Draft dQM CMS Content Implementation Guide
2025.1.0 - CI Build

Draft dQM CMS Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2025.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/dqm-content-cms-2025/ and changes regularly. See the Directory of published versions

## : Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults - Facility OQRFHIR - JSON Representation

Active as of 2026-01-16

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    {
      "resourceType" : "Measure",
      "id" : "CMS1206FHIRCTOQR",
      "meta" : {
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          "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" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n  <table class=\"narrative-table\">\n    <tbody>\n<tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Metadata</th>\n\n\n</tr>\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Title</th>\n\n\n\n<td class=\"content-container\">Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults - Facility OQRFHIR\n</td>\n\n\n</tr>\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Version</th>\n\n\n\n<td class=\"content-container\">1.1.000</td>\n\n\n</tr>\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Short Name</th>\n\n\n\n<td class=\"content-container\">CMS1206FHIR</td>\n\n\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">GUID (Version Independent)</th>\n\n\n\n<td class=\"content-container\">urn:uuid:65c110b9-5f5f-46a5-a10c-81e1341f901f</td>\n\n\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">GUID (Version Specific)</th>\n\n\n\n<td class=\"content-container\">urn:uuid:00b911d5-a1d2-458a-a8bf-cacc92ec7210</td>\n\n\n</tr>\n\n\n\n  \n    \n    \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">CMS Identifier</th>\n\n\n\n<td class=\"content-container\">1206FHIR</td>\n\n\n</tr>\n\n  \n\n\n  \n    \n    \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">CMS Consensus Based Entity Identifier</th>\n\n\n\n<td class=\"content-container\">3663e</td>\n\n\n</tr>\n\n  \n\n\n\n  \n    \n    \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Effective Period</th>\n\n\n\n<td class=\"content-container\">2026-01-01 through 2026-12-31</td>\n\n\n</tr>\n\n  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Steward (Publisher)</th>\n\n\n\n<td class=\"content-container\">Alara Imaging, Inc.</td>\n\n\n</tr>\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Developer</th>\n\n\n\n<td class=\"content-container\">University of California San Francisco</td>\n\n\n</tr>\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Description</th>\n\n\n\n<td class=\"content-container\"><div><p>This measure is an episode of care measure that 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 non-inpatient care settings (including emergency settings) are eligible. This dQM 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 dQM. Additional details are included in the Guidance (Usage) field.</p>\n</div></td>\n\n\n</tr>\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Copyright</th>\n\n\n\n<td class=\"content-container\"><div><p>The translation software was written and will be updated and maintained by Alara Imaging, Inc. 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 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].</p>\n</div></td>\n\n\n</tr>\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Disclaimer</th>\n\n\n\n<td class=\"content-container\"><div><p>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 &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>\n</div></td>\n\n\n</tr>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Rationale</th>\n\n\n\n<td class=\"content-container\"><div><p>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; Hong, Han, Jung, &amp; 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 et al., 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 et al., 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 et al., 2017; Smith-Bindman et al., 2019), modeling of the cancer risk associated with CT at different ages of exposure (Berrington de Gonzalez et al., 2009), and costs of cancer care (Dieguez, Ferro, &amp; Pyenson, 2017; Mariotto, Yabroff, Shao, Feuer, &amp; Brown, 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).</p>\n</div></td>\n\n\n</tr>\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Clinical Recommendation Statement</th>\n\n\n\n<td class=\"content-container\"><div><p>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 et al., 2017), cardiovascular imaging societies (Hirshfeld et al., 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.</p>\n</div></td>\n\n\n</tr>\n\n\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Berrington de Gonzalez A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071-2077.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Board of Radiation Effects Research Division on Earth and Life Sciences National Research Council of the National Academies. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2, Washington, D.C.: The National Academies Press; 2006.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A. 2003;100(24):13761-13766.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Demb J, Chu P, Nelson T, et al. Optimizing Radiation Doses for Computed Tomography Across Institutions: Dose Auditing and Best Practices. JAMA Intern Med. 2017;177(6):810-81.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Dieguez G, Ferro C, Pyenson B. Milliman Research Report: A Multi-Year Look at the Cost Burden of Cancer Care. April 11, 2017. https://www.milliman.com/en/insight/2017/a-multi-year-look-at-the-cost-burden-of-cancer-care</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Halliburton SS, Abbara S, Chen MY, et al. SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr. 2011;5(4):198-224.