Since 2011, the ACR® Dose Index Registry (DIR) has helped clinicians and facilities improve the quality of patient care by collecting CT dose indices through automated data transmission and leveraging that data to provide feedback to participants and establish national benchmarks.
The DIR allows facilities to compare CT dose indices to regional and national values. Comparisons allow facilities to identify dose outliers by exam, so they can focus on reducing radiation exposure while maintaining image quality.
Now, the DIR is expanding beyond CT to add dose indices and comparison feedback reports for three additional modalities: fluoroscopy, nuclear medicine/PET and digital radiography. Participants in the DIR can access all four modality modules as part of their DIR registry fee.
DIR Fluoroscopy Module
The DIR Fluoroscopy Module is now available for enrollment and data submission. You can read about the features of the new interactive fluoroscopy standardized DIR reports in the Knowledge Base. Updated weekly, the reports provide an overview of your systems’ performance and allow you to delve into the details.
If your site already has a National Radiology Data Registry (NRDR®) account, but not DIR, you only need to complete an addendum to your existing agreement to participate in the DIR. No additional registration or fees are required for a facility currently participating in the CT DIR. New sites wishing to participate should complete the application process and create corporate and facility accounts in the NRDR.
Here are some steps to get started using the DIR Fluoroscopy Module:
- Download and install TRIAD software. The TRIAD Site Server software allows your facility to collect, de-identify and transmit data securely from your facility to NRDR registries. The TRIAD software must be downloaded, installed, configured and maintained by a site administrator on a physical or virtual server behind your site’s firewall. Sites already participating in the CT DIR can use the same TRIAD installation for the DIR Fluoroscopy Module.
- Submit your data via TRIAD. DIR data can be transmitted directly from scanners/fluoroscopes, your PACS or radiation dose monitoring software via the TRIAD software. See DIR Data Collection Using TRIAD for more information.
- Conduct exam name mapping. Sites that participate in the DIR Fluoroscopy Module have individual internal clinical procedure “names” (aka, procedure description, study description, etc.) for fluoroscopic procedures performed. Clinical procedure mapping is an ongoing process that allows for procedures that are named differently at different sites to be analyzed and compared with other sites by mapping site-specific clinical procedure names to a common lexicon. Once you begin submitting data, start standardizing your study descriptions, so that your data can be included in aggregate reports and compared with other facility data. Use the online ACR Exam Name Mapping Tool to help. If you need assistance, please view our Exam Name Mapping Webinar.
- Validate your data. The information collected is masked, transmitted to the ACR and stored in a database. Currently, you can use a DIR Fluoroscopy Module report to validate that the data you submitted is accurate. Coming soon: As more facilities participate and submit fluoroscopy dose indices, a suite of comparative benchmark reports similar to those for CT DIR will allow comparison of doses against national and regional benchmarks.
From the DIR Fluoroscopy Co-Chairs
A. Kyle Jones, PhD, FAAPM, and Kevin A. Wunderle, PhD
Participating in a multicenter radiation dose registry such as the ACR DIR Fluoroscopy Module is an indispensable part of a quality assurance program in fluoroscopy. The Fluoroscopy DIR is the only continuously updated radiation dose index dataset for fluoroscopy, allowing participating sites to compare dose indices from their practice against peers in their region and national benchmarks.
The Fluoroscopy DIR also offers participants additional ways to fulfill reporting requirements for the Merit-based Incentive Payment System Improvement Activities, and individuals who actively participate in submission of data to the registry can earn credit for the Maintenance of Certification Part 4: Improvement in Medical Practice requirements of the American Board of Radiology.
Register to participate in the DIR Fluoroscopy today!
DIR Nuclear Medicine/PET Module
The pilot of the nuclear medicine/PET module of the DIR is underway, allowing practices to assess the quality of care they provide to patients. Initially, the registry is focused on PET CT imaging data. Currently, sites submitting data for those exams can review submission summary data as a first step toward the goal of providing dose comparison reports similar to what is available in the DIR for CT exams.
The DIR offers a wide range of reports and tools, including interactive reports using Tableau software, that allow users to quickly identify dose outliers across scanners or exam types. Learn more about the PET CT assessment interactive reports:
DIR Digital Radiography Module
The DIR Digital Radiography Module is now entering the pilot phase, and we are actively recruiting facilities to submit data from digital radiography exams so we can begin developing and testing reports. If your facility is interested in participating in the pilot, please complete the DIR-DR Pilot Site Interest Form.
For more information about participating in any of the new DIR modules, contact NRDRsupport@acr.org.