Medical imaging has revolutionized patient care, enabling physicians to detect disease earlier and improve health outcomes. While evidence shows the benefits of appropriate imaging far outweigh the potential risks, the industry leads a global effort to mitigate radiation dose exposure while maintaining, or even improving, image quality.

While new innovations and standards are available to help ensure proper use of imaging technologies, truly successful dose optimization requires ongoing collaboration with industry partners, health professionals, regulatory bodies and government agencies. Manufacturers are only one piece of the puzzle. At the heart of collaborative efforts to ensure patients receive safe, effective care is the implementation of physician-developed appropriateness criteria to guide decision-making and industry led manufacturer standards to provide tools to manage dose.

Implementing standards ensures physicians and technicians are equipped to produce quality images while customizing a procedure to meet an individual patient’s needs based on age, body size and other factors. In partnership with the National Electrical Manufacturers Association (NEMA), its parent organization, the Medical Imaging & Technology Alliance (MITA) has a long history developing standards and driving consensus among stakeholders to improve imaging technologies for the benefit of patients.


NEMA XR-29 Standard Attributes on Computed Tomography (CT) Equipment Related to Dose Optimization and Management, or MITA Smart Dose, identified four safety features of CT equipment that enable optimization and management of radiation dose, such as notifications and alerts that signal when dose exceeds established thresholds. All new CT equipment includes these features, and in April 2014, President Barack Obama signed into law a policy to incentivize the adoption of XR-29. As a result, scans performed on noncompliant CT and hybrid scanners now receive a 5 percent reduction in Medicare reimbursement, and next January, this will increase to 15 percent. These reductions apply to the hospital outpatient setting as well as services billed under the physician fee schedule.

Continuing its focus on patient safety, NEMA published NEMA XR-31 Standard Attributes on X-ray Equipment for Interventional Procedures, which identifies key features that contribute to enhanced patient care and manage dose delivery while still yielding quality images. XR-31 includes eight features that should be taken into consideration when performing risk management evaluations on stationary x-ray interventional equipment. These features were introduced over the course of the past decade and are now considered state of the art.

XR-29 and XR-31 provide tools for dose measurement, reporting and management. Implementation of these tools is critical to producing quality diagnostic images and managing dose. MITA and its members are dedicated to partnering with all stakeholders to promote use of these tools to ensure safe and appropriate use of medical imaging technology. Our industry has long been committed to patient safety. Over the past few decades, manufacturers have introduced new products and innovations that have reduced dose for many procedures by up to 75 percent, while continually improving the ability of these technologies to aid in diagnosing and treating cancer and other diseases.

Advances in CT imaging, such as the incorporation of iterative reconstruction algorithms and features like DICOM Dose Structured Reporting, have made it possible to dramatically lower dose while still yielding high-quality images. Coupled with improved decision support systems, these advances help ensure all patients receive the right scan at the right time with the lowest possible dose.

Looking ahead to 2017 and beyond, we expect providers will continue upgrading existing CT equipment to comply with XR-29, or purchase new systems with more advanced radiation dose reduction capabilities. MITA continues to coordinate with the Centers for Medicare & Medicaid Services (CMS) and other partners on the implementation of the new reimbursement policy and work with all stakeholders to develop and promote additional equipment standards that will further enhance patient safety for the next generation of advanced imaging technologies.


About the author: Patrick Hope is the executive director of the Medical Imaging & Technology Alliance (MITA).