What you need to know
Radiation safety continues to be a major issue in today’s healthcare environment with organizations like the American College of Radiology (ACR) and the National Equipment Manufacturers Association (NEMA) focused on promoting the adoption of radiation dose standards to improve patient safety. This includes NEMA XR-29, also known as Smart dose, set forward by the Medical Imaging and Technology Alliance (MITA), a division of NEMA. While it addresses four major standards for CT dose optimization it also has the potential to bring down reimbursement, as much at 15% for CT scanners that don’t meet the standards set forward by XR-29.
Preceded by XR-25, XR-26 and XR-27 dose-related standards, XR-29 focuses on improving radiation dose management as well as obtaining high-quality images at the lowest possible dose in medical imaging. It consists of four major standards as outlined by NEMA below:
- DICOM SR – This is the Radiation Dose Structured Report, which enables recording of post-exam dose information in a standardized electronic format. This information can be included in the patient record, promoting the establishment of diagnostic reference levels, as well as facility dose management and quality assurance.
- CT Dose Check –This incorporates two features—dose notifications and dose alerts—that warn operators and physicians when dose exceeds established thresholds.
- Automatic Exposure Control (AEC) – This automatically adjusts the amount of radiation within prescribed bounds as needed to achieve the desired image quality. Studies of AEC procedures have demonstrated dose reductions when used properly.
- Radiation Dose Protocols –This is a set of pre-loaded parameters on a CT system that can be selected by the operator to complete a particular clinical task, such as capturing an image of the abdomen.
The XR-29 standards offer a path to further improve radiation dose optimization and management on all ionizing emitting equipment, not just CT. However, in an era of declining reimbursement, not just with CT, but within radiology/cardiology as well NEMA XR-29 has the potential to bring down reimbursement even further. According to CMS, if a CT scanner is not XR-29 compliant by January 2016 reimbursement will be reduced by 5%. This number jumps to 15% if a CT scanner does not meet XR-29 standards by January 2017.
For older CT scanners that are unable to use the most recent generation of dose reduction packages from CT vendors, products offered by Sapheneia, Radimetrics and Atlantis Worldwide should enable use of older CTs with lower radiation dose protocols to meet XR-29 requirements. At MD Buyline, we have seen XR-29 in action and practice on the CT and PET/CT quotes sent in for analysis for quite some time.
For those interested in learning about XR-29, a copy is available for purchase through global.ihs.com for $51.00.
MD Buyline encourages all of the CT vendors to send us their plans on how they are preparing for to address the XR-29 standard for their portfolio of CT scanners so that we can share this with MD Buyline members.