Development of an Electronic Clinical Quality Measure for Excessive Radiation Dose or Inadequate Image Quality in Diagnostic CT in Adults
- Journal
- Journal of the American College of Radiology : JACR (Q1)
- Published
- 3 November 2026
- Study design
- Narrative review / expert opinion
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Rebecca Smith-Bindman, Andrew B Bindman, Marc D Kohli, Carly Stewart, Timothy P Szczykutowicz, Ronald M Kline, et al.
- PMID
- 42975389
- DOI
- 10.1016/j.jacr.2026.09.021
Why clinicians should know about it
- Picked for Medical Physics (paper of the day, 7 November 2026): Validated automated measure for CT dose and image quality
Abstract
The Excessive Radiation Dose or Inadequate Image Quality for Diagnostic CT in Adults (ExRad) measure is the first automated radiology outcome measure adopted by CMS. We describe its development, specification, calculation, and adoption. Beginning in 2018, the measure was developed under a CMS cooperative agreement following the Measures Management System Blueprint, with oversight from a multidisciplinary Technical Expert Panel. ExRad evaluates each adult diagnostic CT examination in three steps. First, the examination is assigned to 1 of 19 CT categories defined by anatomic region and clinical indication using International Classification of Diseases, 10th Revision, Clinical Modification and Current Procedural Terminology codes. Second, size-adjusted radiation dose and image noise are computed from the DICOM dose report and pixel data; because clinical and radiology data reside in separate systems, translation software inside the hospital firewall performs the linkage and calculations automatically. Third, dose and noise are compared with category-specific thresholds derived from a reader study in which 125 radiologists rated the image quality of 734 CT examinations. An examination is out of range if either value exceeds its threshold, and the measure score is the percentage of eligible examinations that are out of range. Testing across 32 facilities in eight health systems confirmed the availability, accuracy, validity, and reproducibility of all data elements, and the National Quality Forum endorsed the measure in 2021. CMS adopted ExRad in 2023 into hospital inpatient, hospital outpatient, and clinician quality reporting programs, with voluntary reporting beginning in 2025. It is the sole outcome measure in the Diagnostic Radiology MIPS (Merit-Based Incentive Payment System) Value Pathway.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.