Imaging experts warn of challenges implementing CMS radiology quality measure

Imaging experts are warning of challenges in implementing a new Centers for Medicare & Medicaid Services quality measure that impacts the specialty. 

As CT utilization continues to rise, maintaining appropriate image quality while minimizing radiation exposure can prove difficult. To address this, CMS introduced the “Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults” quality measure (CMS1074v3). It evaluates the proportion of scans that exceed certain thresholds for image noise or radiation dose across 18 categories, experts detailed Thursday in JACR. 

Voluntary reporting started in January, while mandatory compliance is slated to begin in 2027. It is being incorporated across the three main CMS quality-based payment programs, including both hospital outpatient and inpatient reporting, along with the Merit-Based Incentive Payment System. 

However, researchers with the University of Kentucky are warning that inconsistencies in how providers measure CT size-adjusted radiation dosing could impact their performance.

“CMS does not clearly define how patient size should be determined, instead referencing existing methodologies,” Gary Ge, PhD, a medical physicist with UK’s Department of Radiology, and co-authors wrote July 31. “Moreover, clinical factors such as anatomical region and protocol selection can influence patient size estimation differently depending on the calculation method used, introducing additional inconsistency. The lack of standardization complicates reporting and undermines the measure’s reliability.” 

To prove their point, researchers analyzed 719 CT exams across seven protocols. These included five abdomen and two chest procedures covering various categories based on examples cited in the CMS measure. They evaluated five differing methods for calculating patient diameter. The analysis showed that size-adjusted dose values varied significantly between different calculation methods. 

Based on the results, Ge and co-authors recommended three actions to improve the consistency and reliability of CMS radiation dose reporting across differing clinical settings:

1. Mandate protocol-specific calibration of patient diameter estimation methods: Institutions should benchmark and tailor patient diameter estimation methods to each CT protocol. These methods should be reviewed annually by qualified medical physicists, ensuring continued alignment with clinical expectations and regulatory compliance thresholds. 
2. Standardize CT exam categorization through DICOM metadata mapping: Variability in these conventions can contribute to inconsistencies in CT exam classification, the authors noted. Radiology providers should adopt standardized mapping protocols to help improve uniformity in reported data. CMS could help facilitate this effort by providing a publicly available mapping table to guide institutions in consistent exam categorization.
3. Classifying CT protocols into appropriate dose categories remains a concern: Ge and co-authors said CMS should undertake a comprehensive evaluation of category dose thresholds using updated, multi-institutional datasets, helping to minimize misclassification and better reflect current clinical practice. 

“Addressing these uncertainties will require ongoing collaboration and refinement of methodologies to ensure that radiation dose reporting remains accurate, meaningful, and actionable for patient safety and clinical decision-making,” the authors concluded. 

You can read much more in the Journal of the American College of Radiology. The American Association of Physicists in Medicine also raised concern about this issue earlier this year.