From virtual deep dives to on-site insights, the revamped Diagnostic Imaging Center of Excellence (DICOE) program is changing how facilities demonstrate excellence.
The ACR’s Diagnostic Imaging Center of Excellence (DICOE) program has long represented a gold standard in imaging quality. Now, with the introduction of a three-tiered designation — DICOE, DICOE With Distinction and DICOE Pinnacle — the program is entering a new phase focused on both flexibility and deeper evaluation.
Recent on-site and virtual experiences from sites and surveyors reveal how these changes are reshaping the DICOE process and what they mean for facilities striving to demonstrate excellence.
For Joanne Johnson, MBA, MHA, CNMT, RT(N)(CT)(ARRT), senior director of academic imaging at the M Health Fairview University of Minnesota Medical Center (UMMC) system in Minneapolis, the transition to virtual surveys has brought an unexpected advantage: structure.
Johnson’s team recently completed a virtual survey under the updated model, and she describes it as one of the most organized experiences they’ve had. By allowing facilities to upload documentation in advance, the virtual format gives surveyors the opportunity to conduct a more comprehensive review before engaging with the team.
“I felt like the virtual process allowed the DICOE team to really do a deeper dive into all the work that we do,” Johnson explains. “There’s only so much time during an in-person visit, but with everything preloaded, they can review every aspect more thoroughly.”
I felt like the virtual process allowed the DICOE team to really do a deeper dive into all the work that we do. There’s only so much time during an in-person visit, but with everything preloaded, they can review every aspect more thoroughly.
Her team leaned heavily on the DICOE toolkit, building a centralized, hyperlinked system of policies, quality metrics and compliance documentation. That level of preparation not only streamlined the virtual survey but also positioned them for ongoing readiness, regardless of format.
The new tiered structure and the advanced criteria add another layer of motivation.
DICOE demonstrates the infrastructure, policies and procedures required to assure consistently high-quality care and service. DICOE With Distinction facilities meet DICOE requirements and demonstrate elements of outstanding performance in some advanced DICOE domains. DICOE Pinnacle facilities meet DICOE with Distinction criteria and demonstrate excellence in many advanced DICOE domains.
“I always love a challenge,” Johnson says. “Now it’s not just about being a center of excellence. It’s about asking, what gets us to the next level?”
Not all facilities are ready to leave in-person surveys behind. At Joe DiMaggio Children's Hospital in Hollywood, Fla., Supervisor and Nuclear Medicine and Radiation Safety Officer Dayna Pronek-Ortiz, MPH, CNMT, NMTCB(RS), RT(N), has experienced both formats and sees clear value in on-site visits.
“For me, I have to see it, feel it, breathe it,” she says. “You can make everything look beautiful on a screen, but you’re not always seeing the full picture.”
At a pediatric hospital where the patient experience includes therapy dogs and even a resident clown, the physical environment is part of the story. Pronek-Ortiz notes that these elements are difficult to fully convey in a virtual setting, where surveys may rely on mobile cameras and video walkthroughs.
She also points to practical challenges. During virtual surveys, teams may need to quickly locate policies or documentation in real time, creating added pressure. In contrast, on-site visits allow for more natural interaction and flexibility.
Still, the evolving process is not without benefits. A recent virtual “pre-DICOE” review — part of the updated program — helped her team organize materials in advance, making the upcoming on-site survey smoother. “It was frustrating at first because it was new,” she admits, “but now I think it’s going to make everything easier.”
From the surveyor side, virtual site visits have expanded access while introducing new considerations.
Maria Piraner, MD, chief of radiology at Emory Johns Creek Hospital in Johns Creek, Ga., serves on the committee that developed the advanced criteria and has conducted both virtual and in-person surveys.
Virtual reviews, she notes, make it easier for surveyors — many of whom balance clinical responsibilities — to participate without travel. They also allow more frequent engagement across sites.
At the same time, in-person visits offer intangible benefits. “You can definitely feel the room differently when you’re on site,” she says. “It can be easier to get a sense of culture and how teams work together.”
Even so, virtual tools have evolved. Facilities now provide detailed documentation, photos and video walkthroughs, and surveyors meet with multidisciplinary teams via video. “You can still get a sense of how engaged a team is,” Piraner explains. “Who shows up, how they interact — it tells you a lot.”
Beyond format, the most significant change may be the introduction of advanced criteria tied to With Distinction and Pinnacle designations.
All facilities must meet core DICOE requirements, but the higher tiers recognize those that go further, demonstrating innovation, measurable quality improvement and patient-centered care.
Examples include robust quality improvement programs, participation in registries with actionable data analysis, recommendation tracking systems to ensure follow-up care and the integration of tools like artificial intelligence or clinical decision support.
“The goal is to recognize facilities that go above and beyond,” Piraner says, “and also to give others a roadmap for how to get there.”
Documentation plays a critical role. Surveyors are looking not just for initiatives, but for clear data showing how projects were implemented and what outcomes they achieved.
As the DICOE program evolves, one thing is clear: there is no one-size-fits-all approach.
Virtual surveys offer efficiency, structure and the ability to conduct deeper document reviews. In-person visits provide immersive insight into culture, environment and patient experience.
For facilities pursuing DICOE designation or aiming for higher tiers, success comes down to preparation, strong documentation and a sustained commitment to continuous improvement. As Pronek-Ortiz puts it, “[DICOE] is a whole other level. It’s a lot, but it’s worth it.”
By Raina Keefer, contributing writer, ACR Press.
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