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Hong JY, Han K, Jung JH, Kim JS. Association of Exposure to Diagnostic Low-Dose Ionizing Radiation With Risk of Cancer Among Youths in South Korea. JAMA Netw Open. 2019;2(9):e1910584.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Hricak H, Brenner DJ, Adelstein SJ, et al. Managing Radiation Use in Medical Imaging: A Multifaceted Challenge. Radiology. 2010.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Image Wisely 2020. The American College of Radiology and the Radiological Society of North America formed the Joint Task Force on Adult Radiation Protection to address concerns about the surge of public exposure to ionizing radiation from medical imaging. The Joint Task Force collaborated with the American Association of Physicists in Medicine and the American Society of Radiologic Technologists to create the Image Wisely campaign with the objective of lowering the amount of radiation used in medically necessary imaging studies and eliminating unnecessary procedures. https://www.imagewisely.org/</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>IMV 2019 CT Market Outlook Report, https://imvinfo.com/ct-departments-seek-workflow-improvements-to-address-increased-ct-utilization/</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Kanal KM, Butler PF, Sengupta D, Bhargavan-Chatfield M, Coombs LP, Morin RL. U.S. Diagnostic Reference Levels and Achievable Doses for 10 Adult CT Examinations. Radiology. 2017;284(1):120-133.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011 Jan 19;103(2):117-28. doi: 10.1093/jnci/djq495. Epub 2011 Jan 12. Erratum in: J Natl Cancer Inst. 2011 Apr 20;103(8):699. PMID: 21228314.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>National Cancer Institute Cancer Statistics. https://www.cancer.gov/about-cancer/understanding/statistics accessed May 25, 2021</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499-505.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Pierce DA, Preston DL. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiation research. 2000;154(2):178-186.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Preston DL, Ron E, Tokuoka S, et al. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiation research. 2007;168(1):1-64.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Shuryak I, Sachs RK, et al. Cancer risks after radiation exposure in middle age. J Natl Cancer Inst. 2010;102(21):1628-1636.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Smith-Bindman R, Lipson J, Marcus R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169(22):2078-2086.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Smith-Bindman R, Moghadassi M, Wilson N, et al. Radiation Doses in Consecutive CT Examinations from Five University of California Medical Centers. Radiology. 2015;277(1):134-141.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Smith-Bindman R, Wang Y, Chu P, et al. International variation in radiation dose for computed tomography examinations: prospective cohort study. BMJ. 2019;364:k4931.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Smith-Bindman R, Chu P, Wang Y, et al. Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography: A Randomized Clinical Trial. JAMA Intern Med. 2020 May 1;180(5):666-675.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Stecker MS, Balter S, Towbin RB, et al. Guidelines for patient radiation dose management. J Vasc Interv Radiol. 2009;20(7 Suppl):S263-273.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>U.S. Food and Drug Administration. FDA White Paper: Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging. 2019; https://www.fda.gov/radiation-emitting-products/initiative-reduce-unnecessary-radiation-exposure-medical-imaging/white-paper-initiative-reduce-unnecessary-radiation-exposure-medical-imaging.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Vance EA, Xie X, Henry A, Wernz C, Slonim AD. Computed tomography scan use variation: patient, hospital, and geographic factors. Am J Manag Care. 2013 Mar 1;19(3):e93-9. PMID: 23534948.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Writing Committee M, Hirshfeld JW, Jr., Ferrari VA, et al. 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. J Am Coll Cardiol. 2018.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Writing Committee M, Hirshfeld JW, Jr., Ferrari VA, et al. 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. J Am Coll Cardiol. 2018.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n<tr>\n  \n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n  \n  \n  \n  <td class=\"content-container\">\n    \n    \n    \n    <div><p>Writing Committee M, Hirshfeld JW, Jr., Ferrari VA, et al. 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. J Am Coll Cardiol. 2018.</p>\n</div>\n    \n    \n    \n    \n    \n    \n    \n  </td>\n</tr>\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Guidance (Usage)</th>\n\n\n\n<td class=\"content-container\">The level of aggregation for this dQM is the facility. A parallel dQM 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, dQMs 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 dQM can consume. This dQM 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 dQM. 