Noise. The free translation software necessary to use this eCQM is written and maintained by Alara Imaging, Inc. However, any software vendor capable of calculating and reporting this eCQM in accordance with the measure’s specifications, including combining radiology data with electronic health system data, and transforming radiology data into a format compatible with eCQM reporting, may report this measure on behalf of hospitals and clinicians.

The translation software will create three variables required for measure computation including the CT Dose and Image Quality Category (LOINC(R) Code 96914-7), the Calculated CT Global Noise (LOINC(R) Code 96912-1) and the Calculated CT Size-Adjusted Dose (LOINC(R) Code 96913-9). These variables are defined in the Definition field above. These transformed data elements can be stored in the EHR.

MEASURE CALCULATION

The measure will evaluate each included CT exam based on allowable thresholds that are specified by the CT Dose and Image Quality Category. An exam is considered out of range if either the Calculated CT Global Noise or the Calculated CT Size-Adjusted Dose is out of range for the CT Dose and Image Quality Category. Exams will be evaluated against their corresponding threshold, shown below with the following format: [Category shorthand (=CT Dose and Image Quality Category), threshold for the Calculated CT Global Noise in Hounsfield units, threshold for the Calculated CT Size-Adjusted Dose in dose length product].

[LA31752-1 (=Abdomen and Pelvis, Low Dose), 64, 598]
[LA31753-9 (=Abdomen and Pelvis, Routine Dose), 29, 644]
[LA31754-7 (=Abdomen and Pelvis, High Dose), 29, 1260]
[LA31755-4 (=Cardiac Low Dose), 55, 93]
[LA31756-2 (=Cardiac Routine Dose), 32, 576]
[LA31758-8 (=Chest Low Dose), 55, 377]
[LA31759-6 (=Chest Routine Dose), 49, 377]
[LA31761-2 (=Chest High Dose or Cardiac High Dose), 49, 1282]
[LA31762-0 (=Head Low Dose), 115, 582]
[LA31763-8 (=Head Routine Dose), 115, 1025]
[LA31764-6 (=Head High Dose), 115, 1832]
[LA31765-3 (=Upper or Lower Extremity), 73, 320]
[LA31766-1 (=Neck or Cervical Spine), 25, 1260]
[LA31767-9 (=Thoracic or Lumbar Spine), 25, 1260]
[LA31768-7 (=Combined Chest, Abdomen and Pelvis), 29, 1637]
[LA31851-1 (=Combined Thoracic and Lumbar Spine), 25, 2520]
[LA31769-5 (=Combined Head and Neck, Routine Dose), 25, 2285]
[LA31770-3 (=Combined Head and Neck, High Dose), 25, 3092]

EXCLUSIONS

CT scans with missing patient age or missing CT Dose and Image Quality Category (LOINC(R) 96914-7) are excluded from the initial population. CT scans with a missing Calculated Global Noise value or a missing Calculated CT Size-Adjusted Dose value are not included in the denominator. CT scans assigned a CT Dose and Image Quality Category (LOINC(R) 96914-7) value using the LOINC(R) answer list (LL5824-9) of full body (LA31771-1) are excluded from the denominator. These exams are included in the initial population because they have a non-missing CT Dose and Image Quality Category but are then removed as a Denominator Exclusion in the eCQM because the value is full body, which reflects CT exams that cannot be categorized by anatomical area or by clinical indication, either because they are simultaneous exams of multiple body regions outside of four commonly encountered multiple region groupings, or because there is insufficient data for their classification based on the given diagnosis and procedure codes.

This eCQM is an episode-based measure and should be reported for each eligible CT scan performed in a hospital outpatient setting.

