AAPM-convened panel flags 20 key issues with the new measure designed to discourage excessive CT radiation dose while preserving image quality, citing ambiguities that could impact implementation and patient care.
An intersocietal panel of experts in computed tomography (CT) convened by the American Association of Physicists in Medicine (AAPM)—with representation from clinical practice, industry, academia, and professional societies—examined a new CT performance measure in the quality-based payment programs of the Centers for Medicare & Medicaid Services (CMS).
The measure seeks to discourage excessive radiation dose while preserving image quality. The measure has been incorporated into the major CMS quality-based payment programs, impacting hospitals and clinician payments. Measure reporting began in January 2025.
Following measure development, practitioners identified a spectrum of concerns and impediments, prompting the AAPM to convene a multidisciplinary expert panel to provide further guidance. The panel identified 20 important issues and ambiguities with the new measure and published their findings in the American Journal of Roentgenology.
“Transparency and stakeholder engagement are essential for effective quality initiatives in medicine,” says M. Mahesh, MS, PhD, president of AAPM, in a release. “We wrote this paper to call attention to issues and ambiguities with the CMS measure, and we look forward to working with CMS to address these issues and continue the culture of quality and safety that has developed in CT imaging over the past two decades.”
Recommendations to Promote the Measure’s Intentions
In the paper, the panel presents recommendations to promote the measure’s intentions. These recommendations include greater data access (eg, to the measure’s source data and to reporting elements for audit support) and a more holistic treatment of image quality. The panel ultimately urges a shift toward open-source, open-access, consensus-based, and community-owned strategies to ensure CT quality and safety.
According to the authors, one of the benefits to patients that will come from this publication is that the expertise of the imaging community—physicians, physicists, technologists, regulators, and industry—will be used to develop quality improvement initiatives that will keep radiation doses as low as possible while maintaining the quality of medically essential CT imaging. “We’re confident that we can get this right by working together,” says Mahesh in a release.
Balancing CT Benefits and Radiation Risk
CT is a lifesaving imaging technology used to diagnose disease and guide treatment. It is the first-line imaging technique in many cases, especially in emergency departments and cancer centers. Concerns have been raised about the increased utilization of CT in medicine because CT uses ionizing radiation, which at very high doses is known to increase a person’s risk for developing cancer. However, at the low doses of radiation used in medical imaging, including in CT, the risk is extremely small, perhaps negligible.
In the past two decades, the CT imaging community has worked together to reduce CT doses. New scanner technologies have played a large role in decreasing doses, including features that automatically measure the size of the patient and adjust the radiation dose to the right value. This is especially important for children, who require lower doses than adults due to their smaller size.
“Some authors multiply the very small potential risk of a CT scan by the millions of patients who receive one and predict that we will see an increase in cancer,” says Cynthia McCollough, PhD, past president of AAPM, in a release. “This can lead to alarmist stories and patients who really need a CT refusing to get one. Further, at the low doses we are talking about, it is debated whether the risk is even real. CT has been around for over 50 years, and the predicted increases in cancer just aren’t being seen.”
Photo caption: CT
Photo credit: AAPM
