Accreditation promises many benefits including a chance to build trust with parents and referring physicians.

On January 1, 2012, the Centers for Medicare and Medicaid Services (CMS) will require imaging centers that offer advanced imaging services to get accreditation from one of three CMS-designated bodies if they want to continue to receive reimbursement for the procedures from CMS. And since third-party payors often follow CMS’ lead, these reimbursements are likely to be impacted as well. With CMS, the US Food and Drug Administration (FDA), and the medical community itself paying more attention to radiation dose, accreditation provides a way to ensure and advertise safety, which can be an advantage in drawing referring physicians and concerned parents.

“Accreditation offers the best opportunity for any facility to have a peer-reviewed evaluation for its practice in the best interest of patient care. It allows the benefit of participating in an educational process with review of protocols and equipment by experts in the field, ensuring that the facility has quality protocols and equipment for its pediatric patient population,” said Theresa Branham, BSRS, CT/MR accreditation manager for the American College of Radiology (ACR) in Reston, Va.

Accreditation, therefore, provides one way to counteract the negative press radiation has recently received. It is a way to build credibility and, ultimately, a competitive edge. “Accreditation is recognized by parents. Today’s health care consumers are very savvy—they look for quality designations. The same applies to referring doctors, who have options as to where to send patients. If they can choose an accredited facility versus one that is not accredited, they are likely to choose the accredited one,” said Sandra Katanick, CAE, CEO of the Intersocietal Accreditation Commission (IAC) headquartered in Ellicott City, Md.

The CMS mandate currently applies only to advanced imaging, which encompasses MR, CT, PET, and nuclear medicine exams, although many expect attention to eventually turn to other modalities as well. The three CMS-approved accrediting agencies, the ACR, the IAC, and The Joint Commission, offer programs designed to meet regulatory requirements in these areas. All three recommend starting the accreditation process early to avoid missing out on reimbursement fees. “Facilities must have the accreditation in hand—done—by January 1, 2012. The process doesn’t happen over night,” Katanick cautioned.

IAC Accreditation

Sandra Katanick, CAE

The length of time does vary, however, primarily depending on the organization’s current efforts. “If a center is well organized with documented procedures and protocols, it could take just a month. But many do not have a quality assurance program in place or in order. We suggest that imaging facilities allot 6 to 9 months to prepare the application,” said Katanick. Cost is consistent, at $2,400 per unit for both CT and MR (additional units may be less).

Once the IAC has a completed application in hand, a decision is typically rendered within 12 to 16 weeks. The process is based on IAC-developed standards (pediatric dose controls and image quality included), and the applying facility is judged on case studies, pathologies, and protocols. A site visit is not required, but starting this year, random audits or visits are possible throughout the 3-year accreditation period to ensure compliance is maintained.

The IAC board of directors does not expect perfection, but rather looks for substantial compliance with its standards. The team that evaluates the applications represents multiple specialties, including physicists. “Many sites have never had a physicist evaluation, and our process includes that,” said Mary Lally, MS, RT, RTMR, technical manager for the Intersocietal Commission for the Accreditation of CT Laboratories (ICACTL) and the Intersocietal Commission for the Accreditation of MR Laboratories (ICAMRL).

The process is, therefore, an excellent education tool that can guide facilities in improving quality and safety. It also provides guidance within the parameters of state requirements. “Every state varies regarding the training requirements for the person operating a CT [scanner] and the protocols that must be in place,” Lally said.

Organized into five divisions, the IAC covers specific standards for vascular, echocardiography, nuclear cardiology/nuclear medicine/PET, magnetic resonance, and CT testing. Each group has published standards to help prepare facilities for the accreditation process.

ACR Accreditation

The ACR offers seven accreditations through its Diagnostics Modality Accreditation Program: breast MRI, breast ultrasound, CT, MR, nuclear medicine and PET, stereotactic breast biopsy, and ultrasound. All facilities applying for CT accreditation must meet ACR limits for dose, regardless of whether the patients are adult or pediatric.

“Facilities applying for ACR CT accreditation must meet our dose pass/fail criteria on the phantom images. In addition, the clinical patient images are reviewed for parameters affecting dose, as well as other image quality attributes,” Branham said.

The ACR accreditation process uses self-assessment and an independent external expert audit. Facilities applying for pediatric CT accreditation submit written protocols and patient images, and perform the phantom scans using typical pediatric protocols. “We have pediatric examination choices within all of the CT accreditation categories—head/neck, chest, abdomen,” Branham said.

Image quality, equipment, quality control procedures, quality assurance programs, and personnel qualifications are all evaluated against ACR standards, which cover practice guidelines and technical standards. A team of certified radiologic technologists helps providers through the process.

“As of June 1, 2010, there are a total of 4,477 facilities accredited in CT and 3,080 accredited in pediatric CT [through the ACR],” Branham said. The organization has accredited more than 20,000 facilities in all categories, according to its statistics.

As with the IAC, ACR-accredited facilities must renew their accreditation every 3 years. This ensures that imaging centers stay on top of advances in technology and technique to maximize efficacy and safety and provides a way to advertise this quality to their customers—physicians, patients, and parents.


Renee Diiulio is a contributing writer for Axis Imaging News.