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ACR Dose Index Registry
Richard L. Morin, Ph.D., FAAPM
AAPM Spring Clinical Meeting
March 17, 2012
Why a Dose Index Registry?
CT scans contribute 25% of radiation dose
From NCRP Report No. 160, “Ionizing Radiation Exposure
of the Population of the United States” (2009)
What is the national average level of
radiation administered by imaging
facilities for a CT of the head?
We don’t really know!
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What is the Dose Index Registry? •  One component of the Na=onal Radiology Data Registry •  Collects and compares dose index informa=on across facili=es •  Uses standard methods of data collec=on –  DICOM SR, IHE REM Profile •  Establishes na=onal benchmarks and prac=ce paJerns in dose indices Does It Work? §  Evidence of data-­‐driven improvement in performance from: §  Medicine in general (outside radiology) §  CT dose (for CCTA) §  ACR registries (for recent registries) 2
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Evidence on CABG mortality from the Society of Thoracic Surgeons Na=onal Adult Cardiac Database Ferguson TB Jr, Hammill BG, Peterson ED, DeLong ER, Grover FL; STS National Database Committee. A
decade of change--risk profiles and outcomes for isolated coronary artery bypass grafting procedures,
1990-1999: a report from the STS National Database Committee and the Duke Clinical Research Institute.
Society of Thoracic Surgeons. Annals of Thoracic Surgery 2002 February;73(2):480-9.
Evidence on CCTA From Michigan Registry 0.96
1600
1400
Dose-­‐length product (mGy x cm)
0.94
1200
0.92
1000
D
L
P
800
0.9
Diagnostic quality scan (%)
%
0.88
600
400
0.86
620
exams
943
exams
804
exams
802
exams
858
exams
Jul-­‐Aug 2007
Sep-­‐Oct 2007
Nov-­‐Dec 2007
Jan-­‐Feb 2008
Mar-­‐Apr 2008
835
exams
0.84
200
0
May-­‐Jun 2008
0.82
Raff GL, Chinnaiyan KM, Share DA, et al., “Radiation Dose From Cardiac Computed
Tomography Before and After Implementation of Radiation Dose-Reduction Techniques,”
Journal of the American Medical Association, June 2009, Vol. 301, No. 22, pp. 2340-2348.
Evidence From ACR Registries: Adequacy of Screening CTC Exams
500
80%
400
60%
300
40%
20%
200
228
exams
from
5 sites
250
exams
from
5 sites
250
exams
from
6 sites
267
exams
from
7 sites
0%
100
Number of screening exams (Denominator)
Registry average ( Measure %)
Evidence from ACR Registries: Adequacy of Screening CTC Exams 100%
0
July 2008 December 2008
January 2009 June 2009
July 2009 December 2009
January 2010 June 2010
The blue line across the chart indicates the trend in the measure over 3me with 95% confidence intervals. The ver3cal orange bars indicate the number of cases used to calculate the measure. 3
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How does the Dose Index Registry
work?
Challenges
•  Procedure name standardization
–  Map procedure names to RadLex
•  Ability to capture data from new and old
scanners
–  DICOM structured report for new scanners
–  OCR on dose screen for old scanners
•  Patient size adjustment
–  Begin collecting localizer image in April 2012
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Registration Process
•  Sign Participation Agreement
•  Register on NRDR website
•  Download software to transmit data
–  We will contact you and walk you through the
installation
•  Configure scanners (or PACs)
•  Data transmission to NRDR is completely
automated – no personnel required
beyond initial setup
Using the registry
•  Run reports on own data at any time
•  Receive benchmark reports every six
months
•  Map facility procedure names to standard
tags to facilitate meaningful comparisons
Current status
Number of registered facilities
392
Number of active facilities
163
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International Participation
Country
Registered
Interested
Brazil
2
2
Spain
1
0
UK (Ireland)
1
0
Canada
0
4
Argentina
0
1
Switzerland
0
1
New Zealand
0
1
19
NRDR.ACR.ORG
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Sample Feedback Report
•  Provided every 6 months
•  Will soon include SSDE
Inclusion Criteria
•  Date range from July 1 – Dec 31, 2011
•  Age of patient > 18
•  Name of exam had to be tagged using DIR
Exam Mapping Tool
•  At least 100 exams from at least 10
different facilities had to be mapped to the
same tags
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CTDIvol Per Exam
CT Head WO IV Con
CTDIvol Per Scan
CT Head WO IV Con
CTDIvol Per Exam
CT Head WO IV Con
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CTDIvol Per Scan
CT Head WO IV Con
Mapping
•  Radlex Playbook
•  Each facility mapped exam descriptions to
standard terms
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Participation fees
§  One =me registra=on fee of $500 §  Annual par=cipa=on fee based on number of radiologists in prac=ce and number of sites. §  For most prac=ces with fewer than five sites, the annual par=cipa=on fee is between $500-­‐$2000 §  For prac=ces with six or more sites, the annual fee is between $1,000-­‐$10,000. §  The annual fee allows a facility to contribute data to any of five NRDR registries as a facility chooses. The five registries include DIR, NMD, CTC, ICE and GRID. For more informa=on, please contact: Laura Coombs, PhD lcoombs@acr.org 703-­‐715-­‐4383 or Mythreyi ChaKield, PhD mchaKield@acr.org 703-­‐715-­‐4394 17