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 dQM 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 dQM is written and maintained by Alara Imaging, Inc. However, any software vendor capable of calculating and reporting this dQM 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 dQM 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\n\\[LA31753-9 (=Abdomen and Pelvis, Routine Dose), 29, 644\\];\n\n\\[LA31754-7 (=Abdomen and Pelvis, High Dose), 29, 1260\\];\n\n\\[LA31755-4 (=Cardiac Low Dose), 55, 93\\];\n\n\\[LA31756-2 (=Cardiac Routine Dose), 32, 576\\];\n\n\\[LA31758-8 (=Chest Low Dose), 55, 377\\];\n\n\\[LA31759-6 (=Chest Routine Dose), 49, 377\\];\n\n\\[LA31761-2 (=Chest High Dose or Cardiac High Dose), 49, 1282\\];\n\n\\[LA31762-0 (=Head Low Dose), 115, 582\\];\n\n\\[LA31763-8 (=Head Routine Dose), 115, 1025\\];\n\n\\[LA31764-6 (=Head High Dose), 115, 1832\\];\n\n\\[LA31765-3 (=Upper or Lower Extremity), 73, 320\\];\n\n\\[LA31766-1 (=Neck or Cervical Spine), 25, 1260\\];\n\n\\[LA31767-9 (=Thoracic or Lumbar Spine), 25, 1260\\];\n\n\\[LA31768-7 (=Combined Chest, Abdomen and Pelvis), 29, 1637\\];\n\n\\[LA31851-1 (=Combined Thoracic and Lumbar Spine), 25, 2520\\];\n\n\\[LA31769-5 (=Combined Head and Neck, Routine Dose), 25, 2285\\];\n\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 dQM 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 dQM is an episode-based measure and should be reported for each eligible CT scan performed in a hospital outpatient setting.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS1206v3. 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).\n</td>\n\n\n</tr>\n\n\n\n  \n  \n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: Group_1)</th>\n\n\n</tr>\n  \n  \n    \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Summary</th>\n\n\n\n<td class=\"content-container\">Patients aged 18 years and older that have a CT Dose and Image Quality Category and were not performed in a hospital inpatient setting\n</td>\n\n\n</tr>\n\n  \n  \n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Basis</th>\n\n\n\n<td class=\"content-container\">Observation</td>\n\n\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Scoring</th>\n\n\n\n<td class=\"content-container\">\n    Proportion\n\n\n</td>\n\n\n</tr>\n\n\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Improvement Notation</th>\n\n\n\n<td class=\"content-container\">\n    Decreased score indicates improvement\n\n\n</td>\n\n\n</tr>\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Type</th>\n\n\n\n<td class=\"content-container\">\n    Intermediate Outcome\n\n\n</td>\n\n\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Rate Aggregation</th>\n\n\n\n<td class=\"content-container\">None\n</td>\n\n\n</tr>\n\n\n\n  \n  \n\n    \n      \n        \n  \n    \n    \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Initial Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: InitialPopulation_1\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">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 not performed in a hospital inpatient setting, that ends during the measurement period, and not part of an inpatient hospitalization.\n</p>\n        \n        \n          \n            \n              \n              <em>Criteria</em>: <a href=\"#Group_1-InitialPopulation_1\">Initial Population</a> \n            \n          \n          \n        \n        \n        \n      </td>\n    </tr>\n  \n\n      \n    \n\n    \n      \n        \n  \n    \n    \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Denominator</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: Denominator_1\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Equals Initial Population with a CT Dose and Image Quality Category, a Calculated Global Noise value, and a Calculated CT Size-Adjusted Dose value\n</p>\n        \n        \n          \n            \n              \n              <em>Criteria</em>: <a href=\"#Group_1-Denominator_1\">Denominator</a> \n            \n          \n          \n        \n        \n        \n      </td>\n    </tr>\n  \n\n      \n    \n\n    \n      \n        \n  \n    \n    \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Denominator Exclusion</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: DenominatorExclusion_1\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Denominator, where a CT scan with a CT Dose and Image Quality Category = full body\n</p>\n        \n        \n          \n            \n              \n              <em>Criteria</em>: <a href=\"#Group_1-DenominatorExclusion_1\">Denominator Exclusion</a> \n            \n          \n          \n        \n        \n        \n      </td>\n    </tr>\n  \n\n      \n    \n\n    \n      \n    \n\n    \n      \n        \n  \n    \n    \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Numerator</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: Numerator_1\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">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\n</p>\n        \n        \n          \n            \n              \n              <em>Criteria</em>: <a href=\"#Group_1-Numerator_1\">Numerator</a> \n            \n          \n          \n        \n        \n        \n      </td>\n    </tr>\n  \n\n      \n    \n\n    \n      \n    \n\n  \n\n\n  \n\n\n\n\n\n\n\n  \n    \n    \n    \n    \n    \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Supplemental Data Guidance Guidance</th>\n\n\n\n<td class=\"content-container\">For every patient evaluated by this measure also identify payer, race, ethnicity and sex</td>\n\n\n</tr>\n\n  \n\n\n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Supplemental Data Elements</th>\n\n\n</tr>\n\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Supplemental Data Element</th>\n\n\n  <td class=\"content-container\">\n    \n      <em>ID</em>: sde-ethnicity\n      \n      <br/>\n      \n    \n    \n      \n        \n          <em>Usage Code</em>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}\">Supplemental Data</span>\n        \n        <br/>\n      \n    \n    \n      <em>Description</em>: SDE Ethnicity\n\n    \n    \n      \n        <br/>\n        \n          \n          <em>Logic Definition</em>: <a href=\"#cms1206fhirctoqr-sde-ethnicity\">SDE Ethnicity</a> \n        \n      \n    \n  </td>\n</tr>\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Supplemental Data Element</th>\n\n\n  <td class=\"content-container\">\n    \n      <em>ID</em>: sde-payer\n      \n      <br/>\n      \n    \n    \n      \n        \n          <em>Usage Code</em>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}\">Supplemental Data</span>\n        \n        <br/>\n      \n    \n    \n      <em>Description</em>: SDE Payer\n\n    \n    \n      \n        <br/>\n        \n          \n          <em>Logic Definition</em>: <a href=\"#cms1206fhirctoqr-sde-payer\">SDE Payer</a> \n        \n      \n    \n  </td>\n</tr>\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Supplemental Data Element</th>\n\n\n  <td class=\"content-container\">\n    \n      <em>ID</em>: sde-race\n      \n      <br/>\n      \n    \n    \n      \n        \n          <em>Usage Code</em>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}\">Supplemental Data</span>\n        \n        <br/>\n      \n    \n    \n      <em>Description</em>: SDE Race\n\n    \n    \n      \n        <br/>\n        \n          \n          <em>Logic Definition</em>: <a href=\"#cms1206fhirctoqr-sde-race\">SDE Race</a> \n        \n      \n    \n  </td>\n</tr>\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Supplemental Data Element</th>\n\n\n  <td class=\"content-container\">\n    \n      <em>ID</em>: sde-sex\n      \n      <br/>\n      \n    \n    \n      \n        \n          <em>Usage Code</em>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}\">Supplemental Data</span>\n        \n        <br/>\n      \n    \n    \n      <em>Description</em>: SDE Sex\n\n    \n    \n      \n        <br/>\n        \n          \n          <em>Logic Definition</em>: <a href=\"#cms1206fhirctoqr-sde-sex\">SDE Sex</a> \n        \n      \n    \n  </td>\n</tr>\n\n\n<tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Logic</th>\n\n\n</tr>\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Primary Library</th>\n\n\n\n<td class=\"content-container\"><a href=\"Library-CMS1206FHIRCTOQR.html\">CMS1206FHIRCTOQR</a></td>\n\n\n</tr>\n\n\n\n\n<tr>\n  <th scope=\"row\" class=\"row-header\">Contents</th>\n  <td class=\"content-container\">\n    <em><a href=\"#population-criteria\">Population Criteria</a></em>\n    <br/>\n    <em><a href=\"#definitions\">Logic Definitions</a></em>\n    <br/>\n    <em><a href=\"#terminology\">Terminology</a></em>\n    <br/>\n    <em><a href=\"#dependencies\">Dependencies</a></em>\n    <br/>\n    <em><a href=\"#data-requirements\">Data Requirements</a></em>\n    <br/>\n    <em><a href=\"#parameters\">Parameters</a></em>\n    <br/>\n  </td>\n</tr>\n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"population-criteria\"> </a>Population Criteria</th>\n\n\n</tr>\n  \n  \n  \n\n  \n  \n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: Group_1)</th>\n\n\n</tr>\n  \n  \n  \n  \n\n    \n      \n          \n    \n      \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n            \n              \n            \n            \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n    Initial Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      \n      <a name=\"Group_1-InitialPopulation_1\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  &quot;Qualified Scan Without Inpatient Encounter&quot;</code></pre>\n    \n      \n      <a href=\"#cms1206fhirctoqr-initial-population\"><em>Definition</em></a>\n    \n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n      \n    \n\n    \n      \n          \n    \n      \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n            \n              \n            \n            \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n    Denominator\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      \n      <a name=\"Group_1-Denominator_1\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Qualified Scan With Values&quot;</code></pre>\n    \n      \n      <a href=\"#cms1206fhirctoqr-denominator\"><em>Definition</em></a>\n    \n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n      \n    \n\n    \n      \n          \n    \n      \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n            \n              \n            \n            \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n    Denominator Exclusion\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      \n      <a name=\"Group_1-DenominatorExclusion_1\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">// TODO: Note that this used to use a .coding contains &quot;Full Body&quot;, presumably to allow for other codings, so long as at least Full Body is present\n// But that is the definition of concept equivalent within CQL, so it should be the same to just use the ~ operator. Please confirm.\ndefine &quot;Denominator Exclusion&quot;:\n  &quot;Qualified Scan With Values&quot; CTScanWithValues\n    where ( CTScanWithValues.value as FHIR.CodeableConcept ) ~ &quot;Full Body&quot;</code></pre>\n    \n      \n      <a href=\"#cms1206fhirctoqr-denominator-exclusion\"><em>Definition</em></a>\n    \n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n      \n    \n\n    \n      \n    \n\n    \n      \n          \n    \n      \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n            \n              \n            \n            \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n    Numerator\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      \n      <a name=\"Group_1-Numerator_1\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Numerator&quot;:\n  &quot;Qualified Scan With Values&quot; CTScanWithValues\n    where CTScanWithValues.ctScanQualifies ( )</code></pre>\n    \n      \n      <a href=\"#cms1206fhirctoqr-numerator\"><em>Definition</em></a>\n    \n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n      \n    \n\n    \n      \n    \n\n  \n\n\n  \n\n\n  \n\n  \n  \n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"definitions\"> </a>Logic Definitions</th>\n\n\n</tr>\n  \n  \n          \n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> SupplementalDataElements</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"supplementaldataelements-sde-sex\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  case\n    when Patient.sex() = '248153007' then &quot;Male (finding)&quot;\n    when Patient.sex() = '248152002' then &quot;Female (finding)&quot;\n    else null\n  end</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> SupplementalDataElements</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"supplementaldataelements-sde-payer\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  [USQualityCore.Coverage: type in &quot;Payer Type&quot;] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> SupplementalDataElements</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"supplementaldataelements-sde-ethnicity\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  (Patient.ethnicity()) E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> SupplementalDataElements</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"supplementaldataelements-sde-race\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  (Patient.race()) R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n\n        \n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-sde-sex\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  SDE.&quot;SDE Sex&quot;</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-qualified-scan\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Qualified Scan&quot;:\n  [ObservationClinicalResult: &quot;CT dose and image quality category&quot;] CTScanResult\n    where CTScanResult.status in { 'final', 'amended', 'corrected' }\n      and CTScanResult.effective.toInterval ( ) ends during day of &quot;Measurement Period&quot;\n      and AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &gt;= 18</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-qualified-scan-without-inpatient-encounter\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Qualified Scan Without Inpatient Encounter&quot;:\n  &quot;Qualified Scan&quot; QualifiedCTScan\n    without [Encounter: &quot;Encounter Inpatient&quot;] InpatientEncounter\n      such that InpatientEncounter.status ~ 'finished'\n        and InpatientEncounter.period ends during day of &quot;Measurement Period&quot;\n        and QualifiedCTScan.effective.toInterval ( ) starts during InpatientEncounter.period</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-qualified-scan-with-values\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Qualified Scan With Values&quot;:\n  &quot;Qualified Scan Without Inpatient Encounter&quot; CTScan\n    where CTScan.globalNoiseValue ( ) is not null\n      and CTScan.sizeAdjustedValue ( ) is not null\n      and CTScan.value is not null</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-numerator\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Numerator&quot;:\n  &quot;Qualified Scan With Values&quot; CTScanWithValues\n    where CTScanWithValues.ctScanQualifies ( )</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-denominator\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Qualified Scan With Values&quot;</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-sde-payer\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  SDE.&quot;SDE Payer&quot;</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-initial-population\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  &quot;Qualified Scan Without Inpatient Encounter&quot;</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-sde-ethnicity\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  SDE.&quot;SDE Ethnicity&quot;</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-denominator-exclusion\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">// TODO: Note that this used to use a .coding contains &quot;Full Body&quot;, presumably to allow for other codings, so long as at least Full Body is present\n// But that is the definition of concept equivalent within CQL, so it should be the same to just use the ~ operator. Please confirm.\ndefine &quot;Denominator Exclusion&quot;:\n  &quot;Qualified Scan With Values&quot; CTScanWithValues\n    where ( CTScanWithValues.value as FHIR.CodeableConcept ) ~ &quot;Full Body&quot;</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> CMS1206FHIRCTOQR</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"cms1206fhirctoqr-sde-race\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  SDE.&quot;SDE Race&quot;</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n\n        \n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> AlaraCommonFunctions</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"alaracommonfunctions-globalnoisevalue\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/* Note since the units has a special character in it this must be escaped in the CQL */\ndefine fluent function &quot;globalNoiseValue&quot;(Result ObservationClinicalResult ):\n  singleton from ( Result.component C\n      where Result.status in { 'final', 'amended', 'corrected' }\n        and C.code ~ &quot;Calculated CT global noise&quot;\n        and ( C.value as Quantity ).unit = '[hnsf\\'U]'\n      return (C.value as Quantity).value\n  )</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> AlaraCommonFunctions</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"alaracommonfunctions-sizeadjustedvalue\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define fluent function &quot;sizeAdjustedValue&quot;(Result ObservationClinicalResult ):\n  singleton from ( Result.component C\n      where Result.status in { 'final', 'amended', 'corrected' }\n        and C.code ~ &quot;Calculated CT size-adjusted dose&quot;\n        and ( C.value as Quantity ).unit = 'mGy.cm'\n      return (C.value as Quantity).value\n  )</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> AlaraCommonFunctions</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"alaracommonfunctions-ctscanqualifies\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define fluent function &quot;ctScanQualifies&quot;(Result ObservationClinicalResult ):\n  Result.qualifies(&quot;Abdomen and Pelvis Low Dose&quot;, 64, 598)\n    or Result.qualifies(&quot;Abdomen and Pelvis Routine Dose&quot;, 29, 644)\n    or Result.qualifies(&quot;Abdomen and Pelvis High Dose&quot;, 29, 1260)\n    or Result.qualifies(&quot;Cardiac Low Dose&quot;, 55, 93)\n    or Result.qualifies(&quot;Cardiac Routine Dose&quot;, 32, 576)\n    or Result.qualifies(&quot;Chest Low Dose&quot;, 55, 377)\n    or Result.qualifies(&quot;Chest Routine Dose&quot;, 49, 377)\n    or Result.qualifies(&quot;Cardiac High Dose or Chest High Dose&quot;, 49, 1282)\n    or Result.qualifies(&quot;Head Low Dose&quot;, 115, 582)\n    or Result.qualifies(&quot;Head Routine Dose&quot;, 115, 1025)\n    or Result.qualifies(&quot;Head High Dose&quot;, 115, 1832)\n    or Result.qualifies(&quot;Extremity&quot;, 73, 320)\n    or Result.qualifies(&quot;Neck or Cervical Spine&quot;, 25, 1260)\n    or Result.qualifies(&quot;Thoracic or Lumbar Spine&quot;, 25, 1260)\n    or Result.qualifies(&quot;Simultaneous Chest and Abdomen and Pelvis&quot;, 29, 1637)\n    or Result.qualifies(&quot;Simultaneous Thoracic and Lumbar Spine&quot;, 25, 2520)\n    or Result.qualifies(&quot;Simultaneous Head and Neck Routine Dose&quot;, 25, 2285)\n    or Result.qualifies(&quot;Simultaneous Head and Neck High Dose&quot;, 25, 3092)</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> AlaraCommonFunctions</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"alaracommonfunctions-qualifies\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define fluent function &quot;qualifies&quot;(Result ObservationClinicalResult, code System.Code, noiseThreshold Decimal, sizeDoseThreshold Decimal ):\n  (Result.value as FHIR.CodeableConcept) ~ code\n    and ( Result.globalNoiseValue() &gt;= noiseThreshold\n        or Result.sizeAdjustedValue() &gt;= sizeDoseThreshold\n    )</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n\n        \n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-tostring\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function ToString(value string): value.value</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-tostring\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function ToString(value uri): value.value</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-tostring\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function ToString(value ObservationStatus): value.value</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-todatetime\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function ToDateTime(value dateTime): value.value</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-tointerval\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\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.&quot;start&quot; is null then\n            Interval(period.&quot;start&quot;.value, period.&quot;end&quot;.value]\n        else\n            Interval[period.&quot;start&quot;.value, period.&quot;end&quot;.value]</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-todatetime\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function ToDateTime(value instant): value.value</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-todate\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function ToDate(value date): value.value</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-toquantity\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) \nvalue to a CQL Quantity\n@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity\nhas a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)\nan error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.\n@seealso: ToCalendarUnit\n*/\ndefine function ToQuantity(quantity FHIR.Quantity):\n    case\n        when quantity is null then null\n        when quantity.value is null then null\n        when quantity.comparator is not null then\n            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')\n        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'\n              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then\n            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }\n        else\n            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' &amp; quantity.unit.value &amp; ' (' &amp; quantity.system.value &amp; '|' &amp; quantity.code.value &amp; ')')\n    end</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-tocalendarunit\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts a UCUM definite duration unit to a CQL calendar duration\nunit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) \ntopic of the CQL specification.\n@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate\n*/\ndefine function ToCalendarUnit(unit System.String):\n    case unit\n        when 'ms' then 'millisecond'\n        when 's' then 'second'\n        when 'min' then 'minute'\n        when 'h' then 'hour'\n        when 'd' then 'day'\n        when 'wk' then 'week'\n        when 'mo' then 'month'\n        when 'a' then 'year'\n        else unit\n    end</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-tostring\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function ToString(value EncounterStatus): value.value</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-toconcept\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-tocode\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\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        }</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhirhelpers-todecimal\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function ToDecimal(value decimal): value.value</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n\n        \n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRCommon</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhircommon-ext\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the single extension (if present) on the given resource with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given resource with the specified url.