Steven Don, MD, FACR, Chair of the American College of Radiology® (ACR®) Dose Index Registry (DIR) Digital Radiography (DR) Subcommittee, contributed this piece.

The pilot phase for the development of the ACR DIR DR module is underway. The initiative’s initial focus is to capture the state of practice nationally. Published research suggests that there is a 10-fold variation in exposure for the same exam for similar patients. The American Association of Physicists in Medicine’s Task Group 232 also showed a large variation in the recommended target exposure index values among participating centers for common examinations such as chest radiographs for adults and extremity radiographs for pediatrics.

Similar to the well-established DIR Computed Tomography (DIR CT) module that includes more than 50 million exams from upwards of 2,100 facilities, we intend to develop diagnostic reverence levels and achievable dose levels for common DR examinations. We also plan to help establish recommended target exposure index values to help decrease radiation-dose variability. This work will enable facilities participating in the DIR DR to compare their data to regional and national aggregate data and to determine if changes in their DR image acquisition techniques are needed to improve patient care.

The DIR DR pilot announced in the Journal of the American College of Radiology builds on the work of the DIR DR subcommittee that has validated the DICOM Radiation Dose Structured Report from seven DR equipment vendors. We also initiated a pilot study that has accrued 435,399 exams from 33 sites as of Jan. 6 ,2021. Chest radiography, as expected, accounts for more than one-third of the examinations.

Now, we are in the process of forming a working group from personnel at participating pilot facilities. Working group members will help identify issues and devise solutions. For example, how best to manage protocol-naming conflicts as, in the pilot data, we have sites that list chest exams 12 different ways for 2-view and portable examinations. Additionally, working group members will verify their facility is sending accurate data and will recommend the content and format for meaningful data summary reports. Finally, members will help provide future direction to the ACR DIR DR.

I invite you to enroll your facility in the ACR DIR DR pilot and participate with the working group. For centers already participating in the DIR CT module, it’s easy to get started by sending data via ACR TRIAD. Sites not already DIR participants can consult the DIR Start-up Guide for step-by-step instructions.

If you decide to join, please provide your contact information using this online form, and a member of our team will be in contact with you shortly after.

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