MITA Smart Dose CT

The MITA Smart Dose standard offers healthcare providers a reference to identify important tools to optimize and manage radiation dose delivery when using computed tomography (CT) equipment. MITA Smart Dose, or XR 29 Standard Attributes on Computed Tomography (CT) Equipment Related to Dose Optimization and Management, bundles four key dose optimization features to ensure that compliant CT equipment produces high-quality diagnostic images while supporting patient safety.

The attributes of MITA Smart Dose CT include:

  • DICOM Dose Structured Reporting, which enables recording of post-exam dose information in a standardized electronic format. This information can be included in the patient record, promoting the establishment of diagnostic reference levels, as well as facility dose management and quality assurance.
  • Pediatric and adult reference protocols, a set of pre-loaded protocols on a CT system that serve as a baseline for a variety of clinical tasks.
  • CT Dose Check, which incorporates two features — dose notifications and dose alerts — that can alert operators and physicians when dose exceeds established thresholds.
  • Automatic Exposure Control (AEC), which automatically adjusts the amount of radiation used, based on the size, shape and composition of the patient, in order to achieve a specified level of image quality. Studies of AEC procedures have demonstrated dose optimizations and reductions when used properly.

On April 1, 2014, the President signed into law the Protecting Access to Medicare Act of 2014. Beginning in 2016, Medicare will pay less for certain diagnostic CT scans performed on CT equipment that does not meet the MITA Smart Dose CT standard.

Does your CT equipment conform to the Smart Dose standard? Find out here.

On January 20, 2016, MITA requested clarification from CMS on several XR 29-2013 implementation issues, including how compliance would be determined (MITA letter to CMS). On March 4, 2016, CMS responded, providing additional clarification to industry and other stakeholders (CMS Response).

XR-29 Vendor Certification Web Portals

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MITA SMART IN THE NEWS

Medicare Imaging Standards Include Payment Penalty, HealthLeaders Media, March 3, 2015

The Dose Debate, Imaging Economics, October 9, 2014

How the MITA Smart Dose Standard is ruling the CT Market, DOTmed HealthCareBusiness News, September 2014

Improving Patient Access to Safer Imaging: Medicare Set to Promote Adoption of CT Safety Technology, AAPM Newsletter, By Gail Rodriguez, July/August 2014

Setting the Standard: XR-29 and the Importance of CT Dose Optimization, DOTmed, July 24, 2014

Why Your Technology Needs to be Compliant With New CT Dose Standards, DiagnosticImaging, July 17, 2014

MITA lauds CMS mandate on medical imaging, AuntMinnie, July 2, 2014

Imaging Coalition Applauds Adoption of Appropriate Use Criteria, ImagingEconomics, May 21, 2014.

MITA publishes radiation therapy gating standard, AuntMinnie, April 16, 2014

One-third of CT installed base must be replaced to avoid Medicare penalties, Radiology Business Journal, April 8, 2014.

 

Frequently Asked Questions

MITA Smart Dose CT Standard

  • What is MITA Smart Dose CT?
    MITA Smart Dose CT is a technology standard that promotes the use of computed tomography (CT) technology designed to help a health care provider optimize the radiation dose a patient receives from a CT scan (also called a CAT scan). MITA Smart Dose CT includes four basic technologies: (1) Automatic Exposure Control, (2) Adult and Pediatric Protocols, (3) Dose Check, and (4) DICOM Structured Reporting. For additional details, you can download the MITA Smart Dose CT standard, under its technical name NEMA XR-29-2013, here.
  • What is Automatic Exposure Control (AEC)?
    Automatic Exposure Control (AEC) is one of the four CT equipment features included in the MITA Smart Dose CT standard. Clinicians conducting an imaging scan focus on adjusting radiation dose to the individual patient’s anatomy to achieve the necessary image quality at minimal dose. Yet, manually adjusting the exposure to each individual patient and exam is challenging in the daily clinical routine. AEC automatically adjusts the amount of radiation within pre-established bounds to achieve the image quality specified by the health care provider while minimizing dose.
  • What are Adult and Pediatric Protocols?
    Adult and Pediatric Protocols are one of the four CT equipment features included in the MITA Smart Dose CT standard. These reference protocols are predetermined parameters that can be selected by the CT equipment operator, in order to better tailor the amount of radiation dose received by the patient to the specific exam and clinical question. Manufacturers develop these parameters based on their knowledge of the equipment’s specific performance characteristics combined with the intended clinical task and the experience of medical physicists and physicians. For example, these parameters enable clinicians to more easily adjust settings to ensure an infant receives less dose than an adult for the same exam type.
  • What is MITA Dose Check?
    MITA Dose Check is one of the four CT equipment features included in the MITA Smart Dose CT standard. Dose Check technology informs CT equipment operators prior to a scan when scan settings would likely exceed dose threshold levels established by the provider. This automatic check helps clinicians to confirm correct settings prior to a scan and avoiding unnecessarily high levels of radiation dose to the patient.
  • What is DICOM Structured Reporting?
    DICOM Structured Reporting is one of the four CT equipment features included in the MITA Smart Dose CT standard. The Digital Imaging and Communications in Medicine (DICOM) device communication standard is used by imaging systems to communicate data between the scanner and the connected computer systems. DICOM Structured Reporting (DICOM SR) produces standardized, interoperable reports from each CT scanning system, listing the amount of ionizing radiation emitted per scan. This software allows dose information to be included in the patient record and enables facility dose management and quality assurance. Adoption of this technology also makes possible the establishment of national dose reference levels through systematic collection of dose information from CT equipment across the country.
  • I’m a patient. How does MITA Smart Dose CT affect me?
    CT equipment that is MITA Smart Dose CT compliant can help your health care provider optimize the amount of radiation used during your procedure. In fact, MITA Smart Dose CT features can significantly reduce radiation during a CT scan.[i]
  • Are all CT machines in the United States compliant to MITA Smart Dose CT?
    All new CT equipment for sale in the United States is compliant with MITA Smart Dose CT. Some previously-installed CT equipment in use today does not meet the MITA Smart Dose CT standard. Equipment manufacturers are working with health care providers to upgrade older equipment to make sure it meets the safety standard. Many machines are already compliant with MITA Smart Dose CT; however, some older CT equipment in use today does not have the capacity to receive an upgrade. As a result, that equipment will not be compliant with this safety standard. Find out if your CT equipment conforms to the Smart Dose standard here.
  • I’m a health care provider. How do I know if my CT equipment is compliant to this standard?
    Find out if your CT equipment conforms to the Smart Dose standard here. Another way to determine if your CT equipment is compliant with MITA Smart Dose CT is to contact the manufacturer of that equipment. Please refer to the company logos below to assist you in contacting the appropriate MITA CT manufacturer.
  • Does MITA Smart Dose CT apply to X-ray machines, magnetic resonance imaging machines (MRI), or other medical imaging equipment?
    No. The MITA Smart Dose CT applies only to equipment capable of performing computed tomography (CT) procedures, including equipment that performs CT procedures in conjunction with other imaging procedures (e.g. PET-CT equipment). It does not apply to other medical imaging technologies. MITA is exploring new safety standards for other radiation-emitting imaging equipment and for imaging technologies that do not use radiation, such as magnetic resonance (MRI) and ultrasound.
  • How was MITA Smart Dose CT developed?
    MITA, a division of NEMA, has a long history of developing important equipment standards for medical imaging and radiation therapy technologies. The MITA Computed Tomography (CT) Group and the MITA X-ray Section developed and approved MITA Smart Dose CT. As a part of this process, MITA incorporated input from the broader medical imaging community of physicians, technologists, and physicists. The imaging community is united in support of optimizing radiation dose to improve patient safety. For more information on MITA and NEMA’s standards writing procedures, please follow this link.

