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FHIR IG Statistics: Measure/CMS1074FHIRCTIQR

Packagegov.healthit.ecqi.ecqms
Resource TypeMeasure
IdCMS1074FHIRCTIQR
FHIR VersionR4
Sourcehttp://ecqi.healthit.gov/ecqms/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2025/Measure-CMS1074FHIRCTIQR.html
URLhttps://madie.cms.gov/Measure/CMS1074FHIRCTIQR
Version0.9.000
Statusactive
Date2025-07-15T13:37:39+00:00
NameCMS1074FHIRCTIQR
TitleExcessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults - Facility IQR FHIR
DescriptionThis measure provides a standardized method for monitoring the performance of diagnostic CT to discourage unnecessarily high radiation doses, a risk factor for cancer, while preserving image quality. This measure is expressed as a percentage of CT exams that are out-of-range based on having either excessive radiation dose or inadequate image quality relative to evidence-based thresholds based on the clinical indication for the exam. All diagnostic CT exams of specified anatomic sites performed in hospital inpatient care settings are eligible. This eCQM requires the use of additional software to access primary data elements stored within radiology electronic health records and translate them into data elements that can be ingested by this eCQM. Additional details are included in the Guidance field.
CopyrightThe translation software was written and will be updated and maintained by Alara Imaging and will be accessible by creating a secure account through Alara’s website. Copyright (C) 2025 Alara Imaging, Inc. All Rights Reserved. This Measure and related data specifications are owned by Alara Imaging, Inc. Alara Imaging, Inc. is not responsible for any use of the Measure. Alara Imaging, Inc. makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and Alara Imaging, Inc. has no liability to anyone who relies on such measures or specifications. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by Alara Imaging, Inc. and are subject to a license at the discretion of Alara Imaging, Inc. Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Alara Imaging, Inc. disclaims all liability for use or accuracy of any third-party code contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2025 American Medical Association. LOINC(R) is copyright 2004-2025 Regenstrief Institute, Inc. SNOMED Clinical Terms(R) (SNOMED CT[R]) is copyright 2004-2025 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2025 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R].

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Narrative

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Metadata
Title Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults - Facility IQR FHIR
Version 0.9.000
Short Name CMS1074FHIR
GUID (Version Independent) urn:uuid:9d126d62-8c93-4327-a3c2-5bfb99cee086
GUID (Version Specific) urn:uuid:dbfd22af-5ea3-4c8f-b459-4f8276cf1fb5
CMS Identifier 1074FHIR
CMS Consensus Based Entity Identifier 3663e
Effective Period 2026-01-01 through 2026-12-31
Steward (Publisher) Alara Imaging, Inc.
Developer University of California San Francisco
Description

This measure provides a standardized method for monitoring the performance of diagnostic CT to discourage unnecessarily high radiation doses, a risk factor for cancer, while preserving image quality. This measure is expressed as a percentage of CT exams that are out-of-range based on having either excessive radiation dose or inadequate image quality relative to evidence-based thresholds based on the clinical indication for the exam. All diagnostic CT exams of specified anatomic sites performed in hospital inpatient care settings are eligible. This eCQM requires the use of additional software to access primary data elements stored within radiology electronic health records and translate them into data elements that can be ingested by this eCQM. Additional details are included in the Guidance field.
Copyright

The translation software was written and will be updated and maintained by Alara Imaging and will be accessible by creating a secure account through Alara’s website.

Copyright (C) 2025 Alara Imaging, Inc. All Rights Reserved.

This Measure and related data specifications are owned by Alara Imaging, Inc. Alara Imaging, Inc. is not responsible for any use of the Measure. Alara Imaging, Inc. makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and Alara Imaging, Inc. has no liability to anyone who relies on such measures or specifications.

The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by Alara Imaging, Inc. and are subject to a license at the discretion of Alara Imaging, Inc.

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Alara Imaging, Inc. disclaims all liability for use or accuracy of any third-party code contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2025 American Medical Association. LOINC(R) is copyright 2004-2025 Regenstrief Institute, Inc. SNOMED Clinical Terms(R) (SNOMED CT[R]) is copyright 2004-2025 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2025 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R].
Disclaimer

The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.

Alara Imaging, Inc., the University of California San Francisco, and its members and users shall not be responsible for any use or accuracy of the Measure or any code contained within the Measure. THE MEASURE AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.
Rationale

Diagnostic imaging using CT occurs in more than a third of acute care hospitalizations in the U.S. (Vance et al., 2013) and greater than 90 million scans are performed annually in the U.S. (IMV, 2019 ). There is marked observed variation in the radiation doses used to perform these exams (Smith-Bindman et al., 2019). The inconsistency in how CT exams are performed represents a significant, unnecessary, and modifiable iatrogenic health risk, as there is extensive epidemiological and biological evidence that suggests exposure to radiation in the same range as that routinely delivered by CT increases a person's risk of developing cancer (Board of Radiation Effects, 2006; Hon, Han, Jung, & Kim, 2019). It is estimated that 2% (37,000) of the 1.8 million cancers diagnosed annually in the U.S. are caused by CT exams (Berrington de Gonzalez, 2009; NCI Cancer Statistics, 2020).

The measure focuses on reducing radiation dose in CT, an intermediate outcome directly and proportionally related to cancer prevention. As radiation dose is known to be directly related and proportional to future cancer risk (Board of Radiation Effects, 2006; Berrington de Gonzalez, 2009), any reduction in radiation exposure would be expected to lead to a proportional reduction in cancers. Research suggests that when healthcare organizations and clinicians are provided with a summary of their CT radiation doses, their subsequent doses can be reduced without changing the usefulness of these tests (Smith-Bindman, 2020).

On the basis of the current estimated number of CT scans performed annually in the U.S. (IMV, 2019), distribution in scan types and observed doses (Demb, 2017; Smith-Bindman, 2019), modeling of the cancer risk associated with CT at different ages of exposure (Berrington de Gonzalez, 2009), and costs of cancer care (Dieguez, Ferro & Pyenson (2017); Mariotto, 2011), an estimated 13,982 cancers could be prevented among Medicare beneficiaries annually, resulting in $1.86 billion to $5.21 billion annual cost savings. These cost calculations were supported by more recent data on cancer survivorship and costs, which yielded an estimated $3.04 billion dollars in annual costs savings to Medicare. (Mariotto, 2020; NCI Office of Cancer Survivorship, 2022).
Clinical Recommendation Statement

The measure aligns with numerous evidence- and consensus-based clinical guidelines asking radiologists to track, optimize, and lower CT radiation doses, guidelines that have been written by the American College of Radiology (Kanal, 2017), cardiovascular imaging societies (Hirshfeld, 2018, references a, b and c noted below), Image Gently Alliance, an initiative begun by the American College of Radiology, the Radiological Society of North America, American Society of Radiologic Technologists, the American Association of Physicists in Medicine, and the Society of Pediatric Radiology, which dozens of U.S. and international organizations have joined as recently as 2020 (Image Gently Alliance, 2022), and the US Food and Drug Administration (FDA, 2019).