This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Transmission Format

TBD

Initial Population

All CT scans in adults aged 18 years and older at the start of the measurement period that have a CT Dose and Image Quality Category and were not performed in a hospital inpatient setting, that end during the measurement period, and not part of an inpatient hospitalization

Denominator

Equals Initial Population with a CT Dose and Image Quality Category, a Calculated Global Noise value, and a Calculated CT Size-Adjusted Dose value

Denominator Exclusions

CT scans in the Denominator, where a CT scan with a CT Dose and Image Quality Category = full body

Numerator

CT scans with a calculated CT Size-Adjusted Dose greater than or equal to a threshold specific to the CT Dose and Image Quality Category, or Calculated CT Global Noise value greater than or equal to a threshold specific to the CT Dose and Image Quality Category

Numerator Exclusions

None

Denominator Exceptions

None

Supplemental Data Elements

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Population Criteria
Definitions
Functions
Terminology
Data Criteria (QDM Data Elements)
Supplemental Data Elements
Risk Adjustment Variables

Population Criteria

Initial Population

  "Qualified Scan Without Inpatient Encounter"

- Denominator
  - "Qualified Scan With Values"

Denominator Exclusions

  "Qualified Scan With Values" CTScan
    where CTScan.result ~ "Full Body"

Numerator

  "Qualified Scan With Values" CTScan
    where AlaraCommon."CT Scan Qualifies" ( CTScan )

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

- Stratification
  - None

Definitions

Denominator
- - "Qualified Scan With Values"

Denominator Exclusion

  "Qualified Scan With Values" CTScan
    where CTScan.result ~ "Full Body"

Initial Population

  "Qualified Scan Without Inpatient Encounter"

Numerator

  "Qualified Scan With Values" CTScan
    where AlaraCommon."CT Scan Qualifies" ( CTScan )

Qualified Scan

  ["Diagnostic Study, Performed": "CT dose and image quality category"] CTScan
    where Global."NormalizeInterval" ( CTScan.relevantDatetime, CTScan.relevantPeriod ) ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of "Measurement Period") >= 18

Qualified Scan With Values

  "Qualified Scan Without Inpatient Encounter" CTScan
    where AlaraCommon."Global Noise Value" ( CTScan ) is not null
      and AlaraCommon."Size Adjusted Value" ( CTScan ) is not null
      and CTScan.result is not null

Qualified Scan Without Inpatient Encounter

  "Qualified Scan" QualifiedCTScan
    without ["Encounter, Performed": "Encounter Inpatient"] Encounter
      such that Global."NormalizeInterval" ( QualifiedCTScan.relevantDatetime, QualifiedCTScan.relevantPeriod ) starts during Encounter.relevantPeriod

SDE Ethnicity

  ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

  ["Patient Characteristic Payer": "Payer Type"]

SDE Race

  ["Patient Characteristic Race": "Race"]

SDE Sex

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

Functions

AlaraCommon.CT Scan Qualifies(Study "Diagnostic Study, Performed")

  "Qualifies"(Study, "Abdomen and Pelvis Low Dose", 64, 598)
    or "Qualifies"(Study, "Abdomen and Pelvis Routine Dose", 29, 644)
    or "Qualifies"(Study, "Abdomen and Pelvis High Dose", 29, 1260)
    or "Qualifies"(Study, "Cardiac Low Dose", 55, 93)
    or "Qualifies"(Study, "Cardiac Routine Dose", 32, 576)
    or "Qualifies"(Study, "Chest Low Dose", 55, 377)
    or "Qualifies"(Study, "Chest Routine Dose", 49, 377)
    or "Qualifies"(Study, "Cardiac High Dose or Chest High Dose", 49, 1282)
    or "Qualifies"(Study, "Head Low Dose", 115, 582)
    or "Qualifies"(Study, "Head Routine Dose", 115, 1025)
    or "Qualifies"(Study, "Head High Dose", 115, 1832)
    or "Qualifies"(Study, "Extremity", 73, 320)
    or "Qualifies"(Study, "Neck or Cervical Spine", 25, 1260)
    or "Qualifies"(Study, "Thoracic or Lumbar Spine", 25, 1260)
    or "Qualifies"(Study, "Simultaneous Chest and Abdomen and Pelvis", 29, 1637)
    or "Qualifies"(Study, "Simultaneous Thoracic and Lumbar Spine", 25, 2520)
    or "Qualifies"(Study, "Simultaneous Head and Neck Routine Dose", 25, 2285)
    or "Qualifies"(Study, "Simultaneous Head and Neck High Dose", 25, 3092)

