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Credit Appropriate Imaging

R-SCAN™ drives quality improvement with PI-CME and new CDS registry.
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The cornerstone of R-SCAN is the collaboration between radiologists and referring physicians to make sure every patient receives the right imaging test at the right time.

—Max Wintermark, MD
May 02, 2019

ACR launched the Radiology Support, Communication, and Alignment Network (R-SCAN™) in 2015 to bring radiologists and referring clinicians together to streamline ordering, lower costs, and improve imaging appropriateness. As of April 1, 2019, practices conducting an R-SCAN quality improvement (QI) project can now earn 20 AMA PRA Category 1 Credits™ for Performance Improvement Continuing Medical Education (PI-CME).

“The cornerstone of R-SCAN is the collaboration between radiologists and referring physicians to make sure every patient receives the right imaging test at the right time,” says Max Wintermark, MD, chief of neuroradiology at Stanford University and clinical advisor to R-SCAN.

A PI-CME activity uses evidence-based performance measures and educational interventions to help clinicians improve outcomes in practice areas that directly impact patient care. Every accredited PI-CME activity includes three stages:

  1. Learning about specific performance measures and areas for improvement
  2. Implementing interventions to improve performance over a period of time
  3. Re-evaluating processes using the same performance measures 

The PI-CME offering is the latest in an array of benefits radiologists and referring providers realize from collaborating on an R-SCAN project.

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ACR, earlier this year, stressed the value of R-SCAN during a CMS-hosted quality and safety meeting — presenting it as a model for professional associations and individual radiology groups to accelerate the shift toward value-based care. A new opportunity for reaching that goal is participation in the CDS R-SCAN Registry, recently added to the ACR National Radiology Data Registry (NRDR®) for facilities using CareSelect® Imaging. CareSelect is based on the ACR Appropriateness Criteria® and other guidelines to advise providers ordering imaging for patients.

The National Decision Support Company (NDSC) maintains the CareSelect database, which houses more than 3,000 clinical scenarios and 15,000 criteria. “An R-SCAN QI project can be completed using the CDS R-SCAN Registry data,” says Nancy Fredericks, R-SCAN program director. “For radiologists and referrers who are affiliated with a facility using CareSelect, we can view their CDS NDSC data with an effective reporting tool to identify areas for improvement. It eliminates the need to do a manual case review,” she says.

PI-CME credit is available for completing an R-SCAN project whether participants use data from the CDS R-SCAN Registry or data entered into the R-SCAN portal.


Participating in an R-SCAN project also allows radiologists and collaborating clinicians to meet the Merit-Based Incentive Payment System Improvement (MIPS) Improvement Activity (IA) requirements under MACRA. Radiologists and referring clinicians participating in MIPS earn seven medium-weight IA credits for completing an R-SCAN project. With MACRA’s payment structure tying radiologists’ reimbursement to their role in delivering better care at lower costs, programs like R-SCAN demonstrate how they bring value to patient care.

Since R-SCAN began, the combined efforts of radiologists and referrers have significantly improved the ordering of value-added exams. Their efforts have been supported by readily available educational materials, such as case reviews, articles, podcasts, and videos, on the most current evidence supporting appropriate imaging at the right time.

The majority of R-SCAN projects to date have involved imaging for suspected pulmonary embolism, low back pain, and inconsequential adnexal cysts. According to Fredericks, as of last fall, R-SCAN supported 158 registered projects implemented by 120 imaging practices and involving 10,000 clinicians. “It’s exciting to see the positive results of radiologists engaging with referring clinicians to improve imaging care across a wide variety of practice settings,” Fredericks says.

According to Wintermark, R-SCAN can help radiologists show the value they bring to patient care. “R-SCAN leverages tools that are going to become part of our routine clinical practice,” he says. “The program reinforces and enhances the role of stewards of appropriate imaging utilization that radiologists have held for many decades.”

Author Chad Hudnall  senior writer, ACR Press