This measure has been strongly supported by a Technical Expert Panel (TEP) comprising a diverse group of clinicians, patient advocates, and leaders of medical specialty societies, payers, and healthcare safety and accrediting organizations, all of whom were engaged through every stage of measure conceptualization, development, and testing. In assessing the face validity of the measure, 100% of TEP members agreed radiation dose and global noise are relevant metrics of CT quality, that size is an appropriate method of risk adjustment, and that performance on this measure of radiation dose and image quality as specified is a representation of quality.
Citation

CITATION - Berrington de González, A., Mahesh, M., Kim, K. P., Bhargavan, M., Lewis, R., Mettler, F., & Land, C. (2009). Projected cancer risks from computed tomographic scans performed in the United States in 2007. Archives of internal medicine, 169(22), 2071–2077. https://doi.org/10.1001/archinternmed.2009.440
Citation

CITATION - Board of Radiation Effects Research Division on Earth and Life Sciences National Research Council of the National Academies. (2006). Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2, Washington, D.C.: The National Academies Press.
Citation

CITATION - Demb, J., Chu, P., Nelson, T., Hall, D., Seibert, A., Lamba, R., … Smith-Bindman, R. (2017). Optimizing Radiation Doses for Computed Tomography Across Institutions: Dose Auditing and Best Practices. JAMA internal medicine, 177(6), 810–817. https://doi.org/10.1001/jamainternmed.2017.0445
Citation

CITATION - Dieguez, G., Ferro, C., Pyenson, B. (2017, April 10). Milliman Research Report: A Multi-Year Look at the Cost Burden of Cancer Care. Milliman. https://www.milliman.com/en/insight/2017/a-multi-year-look-at-the-cost-burden-of-cancer-care
Citation

CITATION - Hong, J. Y., Han, K., Jung, J. H., & Kim, J. S. (2019). Association of Exposure to Diagnostic Low-Dose Ionizing Radiation With Risk of Cancer Among Youths in South Korea. JAMA network open, 2(9), e1910584. https://doi.org/10.1001/jamanetworkopen.2019.10584
Citation

CITATION - IMV 2019 CT Market Outlook Report. (2019). https://imvinfo.com/product/2019-ct-market-outlook-report/
Citation

CITATION - Kanal, K. M., Butler, P. F., Sengupta, D., Bhargavan-Chatfield, M., Coombs, L. P., & Morin, R. L. (2017). U.S. Diagnostic Reference Levels and Achievable Doses for 10 Adult CT Examinations. Radiology, 284(1), 120–133. https://doi.org/10.1148/radiol.2017161911
Citation

CITATION - Mariotto, A. B., Yabroff, K. R., Shao, Y., Feuer, E. J., & Brown, M. L. (2011). Projections of the cost of cancer care in the United States: 2010-2020. Journal of the National Cancer Institute, 103(2), 117–128. https://doi.org/10.1093/jnci/djq495
Citation

CITATION - National Cancer Institute. (2020, September 25). Cancer Statistics. https://www.cancer.gov/about-cancer/understanding/statistics
Citation

CITATION - Smith-Bindman, R., Wang, Y., Chu, P., Chung, R., Einstein, A. J., Balcombe, J., … Miglioretti, D. L. (2019). International variation in radiation dose for computed tomography examinations: prospective cohort study. BMJ (Clinical research ed.), 364, k4931. https://doi.org/10.1136/bmj.k4931
Citation

CITATION - Smith-Bindman, R., Chu, P., Wang, Y., Chung, R., Lopez-Solano, N., Einstein, A. J., … Miglioretti, D. L. (2020). Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography: A Randomized Clinical Trial. JAMA internal medicine, 180(5), 666–675. https://doi.org/10.1001/jamainternmed.2020.0064
Citation

CITATION - U.S. Food and Drug Administration. (2019, June 14) White Paper: Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging. https://www.fda.gov/radiation-emitting-products/initiative-reduce-unnecessary-radiation-exposure-medical-imaging/white-paper-initiative-reduce-unnecessary-radiation-exposure-medical-imaging
Citation

CITATION - Vance, E. A., Xie, X., Henry, A., Wernz, C., & Slonim, A. D. (2013). Computed tomography scan use variation: patient, hospital, and geographic factors. The American journal of managed care, 19(3), e93–e99.
Citation

CITATION - Hirshfeld, J. W. (a), Jr, Ferrari, V. A., Bengel, F. M., Bergersen, L., Chambers, C. E., Einstein, A. J., … Wiggins, B. S. (2018). 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging-Best Practices for Safety and Effectiveness, Part 2: Radiological Equipment Operation, Dose-Sparing Methodologies, Patient and Medical Personnel Protection. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 92(2), 222–246. https://doi.org/10.1002/ccd.27661
Citation

CITATION - Hirshfeld, J. W. (b), Jr, Ferrari, V. A., Bengel, F. M., Bergersen, L., Chambers, C. E., Einstein, A. J., … Wann, L. S. (2018). 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Journal of the American College of Cardiology, 71(24), e283–e351. https://doi.org/10.1016/j.jacc.2018.02.016
Citation

CITATION - Hirshfeld, J. W. (c), Jr, Ferrari, V. A., Bengel, F. M., Bergersen, L., Chambers, C. E., Einstein, A. J., … Wann, L. S. (2018). 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging-Best Practices for Safety and Effectiveness, Part 1: Radiation Physics and Radiation Biology: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Journal of the American College of Cardiology, 71(24), 2811–2828. https://doi.org/10.1016/j.jacc.2018.02.017
Citation

CITATION - Abalo, K. D., Rage, E., Leuraud, K., Richardson, D. B., Le Pointe, H. D., Laurier, D., & Bernier, M. O. (2021). Early life ionizing radiation exposure and cancer risks: systematic review and meta-analysis. Pediatric radiology, 51(1), 45–56. https://doi.org/10.1007/s00247-020-04803-0
Citation

CITATION - Bernier, M. O., Baysson, H., Pearce, M. S., Moissonnier, M., Cardis, E., Hauptmann, M., … Kesminiene, A. (2019). Cohort Profile: the EPI-CT study: a European pooled epidemiological study to quantify the risk of radiation-induced cancer from paediatric CT. International journal of epidemiology, 48(2), 379–381g. https://doi.org/10.1093/ije/dyy231
Citation

CITATION - Berrington de Gonzalez, A., Daniels, R. D., Cardis, E., Cullings, H. M., Gilbert, E., Hauptmann, M., … Schubauer-Berigan, M. K. (2020). Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Rationale and Framework for the Monograph and Overview of Eligible Studies. Journal of the National Cancer Institute. Monographs, 2020(56), 97–113. https://doi.org/10.1093/jncimonographs/lgaa009
Citation