AlaraCommon.Global Noise Value(Study "Diagnostic Study, Performed")

  First ( Study.components StudyComponents
      where StudyComponents.code ~ "Calculated CT global noise"
        and StudyComponents.result.unit = '[hnsf\'U]'
      return StudyComponents.result.value as Decimal
  )

AlaraCommon.Qualifies(Study "Diagnostic Study, Performed", code System.Code, noiseThreshold Decimal, sizeDoseThreshold Decimal)

  Study.result ~ code
    and ( "Global Noise Value"(Study) >= noiseThreshold
        or "Size Adjusted Value"(Study) >= sizeDoseThreshold
    )

AlaraCommon.Size Adjusted Value(Study "Diagnostic Study, Performed")

  First ( Study.components StudyComponents
      where StudyComponents.code ~ "Calculated CT size-adjusted dose"
        and StudyComponents.result.unit = 'mGy.cm'
      return StudyComponents.result.value as Decimal
  )

Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

  if pointInTime is not null then Interval[pointInTime, pointInTime]
    else if period is not null then period 
    else null as Interval<DateTime>

Terminology

code "Abdomen and Pelvis High Dose" ("LOINC Code (LA31754-7)")
code "Abdomen and Pelvis Low Dose" ("LOINC Code (LA31752-1)")
code "Abdomen and Pelvis Routine Dose" ("LOINC Code (LA31753-9)")
code "Calculated CT global noise" ("LOINC Code (96912-1)")
code "Calculated CT size-adjusted dose" ("LOINC Code (96913-9)")
code "Cardiac High Dose or Chest High Dose" ("LOINC Code (LA31761-2)")
code "Cardiac Low Dose" ("LOINC Code (LA31755-4)")
code "Cardiac Routine Dose" ("LOINC Code (LA31756-2)")
code "Chest Low Dose" ("LOINC Code (LA31758-8)")
code "Chest Routine Dose" ("LOINC Code (LA31759-6)")
code "CT dose and image quality category" ("LOINC Code (96914-7)")
code "Extremity" ("LOINC Code (LA31765-3)")
code "Full Body" ("LOINC Code (LA31771-1)")
code "Head High Dose" ("LOINC Code (LA31764-6)")
code "Head Low Dose" ("LOINC Code (LA31762-0)")
code "Head Routine Dose" ("LOINC Code (LA31763-8)")
code "Neck or Cervical Spine" ("LOINC Code (LA31766-1)")
code "Simultaneous Chest and Abdomen and Pelvis" ("LOINC Code (LA31768-7)")
code "Simultaneous Head and Neck High Dose" ("LOINC Code (LA31770-3)")
code "Simultaneous Head and Neck Routine Dose" ("LOINC Code (LA31769-5)")
code "Simultaneous Thoracic and Lumbar Spine" ("LOINC Code (LA31851-1)")
code "Thoracic or Lumbar Spine" ("LOINC Code (LA31767-9)")
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Federal Administrative Sex" (2.16.840.1.113762.1.4.1021.121)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Race" (2.16.840.1.114222.4.11.836)

Data Criteria (QDM Data Elements)

"Diagnostic Study, Performed: CT dose and image quality category" using "CT dose and image quality category (LOINC Code 96914-7)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer Type" using "Payer Type (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: Federal Administrative Sex" using "Federal Administrative Sex (2.16.840.1.113762.1.4.1021.121)"

Supplemental Data Elements

SDE Ethnicity

  ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

  ["Patient Characteristic Payer": "Payer Type"]

SDE Race

  ["Patient Characteristic Race": "Race"]

SDE Sex

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

Risk Adjustment Variables

None

Measure Set