What is a lot of snow? As the northeast just experienced a snow storm, there are many opinions about whether or not it was a lot. Those who live in New Jersey may think 1 foot is average, while those in upstate New York think that’s a light amount. And there is no meteorological standard to define “a lot”; just public opinion.
When you look at medical imaging, the question currently being asked is: what is “low dose”? Is a chest CT scan at 4 mSv low dose? It is lower than today’s standard, but does it qualify as “low dose”? Quite surprisingly, while the topic of low dose CT has been played out for years now, the definition - which is quite necessary when it comes to radiation dose – has often remained undefined.
Until now, that is. The Centers for Medicare & Medicaid Services (CMS) recently announced a proposed decision to reimburse annual low dose CT scans for lung cancer screenings among high risk patients, and additionally outlined the eligibility criteria for radiology departments, radiologists and patients. While the news headlines have been cause for many to rejoice, upon digging into the details, there is a very significant requirement to qualify for reimbursement: utilization of low dose CTs with an effective radiation dose less than 1.5 mSv.
To put it in perspective, successfully achieving effective radiation dose of less than 1.5 mSv will require a nearly 80% reduction from the median radiation dose of 8 mSv in a standard chest CT used today. The positive is that unlike the ambiguity of recommended levels for low dose and recently announced XR-29 standards, the announcement from CMS marks the first time specific dose levels have been defined for eligibility. I applaud the specificity. But can that low a dose be achieved consistently with the high quality results needed? Is additional technology required to meet diagnostic confidence?
In addition to the amount of dose, the eligibility criteria outlined for a low dose CT screening facility also include:
- Past participation in lung cancer screening trials or accreditation with training and experience in low dose CT lung cancer screenings; and
- Ongoing collection and submission of data, incorporating information from CT scanner to effective radiation dose, to a CMS-approved national registry for each low dose CT lung cancer screening performed.
Furthermore, beyond the details on dose, specifics on eligibility criteria for patients and radiologists were within the CMS decision on lung screening as well:
- For patients to meet the criteria for annual lung cancer screenings with low dose CT, they must be within the age range of 55-74 years and have no signs or symptoms of lung disease. Eligible patients must have at least a thirty-year history of smoking one pack per day and are either current smokers or have quit smoking within the last 15 years.
- The requirements set for radiologists to meet the eligibility criteria include present certification with the American Board of Radiology (or equivalent organization), training in diagnostic radiology and radiation safety, involvement in supervision and interpretation of at least 300 chest CT scans within the past three years and a record of participation in CME in accordance with current ACR standards.
So, the ball is clearly in the court of provider organizations – and we look forward to how they capitalize on this decision from CMS in 2015 and especially how they plan to meet this definition of low dose.
What do you think? How will your facility meet these regulations? Let us know your thoughts.