CITATION - Brenner, A. V., Sugiyama, H., Preston, D. L., Sakata, R., French, B., Sadakane, A., … Ozasa, K. (2020). Radiation risk of central nervous system tumors in the Life Span Study of atomic bomb survivors, 1958-2009. European journal of epidemiology, 35(6), 591–600. https://doi.org/10.1007/s10654-019-00599-y
Citation

CITATION - Cao, C. F., Ma, K. L., Shan, H., Liu, T. F., Zhao, S. Q., Wan, Y., … Wang, H. Q. (2022). CT Scans and Cancer Risks: A Systematic Review and Dose-response Meta-analysis. BMC cancer, 22(1), 1238. https://doi.org/10.1186/s12885-022-10310-2
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CITATION - Grant, E. J., Brenner, A., Sugiyama, H., Sakata, R., Sadakane, A., Utada, M., … Ozasa, K. (2017). Solid Cancer Incidence among the Life Span Study of Atomic Bomb Survivors: 1958-2009. Radiation research, 187(5), 513–537. https://doi.org/10.1667/RR14492.1
Citation

CITATION - Hauptmann, M., Daniels, R. D., Cardis, E., Cullings, H. M., Kendall, G., Laurier, D., … Berrington de Gonzalez, A. (2020). Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Summary Bias Assessment and Meta-Analysis. Journal of the National Cancer Institute. Monographs, 2020(56), 188–200. https://doi.org/10.1093/jncimonographs/lgaa010
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CITATION - Hauptmann, M., Byrnes, G., Cardis, E., Bernier, M. O., Blettner, M., Dabin, J., … Kesminiene, A. (2023). Brain cancer after radiation exposure from CT examinations of children and young adults: results from the EPI-CT cohort study. The Lancet. Oncology, 24(1), 45–53. https://doi.org/10.1016/S1470-2045(22)00655-6
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CITATION - Huang, R., Liu, X., He, L., & Zhou, P. K. (2020). Radiation Exposure Associated With Computed Tomography in Childhood and the Subsequent Risk of Cancer: A Meta-Analysis of Cohort Studies. Dose-response : a publication of International Hormesis Society, 18(2), 1559325820923828. https://doi.org/10.1177/1559325820923828
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CITATION - Mariotto, A. B., Enewold, L., Zhao, J., Zeruto, C. A., & Yabroff, K. R. (2020). Medical Care Costs Associated with Cancer Survivorship in the United States. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 29(7), 1304–1312. https://doi.org/10.1158/1055-9965.EPI-19-1534
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CITATION - Meulepas, J. M., Ronckers, C. M., Smets, A. M. J. B., Nievelstein, R. A. J., Gradowska, P., Lee, C., … Hauptmann, M. (2019). Radiation Exposure From Pediatric CT Scans and Subsequent Cancer Risk in the Netherlands. Journal of the National Cancer Institute, 111(3), 256–263. https://doi.org/10.1093/jnci/djy104
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CITATION - National Cancer Institute Office of Cancer Survivorship. Statistics and Graphs. (2022, November 17). https://cancercontrol.cancer.gov/ocs/statistics#stats
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CITATION - Sugiyama, H., Misumi, M., Brenner, A., Grant, E. J., Sakata, R., Sadakane, A., … Ozasa, K. (2020). Radiation risk of incident colorectal cancer by anatomical site among atomic bomb survivors: 1958-2009. International journal of cancer, 146(3), 635–645. https://doi.org/10.1002/ijc.32275
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CITATION - Image Gently Alliance, Strategic Agenda 2022 – 2027. (2022). http://www.imagegently.org/About-Us/The-Alliance http://www.imagegently.org/Portals/6/IGA%20Strategic%20Plan%201_10_22.pdf
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CITATION - Sadakane A, French B, Brenner AV et al (2019) Radiation and Risk of Liver, Biliary Tract, and Pancreatic Cancers among Atomic Bomb Survivors in Hiroshima and Nagasaki: 1958-2009. Radiat Res 192:299-310
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CITATION - Sadakane A, Landes RD, Sakata R, Nagano J, Shore RE, Ozasa K (2019) Medical Radiation Exposure among Atomic Bomb Survivors: Understanding its Impact on Risk Estimates of Atomic Bomb Radiation. Radiat Res 191:507-517
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CITATION - Sakata R, Preston DL, Brenner AV et al (2019) Radiation-Related Risk of Cancers of the Upper Digestive Tract among Japanese Atomic Bomb Survivors. Radiat Res 192:331-344
Guidance (Usage) The level of aggregation for this eCQM is the facility. A parallel eCQM measures CT exams aggregated at the level of the clinician or clinician group. A single CT exam may be simultaneously measured in both the Merit-based Incentive Payment System (MIPS) and one of the hospital reporting programs (inpatient or outpatient); however, a single exam cannot be measured in both the inpatient and outpatient hospital quality reporting programs. TRANSLATION SOFTWARE As a radiology measure, the measure derives standardized data elements from structured fields within both the electronic health record (EHR) and the radiology electronic clinical data systems, including the Radiology Information System (RIS) and the Picture Archiving and Communication System (PACS). Primary imaging data including Radiation Dose Structured Reports and image pixel data are stored in the PACS in Digital Imaging and Communications in Medicine (DICOM) format, a universally adopted standard for medical imaging information. Because of limitations in their specifications and format, eCQMs cannot currently access and consume elements from these radiology sources in their original DICOM formats. Thus, translation software was developed to transform primary data into a format that the eCQM can consume. This eCQM requires the use of additional software (translation software) to access the primary data elements that are required for measure computation and translate them into data elements that can be ingested by this eCQM. The purpose of this translation software is to access and link these primary data elements with minimal site burden, assess each CT exam for eligibility based on initial population criteria, and generate the three data elements mapped to a clinical terminology for eCQM consumption: CT Dose and Image Quality Category, Calculated CT Size-Adjusted Dose, and Calculated CT Global Noise. The free translation software necessary to use this eCQM is written and maintained by Alara Imaging, Inc. However, any software vendor capable of calculating and reporting this eCQM in accordance with the measure’s specifications, including combining radiology data with electronic health system data, and transforming radiology data into a format compatible with eCQM reporting, may report this measure on behalf of hospitals and clinicians. CODING The translation software will create three variables required for measure computation including the CT Dose and Image Quality Category (LOINC(R) Code 96914-7), the Calculated CT Global Noise (LOINC(R) Code 96912-1) and the Calculated CT Size-Adjusted Dose (LOINC(R) Code 96913-9). These variables are defined in the Definition field above. These transformed data elements can be stored in the EHR. MEASURE CALCULATION The measure will evaluate each included CT exam based on allowable thresholds that are specified by the CT Dose and Image Quality Category. An exam is considered out of range if either the Calculated CT Global Noise or the Calculated CT Size-Adjusted Dose is out of range for the CT Dose and Image Quality Category. Exams will be evaluated against their corresponding threshold, shown below with the following format: [Category shorthand (=CT Dose and Image Quality Category), threshold for the Calculated CT Global Noise in Hounsfield units, threshold for the Calculated CT Size-Adjusted Dose in dose length product]. [LA31752-1 (=Abdomen and Pelvis, Low Dose), 64, 598]; [LA31753-9 (=Abdomen and Pelvis, Routine Dose), 29, 644]; [LA31754-7 (=Abdomen and Pelvis, High Dose), 29, 1260]; [LA31755-4 (=Cardiac Low Dose), 55, 93]; [LA31756-2 (=Cardiac Routine Dose), 32, 576]; [LA31758-8 (=Chest Low Dose), 55, 377]; [LA31759-6 (=Chest Routine Dose), 49, 377]; [LA31761-2 (=Chest High Dose or Cardiac High Dose), 49, 1282]; [LA31762-0 (=Head Low Dose), 115, 582]; [LA31763-8 (=Head Routine Dose), 115, 1025]; [LA31764-6 (=Head High Dose), 115, 1832]; [LA31765-3 (=Upper or Lower Extremity), 73, 320]; [LA31766-1 (=Neck or Cervical Spine), 25, 1260]; [LA31767-9 (=Thoracic or Lumbar Spine), 25, 1260]; [LA31768-7 (=Combined Chest, Abdomen and Pelvis), 29, 1637]; [LA31851-1 (=Combined Thoracic and Lumbar Spine), 25, 2520]; [LA31769-5 (=Combined Head and Neck, Routine Dose), 25, 2285]; [LA31770-3 (=Combined Head and Neck, High Dose), 25, 3092] EXCLUSIONS CT scans with missing patient age or missing CT Dose and Image Quality Category (LOINC(R) 96914-7) are excluded from the initial population. CT scans with a missing Calculated Global Noise value or a missing Calculated CT Size-Adjusted Dose value are not included in the denominator. CT scans assigned a CT Dose and Image Quality Category (LOINC(R) 96914-7) value using the LOINC(R) answer list (LL5824-9) of full body (LA31771-1) are excluded from the denominator. These exams are included in the initial population because they have a non-missing CT Dose and Image Quality Category but are then removed as a Denominator Exclusion in the eCQM because the value is full body, which reflects CT exams that cannot be categorized by anatomical area or by clinical indication, either because they are simultaneous exams of multiple body regions outside of four commonly encountered multiple region groupings, or because there is insufficient data for their classification based on the given diagnosis and procedure codes. This eCQM is an episode-based measure and should be reported for each eligible CT scan performed in a hospital inpatient setting. This FHIR-based measure has been derived from the QDM-based measure: CMS1074v3. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
Measure Group (Rate) (ID: Group_1)
Summary Adults aged 18 years or older that received a CTScan during an inpatient hospitalization
Basis Observation
Scoring Proportion
Type Outcome
Rate Aggregation None
Improvement Notation Increased score indicates improvement
Initial Population ID: InitialPopulation_1
Description:

