1. Dose Index Registry CT Stakeholders Meeting November 30, 2010 Richard L. Morin, PhD, FACR Mayo Clinic Florida Chair, DIR Subcommittee

2. Facility and physicians submit data Receive periodic national benchmarking reports Analyze results Develop and implement improvement plan Cyclic Data Driven Improvement Process Guiding principle behind registries

3. 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

4. Evidence on CABG mortality from the Society of Thoracic Surgeons National 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.

5. Evidence on CCTA from Michigan Registry 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.

6. Evidence from ACR Registries: Adequacy of Screening CTC Exams The blue line across the chart indicates the trend in the measure over time with 95% confidence intervals. The vertical orange bars indicate the number of cases used to calculate the measure.

7. What is the Dose Index Registry?  Registry to collect and compare dose index information across facilities  Uses standard methods of data collection  DICOM SR, IHE REM Profile  Establishes national benchmarks and practice patterns in dose indices

9. Sample Scenario: Facility XYZ  Community Hospital  Located in the Midwest  Metropolitan Area (>100,000)  3 CT scanners (2 new, 1 old) from 2 vendors  Internal monitoring of dose indices  No idea how they compare to others

10. Facility XYZ: First Steps  Facility XYZ signs a Participation Agreement  ACR installs software on a free-standing PC at the facility  New scanners are able to implement IHE REM profile  DICOM SR for CT Dose  ACR software extracts the appropriate DICOM information from the CT image and transfers the data to the ACR  For legacy scanner Facility XYZ provides dose information in an acceptable format

11. Mapping to Radlex Playbook RPIDPlaybook TermScanner A and BScanner C RPID149051CT ABD/PEL WO IVCON CT ABD+PELVIS WO/CSTCT ABDOMEN & PELVIS WO IVC RPID149050CT ABD/PEL W IVCON CT ABD + PELVIS W/CSTCT ABDOMEN & PELVIS W/IVC

12. Facility XYZ: Active DIR Participant  For 6 months, the CT Dose SR for every exam is submitted to the DIR.  NO human intervention required!  After 6 months, Facility XYZ receives its first feedback report.

19. Facility XYZ: Quality Improvement Efforts  Examine protocols for CT ABD/PEL  Reach out to other facilities/organizations  Make adjustments to protocols

20. Facility XYZ: Second Feedback Report

21. Timeline  Summer/Fall 2010 Pilot for facilities with the following capabilities:  IHE REM Profile - includes DICOM SR (PS 3.16)  OR ability to collect and transmit data from legacy scanners  Open DIR nationwide in Spring 2011

22. For more information please contact: Laura Coombs, PhD lcoombs@acr.org (703) 715-4383 or Mythreyi Chatfield, PhD mchatfield@acr.org (703) 715-4394