NQF Measure: The UCSF Computed Tomography Radiation Dose Patient Safety Measure

National Quality Forum Measure: PSM-044-10

The National Quality Forum (NQF) is a nonprofit organization that operates under a mission to improve the quality of American healthcare. The NQF’s three-part mission (1) builds consensus on national priorities and goals for performance improvement; (2) endorses national consensus standards for measuring and publicly reporting on performance; and (3) promotes the attainment of national goals through education and outreach programs.

The NQF has recently endorsed the UCSF Computed Tomography (CT) Radiation Dose Patient Safety Measure (PSM-044-10), developed by UCSF Radiologist, Rebecca Smith-Bindman, MD.  As part of the measure, medical institutions will voluntarily submit CT dose information for a sequential number of patients undergoing CT exams. The data from each institution will be used to develop a large database of radiation dose information based on protocol ordered, size of facility, and geography. Using the data gathered at an international level, the NQF will provide each institution with a report (audit) detailing site performance in comparison to regional, national, and international levels of radiation dose in CT imaging.

Using the NQF audits, institutions will be aware of site performance levels with regards to CT radiation and can act accordingly to address any high dose concerns. The NQF Measure will take into account recently improved ways to assess patient dose that account for patient size (this standard was developed by Task Group 204 of the American Association of Physicists in Medicine). By using up-to-date patient dose estimates, the NQF audits will provide sites with an accurate representation of patient dose.

What Does the NQF Measure Do, Exactly

  • The NQF will use dose-length product (DLP) as a measure of dose
  • DLP quantifies the radiation dose to which a patient is exposed, and thus, provides an estimate of the dose absorbed by the patient
  • The NQF will also consider effective dose measurements, which are helpful in easily identifying exceedingly high exam doses, tracking doses over time, and assessing facility performance
  • After collecting dose measurements for patients undergoing scans, the NQF will have CT radiation dose distributions across numerous institutions
  • Each institution will receive an audit report from the NQF comparing the institution’s radiation dose levels for various protocols to national levels
  • For institutions with doses above average, the NQF will provide suggested approaches to reduce the high radiation dose levels
  • These approaches include protocol revision, utilization reduction when appropriate, and dose reduction software alternatives

Why Should I Take Part in the NQF Measure If It's Voluntary

  • Improve the quality of care by reducing radiation dose exposed to a patient
  • California has passed Senate Bill 1237 mandating all health care providers to record radiation doses in the patient medical records and to report exceedingly high doses
  • Other states and organizations will likely follow CA SB1237
  • The Joint Commission on Accreditation and Health Care (JCAHO) has created a sentinel event system to monitor CT radiation (includes SB1237 regulations)
  • Sites will be able to easily identify exceedingly high-dose protocols and individual exams in the NQF audit reports
  • With the potential to look at dose distributions based on machine used, ordering physician and performing technologist, institutions will be able to address specific issues that have raised dose levels
  • The NQF measure aims to provide institutions with a suggested approach to empower physicians and technologists with the tools necessary to reduce dose