All CT scans in adults aged 18 years and older at the start of the measurement period that have a CT Dose and Image Quality Category and were performed during an inpatient hospitalization that ends during the measurement period

Logic Definition: Initial Population
Denominator ID: Denominator_1
Description:

Equals Initial Population with a CT Dose and Image Quality Category, a Calculated Global Noise value, and a Calculated CT Size-Adjusted Dose value

Logic Definition: Denominator
Denominator Exclusion ID: DenominatorExclusion_1
Description:

Denominator, where a CT scan with a CT Dose and Image Quality Category = full body

Logic Definition: Denominator Exclusion
Numerator ID: Numerator_1
Description:

Calculated CT Size-Adjusted Dose greater than or equal to a threshold specific to the CT Dose and Image Quality Category, or Calculated CT Global Noise value greater than or equal to a threshold specific to the CT Dose and Image Quality Category

Logic Definition: Numerator
Supplemental Data Guidance For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Ethnicity of the Patient SDE Payer-Payer that was billed SDE Race-Race of the Patient SDE Sex-Administrative Gender
Supplemental Data Elements
Supplemental Data Element ID: sde-ethnicity
Usage Code: Supplemental Data
Description: SDE Ethnicity
Logic Definition: SDE Ethnicity
Supplemental Data Element ID: sde-payer
Usage Code: Supplemental Data
Description: SDE Payer
Logic Definition: SDE Payer
Supplemental Data Element ID: sde-race
Usage Code: Supplemental Data
Description: SDE Race
Logic Definition: SDE Race
Supplemental Data Element ID: sde-sex
Usage Code: Supplemental Data
Description: SDE Sex
Logic Definition: SDE Sex
Measure Logic
Primary Library CMS1074FHIRCTIQR
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population 
define "Initial Population":
  "Qualifying Scan During Inpatient Encounter"
Denominator 
define "Denominator":
  "Qualifying Scan with Values"
Denominator Exclusion 
define "Denominator Exclusion":
  "Qualifying Scan with Values" CTScanWithValues
    where ( CTScanWithValues.value as Concept ).codes contains "Full Body"
Numerator 
define "Numerator":
  "Qualifying Scan with Values" CTScanWithValues
    where CTScanWithValues."ctScanQualifies" ( )
Logic Definitions
Logic Definition Library Name: SupplementalDataElements 
define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end
Logic Definition Library Name: SupplementalDataElements 
define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "SDE Sex":
  SDE."SDE Sex"
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "Qualifying Inpatient Encounters":
  ["Encounter": "Encounter Inpatient"] InpatientEncounter
    where InpatientEncounter.status ~ 'finished'
      and InpatientEncounter.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of "Measurement Period") >= 18
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "Qualifying Scan During Inpatient Encounter":
  [ObservationClinicalResult: "CT dose and image quality category"] CTScan
    with "Qualifying Inpatient Encounters" InpatientEncounters
      such that CTScan.effective.toInterval ( ) starts during InpatientEncounters.period
        and CTScan.effective.toInterval ( ) ends during day of "Measurement Period"
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "Qualifying Scan with Values":
  "Qualifying Scan During Inpatient Encounter" CTScan
    where CTScan."globalNoiseValue" ( ) is not null
      and CTScan."sizeAdjustedValue" ( ) is not null
      and CTScan.value is not null
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "Numerator":
  "Qualifying Scan with Values" CTScanWithValues
    where CTScanWithValues."ctScanQualifies" ( )
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "Denominator":
  "Qualifying Scan with Values"
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "SDE Payer":
  SDE."SDE Payer"
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "Initial Population":
  "Qualifying Scan During Inpatient Encounter"
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "SDE Ethnicity":
  SDE."SDE Ethnicity"
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "Denominator Exclusion":
  "Qualifying Scan with Values" CTScanWithValues
    where ( CTScanWithValues.value as Concept ).codes contains "Full Body"
Logic Definition Library Name: CMS1074FHIRCTIQR 
define "SDE Race":
  SDE."SDE Race"
Logic Definition Library Name: AlaraCommonFunctions 
/* Note since the units has a special character in it this must be escaped in the CQL */
define fluent function "globalNoiseValue"(Result ObservationClinicalResult ):
  singleton from ( Result.component C
      where Result.status in { 'final', 'amended', 'corrected' }
        and C.code ~ "Calculated CT global noise"
        and ( C.value as Quantity ).unit = '[hnsf\'U]'
      return (C.value as Quantity).value
  )
Logic Definition Library Name: AlaraCommonFunctions 
define fluent function "sizeAdjustedValue"(Result ObservationClinicalResult ):
  singleton from ( Result.component C
      where Result.status in { 'final', 'amended', 'corrected' }
        and C.code ~ "Calculated CT size-adjusted dose"
        and ( C.value as Quantity ).unit = 'mGy.cm'
      return (C.value as Quantity).value
  )
Logic Definition Library Name: AlaraCommonFunctions 
define fluent function "ctScanQualifies"(Result ObservationClinicalResult ):
  Result.qualifies("Abdomen and Pelvis Low Dose", 64, 598)
    or Result.qualifies("Abdomen and Pelvis Routine Dose", 29, 644)
    or Result.qualifies("Abdomen and Pelvis High Dose", 29, 1260)
    or Result.qualifies("Cardiac Low Dose", 55, 93)
    or Result.qualifies("Cardiac Routine Dose", 32, 576)
