Lessons learned from early adopters of new CMS radiology quality measure
Experts are sharing lessons learned from early adopters of a new Centers for Medicare & Medicaid Services quality metric, measuring excessive radiation dosage from CT scans.
CMS first adopted the Excessive Radiation Dose or Inadequate Image Quality for Diagnostic CT in Adults (also known as ExRad) in late 2023. It’s used across three quality reporting programs, with voluntary reporting beginning in January 2025, experts write Tuesday in JACR.
Researchers aimed to gather early takeaways from 254 facilities that have adopted the measure during the first 16 months of its inclusion in CMS programs. Out of nearly 784,000 scans in 16 CT categories, they found that about 31% of scans fell outside of the acceptable radiation range. This included wide variation across facilities and different CT categories, even in the same institution.
"The same CT scan can expose one patient to many times the radiation of another, depending simply on where that patient is imaged—and that variation is entirely modifiable,” lead author Rebecca Smith-Bindman, MD, a professor with the University of California, San Francisco, said in a statement from the American College of Radiology, shared Nov. 3. “What these data show is that excellent performance is already achievable with the scanners hospitals have today: Some facilities are at near-zero out-of-range rates in the exact categories where others exceed 90%.”
Among the out-of-range scans, nearly 31% exceeded the established dose threshold and about 1% fell short on image quality, the study found. Facility scores varied widely, with a median of about 30%. Facilities at the 90th percentile scored nearly 5 times more out-of-range scans than those at the 10th percentile.
Median out-of-range percentages by category varied from 0% (routine and low-dose cardiac CT) to 83% (high-dose head scans). Routine abdomen and pelvis CT—the highest-volume category—had a median of about 44%. Within facilities, the median gap between best- and worst-performing category was 74 percentage points, the authors noted. Three common scan types—routine abdominopelvic, chest, or head CT—accounted for 72% of all out-of-range scans while representing 56% of imaging volume.
“Early results from 254 facilities are both encouraging and sobering,” the authors wrote. “The wide variation in performance, both across and within facilities, indicates substantial opportunities for improvement, and near-zero out-of-range rates at some facilities, for the same body regions in which other facilities have high rates, demonstrate that excellent performance is achievable with existing technology,” they added.
You can read much more, including potential study limitations, in the Journal of the American College of Radiology. Smith-Bindman—who also is co-founder and chief medical officer of Alara Imaging, a company that helps health systems with radiology measure compliance—and co-authors also published a companion JACRpiece on Tuesday, offering further background and details on the ExRad measure.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.