Medicare Imaging Quality Incentive Policy

  • What is this new Medicare policy?
    On April 1, 2014, the President signed into law the Protecting Access to Medicare Act of 2014. Section 218(a) of this law includes a new policy that reduces some Medicare payments in order to encourage health care providers to use diagnostic medical imaging technologies that promote patient safety and public health by optimizing the radiation dose used during a computed tomography (CT) scan. Beginning in 2016, Medicare will pay less for certain diagnostic CT scans performed on CT equipment that does not meet the MITA Smart Dose CT standard.
  • What types of procedures will see their Medicare payments change?
    Under the law, payments are expected to remain the same for all procedures performed on computed tomography (CT) equipment that is compliant with MITA Smart Dose CT. Medicare will reduce payments under the Hospital Outpatient Prospective Payment System (HOPPS) and the Physician Fee Schedule (PFS) for certain diagnostic procedures performed on CT equipment or hybrid CT equipment (e.g. PET-CT) that is not compliant with MITA Smart Dose CT. This payment reduction would apply to diagnostic radiological imaging codes for CT, identified as of January 1, 2014, by HCPCS codes 70450-70498, 71250-71275, 72191-72194, 73200-73206, 73700-73706, 74150-74178, 74261-74263, and 75571-75574. The reduction would also apply to any succeeding codes.
  • When does this new policy begin and how much will it change payments?
    The exact details will be determined by the Centers for Medicare and Medicaid Services (CMS), which administers Medicare for the federal government. The policy will begin in 2016, and the policy will expand in 2017. According to the law, beginning on January 1, 2016, Medicare will reduce by five percent diagnostic CT procedure payments, if the procedure is performed on CT equipment that does not meet the MITA Smart Dose CT standard. Beginning January 1, 2017, the 5 percent payment differential will increase to a 15 percent differential.
  • As a patient, how will this affect me?
    CT equipment that is MITA Smart Dose CT compliant can help your health care provider protect your safety by optimizing the amount of radiation you receive during your procedure. In fact, MITA Smart Dose CT features can significantly reduce radiation during a CT scan.[ii] Yet, some CT machines in the United States do not meet the MITA Smart Dose CT standard. Congress put this policy into place to promote the use of these safety features by health care providers.
  • As a health care provider, how will this affect my payments?
    If you conduct CT procedures using a scanner that currently meets the MITA Smart Dose CT standard, your Medicare reimbursements will remain the same. If you continue to operate a machine that is not MITA Smart Dose CT compliant, you will begin to receive lower Medicare reimbursements for diagnostic CT procedures in 2016.
  • How does this policy affect “hybrid CT” equipment like PET-CT machines?
    The law does not specifically exempt hybrid CT equipment from the policy. As a result, Medicare may reduce payments for diagnostic CT scans conducted on hybrid equipment that does not meet the standard. The Centers for Medicare and Medicare Services (CMS) will determine the final details when they issue the formal regulations that implement this policy.
  • When will CMS finalize the rules for this policy?
    The Centers for Medicare and Medicaid Services (CMS) is expected to outline the implementation details for this policy prior to 2016. CMS has not yet specified when it will release the draft or final regulations that will govern Medicare’s implementation of the policy. CMS may discuss the policy in its Calendar Year 2016 Hospital Outpatient Prospective Payment System (HOPPS) and Physician Fee Schedule (PFS) rules, which will be released in summer 2015.

For more information on MITA Smart Dose CT

  • On dose optimization features and the research demonstrating their clinical benefit click here.
  • On compliant devices, visit our members’ websites