    or Result.qualifies("Chest Low Dose", 55, 377)
    or Result.qualifies("Chest Routine Dose", 49, 377)
    or Result.qualifies("Cardiac High Dose or Chest High Dose", 49, 1282)
    or Result.qualifies("Head Low Dose", 115, 582)
    or Result.qualifies("Head Routine Dose", 115, 1025)
    or Result.qualifies("Head High Dose", 115, 1832)
    or Result.qualifies("Extremity", 73, 320)
    or Result.qualifies("Neck or Cervical Spine", 25, 1260)
    or Result.qualifies("Thoracic or Lumbar Spine", 25, 1260)
    or Result.qualifies("Simultaneous Chest and Abdomen and Pelvis", 29, 1637)
    or Result.qualifies("Simultaneous Thoracic and Lumbar Spine", 25, 2520)
    or Result.qualifies("Simultaneous Head and Neck Routine Dose", 25, 2285)
    or Result.qualifies("Simultaneous Head and Neck High Dose", 25, 3092)
Logic Definition Library Name: AlaraCommonFunctions 
define fluent function "qualifies"(Result ObservationClinicalResult, code System.Code, noiseThreshold Decimal, sizeDoseThreshold Decimal ):
  (Result.value as Concept) ~ code
    and ( Result.globalNoiseValue() >= noiseThreshold
        or Result.sizeAdjustedValue() >= sizeDoseThreshold
    )
Logic Definition Library Name: FHIRHelpers 
define function ToString(value uri): value.value
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }
Terminology
Code System Description: Code system SNOMEDCT
Resource: SNOMED CT (all versions)
Canonical URL: http://snomed.info/sct
Code System Description: Code system LOINC
Resource: Logical Observation Identifiers, Names and Codes (LOINC)
Canonical URL: http://loinc.org
Code System Description: Code system LOINC
Resource: Logical Observation Identifiers, Names and Codes (LOINC)
Canonical URL: http://loinc.org
Value Set Description: Value set Encounter Inpatient
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Value Set Description: Value set Payer Type
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Direct Reference Code Display: Male (finding)
Code: 248153007
System: http://snomed.info/sct
Direct Reference Code Display: Female (finding)
Code: 248152002
System: http://snomed.info/sct
Direct Reference Code Display: CT dose and image quality category
Code: 96914-7
System: http://loinc.org
Direct Reference Code Display: Calculated CT global noise
Code: 96912-1
System: http://loinc.org
Direct Reference Code Display: Calculated CT size-adjusted dose
Code: 96913-9
System: http://loinc.org
Direct Reference Code Display: Abdomen and Pelvis Low Dose
Code: LA31752-1
System: http://loinc.org
Direct Reference Code Display: Abdomen and Pelvis Routine Dose
Code: LA31753-9
System: http://loinc.org
Direct Reference Code Display: Abdomen and Pelvis High Dose
Code: LA31754-7
System: http://loinc.org
Direct Reference Code Display: Cardiac Low Dose
Code: LA31755-4
System: http://loinc.org
Direct Reference Code Display: Cardiac Routine Dose
Code: LA31756-2
System: http://loinc.org
Direct Reference Code Display: Chest Low Dose
Code: LA31758-8
System: http://loinc.org
Direct Reference Code Display: Chest Routine Dose
Code: LA31759-6
System: http://loinc.org
Direct Reference Code Display: Cardiac High Dose or Chest High Dose
Code: LA31761-2
System: http://loinc.org
Direct Reference Code Display: Head Low Dose
Code: LA31762-0
System: http://loinc.org
Direct Reference Code Display: Head Routine Dose
Code: LA31763-8
System: http://loinc.org
Direct Reference Code Display: Head High Dose
Code: LA31764-6
System: http://loinc.org
Direct Reference Code Display: Extremity
Code: LA31765-3
System: http://loinc.org
Direct Reference Code Display: Neck or Cervical Spine
Code: LA31766-1
System: http://loinc.org
Direct Reference Code Display: Thoracic or Lumbar Spine
Code: LA31767-9
System: http://loinc.org
Direct Reference Code Display: Simultaneous Chest and Abdomen and Pelvis
Code: LA31768-7
System: http://loinc.org
Direct Reference Code Display: Simultaneous Thoracic and Lumbar Spine
Code: LA31851-1
System: http://loinc.org
Direct Reference Code Display: Simultaneous Head and Neck Routine Dose
Code: LA31769-5
System: http://loinc.org
Direct Reference Code Display: Simultaneous Head and Neck High Dose
Code: LA31770-3
System: http://loinc.org
Direct Reference Code Display: Full Body
Code: LA31771-1
System: http://loinc.org
Dependencies
Dependency Description: Library SDE
Resource: Library/SupplementalDataElements|5.1.000
Canonical URL: Library/SupplementalDataElements|5.1.000
Dependency Description: Library FHIRHelpers
Resource: Library/FHIRHelpers|4.4.000
Canonical URL: Library/FHIRHelpers|4.4.000
Dependency Description: Library FHIRHelpers
Resource: Library/FHIRHelpers|4.4.000
Canonical URL: Library/FHIRHelpers|4.4.000
Dependency Description: Library QICoreCommon
Resource: Library/QICoreCommon|4.0.000
Canonical URL: Library/QICoreCommon|4.0.000
Dependency Description: Library AlaraCommon
Resource: Library/AlaraCommonFunctions|1.10.000
Canonical URL: Library/AlaraCommonFunctions|1.10.000
Dependency Description: Library FHIRHelpers
Resource: Library/FHIRHelpers|4.4.000
Canonical URL: Library/FHIRHelpers|4.4.000
Data Requirements
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result
Must Support Elements: code, effective
Code Filter(s):
Path: code
Code(s): LOINC 96914-7: CT dose and image quality category
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, status, status.value, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Must Support Elements: url
Data Requirement Type: Coverage
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
Must Support Elements: type, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Must Support Elements: url, extension
Generated using version 0.4.8 of the sample-content-ig Liquid templates

