The Medical Imaging and Technology Alliance (MITA) authored a white paper designed to help technologists and healthcare providers determine if their CT equipment is compliant with the XR-29-2013 standard, also known as Smart Dose CT.

Beginning in 2016, Medicare will pay less for scans performed on CT systems found to be not compliant with this new standard. It is believed that, at minimum, healthcare providers will be asked to provide documentation that proves their systems are compliant with certain Smart Dose requirements.

The MITA white paper identifies the four key attributes as: CT DICOM Radiation Dose Structured Reports, CT Dose Check, Automatic Exposure Control, and Pediatric and Adult Reference Protocols.

1.      CT DICOM Radiation Dose Structured Reports (DICOM RDSRs), which capture pre- and post-exam dose information in a standardized electronic format, must be included with each scan. The report can then be included in the patient’s record.

Older scanners would store information with a “screen capture” of the dose report listing, and some software has attempted to produce results similar to a DICOM RDSR, but these reporting techniques are not compliant, MITA states.

2.      CT Dose Check notifies and alerts the user when a dose index is estimated to be above predetermined limitations built into the system’s firmware. The limits are calculated by the healthcare provider, but entered into the system by the manufacturer.

A series of prompts then appear, requiring the user to enter their name, provide their reason for going past the limits, and confirm the protocol. A password also sometimes is required before beginning the scan.

3.      Automatic Exposure Control (AEC) adapts radiation output according to the body region being scanned. Parameters for AEC are determined either during the scan setup process or during the scan.

4.      Pediatric and Adult Reference Protocols are established by the healthcare provider and then pre-loaded into the CT system, with help from the manufacturer. These reference protocols serve as a baseline for a variety of scan types.

The white paper also points out that providers attempting to update their old CT systems to meet these new requirements should use extreme caution. The systems are complex, and making changes to the equipment could cost a great deal of money and/or void manufacturer warranties.