Source

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  "resourceType": "Measure",
  "id": "CMS1074FHIRCTIQR",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248153007",
            "display": "Male (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248152002",
            "display": "Female (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "96914-7",
            "display": "CT dose and image quality category"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "96912-1",
            "display": "Calculated CT global noise"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "96913-9",
            "display": "Calculated CT size-adjusted dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31752-1",
            "display": "Abdomen and Pelvis Low Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31753-9",
            "display": "Abdomen and Pelvis Routine Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31754-7",
            "display": "Abdomen and Pelvis High Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31755-4",
            "display": "Cardiac Low Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31756-2",
            "display": "Cardiac Routine Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31758-8",
            "display": "Chest Low Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31759-6",
            "display": "Chest Routine Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31761-2",
            "display": "Cardiac High Dose or Chest High Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31762-0",
            "display": "Head Low Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31763-8",
            "display": "Head Routine Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31764-6",
            "display": "Head High Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31765-3",
            "display": "Extremity"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31766-1",
            "display": "Neck or Cervical Spine"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31767-9",
            "display": "Thoracic or Lumbar Spine"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31768-7",
            "display": "Simultaneous Chest and Abdomen and Pelvis"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31851-1",
            "display": "Simultaneous Thoracic and Lumbar Spine"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31769-5",
            "display": "Simultaneous Head and Neck Routine Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31770-3",
            "display": "Simultaneous Head and Neck High Dose"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "LA31771-1",
            "display": "Full Body"
          }
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  case\n    when Patient.sex = '248153007' then \"Male (finding)\"\n    when Patient.sex = '248152002' then \"Female (finding)\"\n    else null\n  end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "Qualifying Inpatient Encounters"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Inpatient Encounters\":\n  [\"Encounter\": \"Encounter Inpatient\"] InpatientEncounter\n    where InpatientEncounter.status ~ 'finished'\n      and InpatientEncounter.period ends during day of \"Measurement Period\"\n      and AgeInYearsAt(date from start of \"Measurement Period\") >= 18"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "Qualifying Scan During Inpatient Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Scan During Inpatient Encounter\":\n  [ObservationClinicalResult: \"CT dose and image quality category\"] CTScan\n    with \"Qualifying Inpatient Encounters\" InpatientEncounters\n      such that CTScan.effective.toInterval ( ) starts during InpatientEncounters.period\n        and CTScan.effective.toInterval ( ) ends during day of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "Qualifying Scan with Values"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Scan with Values\":\n  \"Qualifying Scan During Inpatient Encounter\" CTScan\n    where CTScan.\"globalNoiseValue\" ( ) is not null\n      and CTScan.\"sizeAdjustedValue\" ( ) is not null\n      and CTScan.value is not null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Qualifying Scan with Values\" CTScanWithValues\n    where CTScanWithValues.\"ctScanQualifies\" ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Qualifying Scan with Values\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  [Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  \"Qualifying Scan During Inpatient Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusion"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusion\":\n  \"Qualifying Scan with Values\" CTScanWithValues\n    where ( CTScanWithValues.value as Concept ).codes contains \"Full Body\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1074FHIRCTIQR"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value uri): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period.\"start\" is null then\n            Interval(period.\"start\".value, period.\"end\".value]\n        else\n            Interval[period.\"start\".value, period.\"end\".value]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlaraCommonFunctions"
            },
            {
              "url": "name",
              "valueString": "globalNoiseValue"
            },
            {
              "url": "statement",
              "valueString": "/* Note since the units has a special character in it this must be escaped in the CQL */\ndefine fluent function \"globalNoiseValue\"(Result ObservationClinicalResult ):\n  singleton from ( Result.component C\n      where Result.status in { 'final', 'amended', 'corrected' }\n        and C.code ~ \"Calculated CT global noise\"\n        and ( C.value as Quantity ).unit = '[hnsf\\'U]'\n      return (C.value as Quantity).value\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlaraCommonFunctions"
            },
            {
              "url": "name",
              "valueString": "sizeAdjustedValue"
            },
            {
              "url": "statement",
              "valueString": "define fluent function \"sizeAdjustedValue\"(Result ObservationClinicalResult ):\n  singleton from ( Result.component C\n      where Result.status in { 'final', 'amended', 'corrected' }\n        and C.code ~ \"Calculated CT size-adjusted dose\"\n        and ( C.value as Quantity ).unit = 'mGy.cm'\n      return (C.value as Quantity).value\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlaraCommonFunctions"
            },
            {
              "url": "name",
              "valueString": "ctScanQualifies"
            },
            {
              "url": "statement",
              "valueString": "define fluent function \"ctScanQualifies\"(Result ObservationClinicalResult ):\n  Result.qualifies(\"Abdomen and Pelvis Low Dose\", 64, 598)\n    or Result.qualifies(\"Abdomen and Pelvis Routine Dose\", 29, 644)\n    or Result.qualifies(\"Abdomen and Pelvis High Dose\", 29, 1260)\n    or Result.qualifies(\"Cardiac Low Dose\", 55, 93)\n    or Result.qualifies(\"Cardiac Routine Dose\", 32, 576)\n    or Result.qualifies(\"Chest Low Dose\", 55, 377)\n    or Result.qualifies(\"Chest Routine Dose\", 49, 377)\n    or Result.qualifies(\"Cardiac High Dose or Chest High Dose\", 49, 1282)\n    or Result.qualifies(\"Head Low Dose\", 115, 582)\n    or Result.qualifies(\"Head Routine Dose\", 115, 1025)\n    or Result.qualifies(\"Head High Dose\", 115, 1832)\n    or Result.qualifies(\"Extremity\", 73, 320)\n    or Result.qualifies(\"Neck or Cervical Spine\", 25, 1260)\n    or Result.qualifies(\"Thoracic or Lumbar Spine\", 25, 1260)\n    or Result.qualifies(\"Simultaneous Chest and Abdomen and Pelvis\", 29, 1637)\n    or Result.qualifies(\"Simultaneous Thoracic and Lumbar Spine\", 25, 2520)\n    or Result.qualifies(\"Simultaneous Head and Neck Routine Dose\", 25, 2285)\n    or Result.qualifies(\"Simultaneous Head and Neck High Dose\", 25, 3092)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlaraCommonFunctions"
            },
            {
              "url": "name",
              "valueString": "qualifies"
            },
            {
              "url": "statement",
              "valueString": "define fluent function \"qualifies\"(Result ObservationClinicalResult, code System.Code, noiseThreshold Decimal, sizeDoseThreshold Decimal ):\n  (Result.value as Concept) ~ code\n    and ( Result.globalNoiseValue() >= noiseThreshold\n        or Result.sizeAdjustedValue() >= sizeDoseThreshold\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToCode"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "Library/SupplementalDataElements|5.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library AlaraCommon",
          "resource": "Library/AlaraCommonFunctions|1.10.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system LOINC",
          "resource": "http://loinc.org"
        },
        {
          "type": "depends-on",
          "display": "Code system LOINC",
          "resource": "http://loinc.org"
        },
        {
          "type": "depends-on",
          "display": "Value set Encounter Inpatient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
        },
        {
          "type": "depends-on",
          "display": "Value set Payer Type",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
        }
      ],
      "parameter": [
        {
          "name": "Measurement Period",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "Period"
        },
        {
          "name": "SDE Sex",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Coding"
        },
        {
          "name": "Numerator",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Denominator",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Payer",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Ethnicity",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "Denominator Exclusion",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        }
      ],
      "dataRequirement": [
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "value.value"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "value.value"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "status",
            "status.value",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result"
          ],
          "mustSupport": [
            "code",
            "effective"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "96914-7",
                  "display": "CT dose and image quality category"
                }
              ]
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "status",
            "status.value",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
            }
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Ethnicity of the Patient \n SDE Payer-Payer that was billed \n SDE Race-Race of the Patient \n SDE Sex-Administrative Gender \n "
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "supplemental-data",
                "display": "Supplemental Data"
              }
            ],
            "text": "Supplemental Data Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    },
    {
      "id": "effective-data-requirements",
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    }
  ],
  "url": "https://madie.cms.gov/Measure/CMS1074FHIRCTIQR",
  "identifier": [
    {
      "use": "usual",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "short-name",
            "display": "Short Name"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/shortName",
      "value": "CMS1074FHIR"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-independent",
            "display": "Version Independent"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:9d126d62-8c93-4327-a3c2-5bfb99cee086"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-specific",
            "display": "Version Specific"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:dbfd22af-5ea3-4c8f-b459-4f8276cf1fb5"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "endorser",
            "display": "Endorser"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cbeId",
      "value": "3663e",
      "assigner": {
        "display": "CMS Consensus Based Entity"
      }
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "publisher",
            "display": "Publisher"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "1074FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.9.000",
  "name": "CMS1074FHIRCTIQR",
  "title": "Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults - Facility IQR FHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-07-15T13:37:39+00:00",
  "publisher": "Alara Imaging, Inc.",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.alaracare.com/our-commitment"
        }
      ]
    }
  ],
  "description": "This measure provides a standardized method for monitoring the performance of diagnostic CT to discourage unnecessarily high radiation doses, a risk factor for cancer, while preserving image quality. This measure is expressed as a percentage of CT exams that are out-of-range based on having either excessive radiation dose or inadequate image quality relative to evidence-based thresholds based on the clinical indication for the exam. All diagnostic CT exams of specified anatomic sites performed in hospital inpatient care settings are eligible. This eCQM requires the use of additional software to access primary data elements stored within radiology electronic health records and translate them into data elements that can be ingested by this eCQM. Additional details are included in the Guidance field.",
  "usage": "The level of aggregation for this eCQM is the facility. A parallel eCQM measures CT exams aggregated at the level of the clinician or clinician group. A single CT exam may be simultaneously measured in both the Merit-based Incentive Payment System (MIPS) and one of the hospital reporting programs (inpatient or outpatient); however, a single exam cannot be measured in both the inpatient and outpatient hospital quality reporting programs.\n\nTRANSLATION SOFTWARE\n\nAs a radiology measure, the measure derives standardized data elements from structured fields within both the electronic health record (EHR) and the radiology electronic clinical data systems, including the Radiology Information System (RIS) and the Picture Archiving and Communication System (PACS). Primary imaging data including Radiation Dose Structured Reports and image pixel data are stored in the PACS in Digital Imaging and Communications in Medicine (DICOM) format, a universally adopted standard for medical imaging information. Because of limitations in their specifications and format, eCQMs cannot currently access and consume elements from these radiology sources in their original DICOM formats. Thus, translation software was developed to transform primary data into a format that the eCQM can consume. This eCQM requires the use of additional software (translation software) to access the primary data elements that are required for measure computation and translate them into data elements that can be ingested by this eCQM. The purpose of this translation software is to access and link these primary data elements with minimal site burden, assess each CT exam for eligibility based on initial population criteria, and generate the three data elements mapped to a clinical terminology for eCQM consumption: CT Dose and Image Quality Category, Calculated CT Size-Adjusted Dose, and Calculated CT Global Noise. The free translation software necessary to use this eCQM is written and maintained by Alara Imaging, Inc. However, any software vendor capable of calculating and reporting this eCQM in accordance with the measure’s specifications, including combining radiology data with electronic health system data, and transforming radiology data into a format compatible with eCQM reporting, may report this measure on behalf of hospitals and clinicians.\n\nCODING\n\nThe translation software will create three variables required for measure computation including the CT Dose and Image Quality Category (LOINC(R) Code 96914-7), the Calculated CT Global Noise (LOINC(R) Code 96912-1) and the Calculated CT Size-Adjusted Dose (LOINC(R) Code 96913-9). These variables are defined in the Definition field above. These transformed data elements can be stored in the EHR. \n\nMEASURE CALCULATION\n\nThe measure will evaluate each included CT exam based on allowable thresholds that are specified by the CT Dose and Image Quality Category. An exam is considered out of range if either the Calculated CT Global Noise or the Calculated CT Size-Adjusted Dose is out of range for the CT Dose and Image Quality Category. Exams will be evaluated against their corresponding threshold, shown below with the following format: [Category shorthand (=CT Dose and Image Quality Category), threshold for the Calculated CT Global Noise in Hounsfield units, threshold for the Calculated CT Size-Adjusted Dose in dose length product].\n\n[LA31752-1 (=Abdomen and Pelvis, Low Dose), 64, 598];\n[LA31753-9 (=Abdomen and Pelvis, Routine Dose), 29, 644];\n[LA31754-7 (=Abdomen and Pelvis, High Dose), 29, 1260];\n[LA31755-4 (=Cardiac Low Dose), 55, 93];\n[LA31756-2 (=Cardiac Routine Dose), 32, 576];\n[LA31758-8 (=Chest Low Dose), 55, 377];\n[LA31759-6 (=Chest Routine Dose), 49, 377];\n[LA31761-2 (=Chest High Dose or Cardiac High Dose), 49, 1282];\n[LA31762-0 (=Head Low Dose), 115, 582];\n[LA31763-8 (=Head Routine Dose), 115, 1025];\n[LA31764-6 (=Head High Dose), 115, 1832];\n[LA31765-3 (=Upper or Lower Extremity), 73, 320];\n[LA31766-1 (=Neck or Cervical Spine), 25, 1260];\n[LA31767-9 (=Thoracic or Lumbar Spine), 25, 1260];\n[LA31768-7 (=Combined Chest, Abdomen and Pelvis), 29, 1637];\n[LA31851-1 (=Combined Thoracic and Lumbar Spine), 25, 2520];\n[LA31769-5 (=Combined Head and Neck, Routine Dose), 25, 2285];\n[LA31770-3 (=Combined Head and Neck, High Dose), 25, 3092]\n\nEXCLUSIONS\n\nCT scans with missing patient age or missing CT Dose and Image Quality Category (LOINC(R) 96914-7) are excluded from the initial population. CT scans with a missing Calculated Global Noise value or a missing Calculated CT Size-Adjusted Dose value are not included in the denominator. CT scans assigned a CT Dose and Image Quality Category (LOINC(R) 96914-7) value using the LOINC(R) answer list (LL5824-9) of full body (LA31771-1) are excluded from the denominator. These exams are included in the initial population because they have a non-missing CT Dose and Image Quality Category but are then removed as a Denominator Exclusion in the eCQM because the value is full body, which reflects CT exams that cannot be categorized by anatomical area or by clinical indication, either because they are simultaneous exams of multiple body regions outside of four commonly encountered multiple region groupings, or because there is insufficient data for their classification based on the given diagnosis and procedure codes.\n\nThis eCQM is an episode-based measure and should be reported for each eligible CT scan performed in a hospital inpatient setting.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS1074v3. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "copyright": "The translation software was written and will be updated and maintained by Alara Imaging and will be accessible by creating a secure account through Alara’s website.\n\nCopyright (C) 2025 Alara Imaging, Inc. All Rights Reserved. \n\nThis Measure and related data specifications are owned by Alara Imaging, Inc. Alara Imaging, Inc. is not responsible for any use of the Measure. Alara Imaging, Inc. makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and Alara Imaging, Inc. has no liability to anyone who relies on such measures or specifications.\n\nThe Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by Alara Imaging, Inc. and are subject to a license at the discretion of Alara Imaging, Inc.\n\nLimited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Alara Imaging, Inc. disclaims all liability for use or accuracy of any third-party code contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2025 American Medical Association. LOINC(R) is copyright 2004-2025 Regenstrief Institute, Inc. SNOMED Clinical Terms(R) (SNOMED CT[R]) is copyright 2004-2025 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2025 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R].",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "University of California San Francisco",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.ucsf.edu/"
        }
      ]
    }
  ],
  "relatedArtifact": [
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    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS1074FHIRCTIQR"
  ],
  "disclaimer": "The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.\n\nAlara Imaging, Inc., the University of California San Francisco, and its members and users shall not be responsible for any use or accuracy of the Measure or any code contained within the Measure. THE MEASURE AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.",
  "rationale": "Diagnostic imaging using CT occurs in more than a third of acute care hospitalizations in the U.S. (Vance et al., 2013) and greater than 90 million scans are performed annually in the U.S. (IMV, 2019 ). There is marked observed variation in the radiation doses used to perform these exams (Smith-Bindman et al., 2019). The inconsistency in how CT exams are performed represents a significant, unnecessary, and modifiable iatrogenic health risk, as there is extensive epidemiological and biological evidence that suggests exposure to radiation in the same range as that routinely delivered by CT increases a person's risk of developing cancer (Board of Radiation Effects, 2006; Hon, Han, Jung, & Kim, 2019). It is estimated that 2% (37,000) of the 1.8 million cancers diagnosed annually in the U.S. are caused by CT exams (Berrington de Gonzalez, 2009; NCI Cancer Statistics, 2020).\n\nThe measure focuses on reducing radiation dose in CT, an intermediate outcome directly and proportionally related to cancer prevention. As radiation dose is known to be directly related and proportional to future cancer risk (Board of Radiation Effects, 2006; Berrington de Gonzalez, 2009), any reduction in radiation exposure would be expected to lead to a proportional reduction in cancers. Research suggests that when healthcare organizations and clinicians are provided with a summary of their CT radiation doses, their subsequent doses can be reduced without changing the usefulness of these tests (Smith-Bindman, 2020).\n\nOn the basis of the current estimated number of CT scans performed annually in the U.S. (IMV, 2019), distribution in scan types and observed doses (Demb, 2017; Smith-Bindman, 2019), modeling of the cancer risk associated with CT at different ages of exposure (Berrington de Gonzalez, 2009), and costs of cancer care (Dieguez, Ferro & Pyenson (2017); Mariotto, 2011), an estimated 13,982 cancers could be prevented among Medicare beneficiaries annually, resulting in $1.86 billion to $5.21 billion annual cost savings. These cost calculations were supported by more recent data on cancer survivorship and costs, which yielded an estimated $3.04 billion dollars in annual costs savings to Medicare. (Mariotto, 2020; NCI Office of Cancer Survivorship, 2022).",
  "clinicalRecommendationStatement": "The measure aligns with numerous evidence- and consensus-based clinical guidelines asking radiologists to track, optimize, and lower CT radiation doses, guidelines that have been written by the American College of Radiology (Kanal, 2017), cardiovascular imaging societies (Hirshfeld, 2018, references a, b and c noted below), Image Gently Alliance, an initiative begun by the American College of Radiology, the Radiological Society of North America, American Society of Radiologic Technologists, the American Association of Physicists in Medicine, and the Society of Pediatric Radiology, which dozens of U.S. and international organizations have joined as recently as 2020 (Image Gently Alliance, 2022), and the US Food and Drug Administration (FDA, 2019).\n\nThis measure has been strongly supported by a Technical Expert Panel (TEP) comprising a diverse group of clinicians, patient advocates, and leaders of medical specialty societies, payers, and healthcare safety and accrediting organizations, all of whom were engaged through every stage of measure conceptualization, development, and testing. In assessing the face validity of the measure, 100% of TEP members agreed radiation dose and global noise are relevant metrics of CT quality, that size is an appropriate method of risk adjustment, and that performance on this measure of radiation dose and image quality as specified is a representation of quality.",
  "group": [
    {
      "id": "Group_1",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code": "proportion",
                "display": "Proportion"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode": "Observation"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "outcome",
                "display": "Outcome"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "Adults aged 18 years or older that received a CTScan during an inpatient hospitalization",
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "All CT scans in adults aged 18 years and older at the start of the measurement period that have a CT Dose and Image Quality Category and were performed during an inpatient hospitalization that ends during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Equals Initial Population with a CT Dose and Image Quality Category, a Calculated Global Noise value, and a Calculated CT Size-Adjusted Dose value ",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "DenominatorExclusion_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exclusion",
                "display": "Denominator Exclusion"
              }
            ]
          },
          "description": "Denominator, where a CT scan with a CT Dose and Image Quality Category = full body",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusion"
          }
        },
        {
          "id": "Numerator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Calculated CT Size-Adjusted Dose greater than or equal to a threshold specific to the CT Dose and Image Quality Category, or Calculated CT Global Noise value greater than or equal to a threshold specific to the CT Dose and Image Quality Category",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "id": "sde-payer",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Payer",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer"
      }
    },
    {
      "id": "sde-race",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Race",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Race"
      }
    },
    {
      "id": "sde-sex",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    }
  ]
}