\n*/\ndefine fluent function ext(domainResource DomainResource, url String):\n  singleton from domainResource.exts(url)</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRCommon</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhircommon-exts\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns any extensions defined on the given resource with the specified url\n*/\ndefine fluent function exts(domainResource DomainResource, url String):\n  domainResource.extension E\n    where E.url = url\n    return E</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRCommon</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhircommon-tointerval\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in FHIR, allowing this function to be used across any resource.\n\nThe input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.\nIf the input is a Period, the result is a DateTime Interval.\nIf the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.\nIf the input is an instant, the result is a DateTime Interval beginning and ending on that instant.\nIf the input is a string, an error is raised indicating a single interval cannot be computed from a string.\nIf the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,\nand ending immediately prior to when the patient was the given Age plus one year.\nIf the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given\nby the low end of the Range, and ending immediately prior to when the patient was the Age given by the\nhigh end of the Range plus one year.\n\nNOTE: Due to the\ncomplexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used\nwith a Timing or String.\n*/\ndefine fluent function toInterval(choice Choice&lt;FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range&gt;):\n  case\n    when choice is FHIR.dateTime then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n    when choice is FHIR.Period then\n      FHIRHelpers.ToInterval(choice as FHIR.Period)\n    when choice is FHIR.instant then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]\n    when choice is FHIR.Age then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)\n    when choice is FHIR.Range then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)\n    when choice is FHIR.Timing then\n      Message(null as Interval&lt;DateTime&gt;, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')\n    when choice is FHIR.string then\n      Message(null as Interval&lt;DateTime&gt;, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n    else\n      null as Interval&lt;DateTime&gt;\n  end</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRCommon</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhircommon-ext\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the single extension (if present) on the given element with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given element with the specified url.\n*/\ndefine fluent function ext(element Element, url String):\n  singleton from element.exts(url)</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> FHIRCommon</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"fhircommon-exts\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns any extensions defined on the given element with the specified url.\n*/\ndefine fluent function exts(element Element, url String):\n  element.extension E\n    where E.url = url\n    return E</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n\n        \n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> USCoreCommon</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"uscorecommon-sex\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the sex element as defined for the USCore patient profile\n*/\ndefine fluent function sex(patient Patient):\n  patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> USCoreCommon</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"uscorecommon-ethnicity\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define fluent function ethnicity(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E\n    return {\n      ombCategory: E.ext('ombCategory').value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n\n        \n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> USCoreCommon</td>\n\n</tr>\n<tr>\n\n  <td>\n    \n    \n    \n    \n      <a name=\"uscorecommon-race\"> </a>\n    \n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define fluent function race(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E\n    return {\n      ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }</code></pre>\n  </td>\n\n</tr>\n\n\n\n\n\n  \n  \n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"terminology\"> </a>Terminology</th>\n\n\n</tr>\n  \n  \n  \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n\n<tr>\n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Code System</th>\n\n\n  \n  <td class=\"content-container\">\n    \n    <em>Description</em>: Code system SNOMEDCT\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">SNOMED CT (all versions)</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>http://snomed.info/sct</tt>\n    \n  </td>\n</tr>\n \n\n\n<tr>\n  \n  \n  \n\n<th scope=\"row\" class=\"row-header\">Code System</th>\n\n\n  \n  <td class=\"content-container\">\n    \n    <em>Description</em>: Code system LOINC\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-loinc.html\">Logical Observation Identifiers, Names and Codes (LOINC)</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>http://loinc.org</tt>\n    \n  </td>\n</tr>\n \n\n\n<tr>\n  \n  \n\n<th scope=\"row\" class=\"row-header\">Value Set</th>\n\n\n  \n  \n  <td class=\"content-container\">\n    \n    <em>Description</em>: Value set Encounter Inpatient\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307</tt>\n    \n  </td>\n</tr>\n \n\n\n<tr>\n  \n  \n\n<th scope=\"row\" class=\"row-header\">Value Set</th>\n\n\n  \n  \n  <td class=\"content-container\">\n    \n    <em>Description</em>: Value set Payer Type\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer Type</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591</tt>\n    \n  </td>\n</tr>\n \n\n\n  \n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Male (finding)\n        <br/>\n      \n      <em>Code</em>: 248153007\n      <br/>\n      <em>System</em>: <tt>http://snomed.info/sct</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Female (finding)\n        <br/>\n      \n      <em>Code</em>: 248152002\n      <br/>\n      <em>System</em>: <tt>http://snomed.info/sct</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: CT dose and image quality category\n        <br/>\n      \n      <em>Code</em>: 96914-7\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Calculated CT global noise\n        <br/>\n      \n      <em>Code</em>: 96912-1\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Calculated CT size-adjusted dose\n        <br/>\n      \n      <em>Code</em>: 96913-9\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Abdomen and Pelvis Low Dose\n        <br/>\n      \n      <em>Code</em>: LA31752-1\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Abdomen and Pelvis Routine Dose\n        <br/>\n      \n      <em>Code</em>: LA31753-9\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Abdomen and Pelvis High Dose\n        <br/>\n      \n      <em>Code</em>: LA31754-7\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Cardiac Low Dose\n        <br/>\n      \n      <em>Code</em>: LA31755-4\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Cardiac Routine Dose\n        <br/>\n      \n      <em>Code</em>: LA31756-2\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Chest Low Dose\n        <br/>\n      \n      <em>Code</em>: LA31758-8\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Chest Routine Dose\n        <br/>\n      \n      <em>Code</em>: LA31759-6\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Cardiac High Dose or Chest High Dose\n        <br/>\n      \n      <em>Code</em>: LA31761-2\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Head Low Dose\n        <br/>\n      \n      <em>Code</em>: LA31762-0\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Head Routine Dose\n        <br/>\n      \n      <em>Code</em>: LA31763-8\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Head High Dose\n        <br/>\n      \n      <em>Code</em>: LA31764-6\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Extremity\n        <br/>\n      \n      <em>Code</em>: LA31765-3\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Neck or Cervical Spine\n        <br/>\n      \n      <em>Code</em>: LA31766-1\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Thoracic or Lumbar Spine\n        <br/>\n      \n      <em>Code</em>: LA31767-9\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Simultaneous Chest and Abdomen and Pelvis\n        <br/>\n      \n      <em>Code</em>: LA31768-7\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Simultaneous Thoracic and Lumbar Spine\n        <br/>\n      \n      <em>Code</em>: LA31851-1\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Simultaneous Head and Neck Routine Dose\n        <br/>\n      \n      <em>Code</em>: LA31769-5\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Simultaneous Head and Neck High Dose\n        <br/>\n      \n      <em>Code</em>: LA31770-3\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  <tr>\n    <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n    <td class=\"content-container\">\n      \n        <em>Display</em>: Full Body\n        <br/>\n      \n      <em>Code</em>: LA31771-1\n      <br/>\n      <em>System</em>: <tt>http://loinc.org</tt>\n    </td>\n  </tr>\n\n  \n  \n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"dependencies\"> </a>Dependencies</th>\n\n\n</tr>\n  \n  \n  \n\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n  <td class=\"content-container\">\n    \n    <em>Description</em>: USQualityCore model information\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <code>https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild</code>\n    <br/>\n    <em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild</tt>\n    \n  </td>\n</tr>\n \n\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n  <td class=\"content-container\">\n    \n    <em>Description</em>: USCore model information\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"https://build.fhir.org/ig/HL7/us-cql-ig/Library-USCore-ModelInfo.html\">http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived</tt>\n    \n  </td>\n</tr>\n \n\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n  <td class=\"content-container\">\n    \n    <em>Description</em>: FHIR model information\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"http://hl7.org/fhir/uv/cql/STU2/Library-FHIR-ModelInfo.html\">http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1</tt>\n    \n  </td>\n</tr>\n \n\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n  <td class=\"content-container\">\n    \n    <em>Description</em>: Library SDE\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"Library-SupplementalDataElements.html\">SupplementalDataElementsversion: null6.1.000)</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/SupplementalDataElements|6.1.000</tt>\n    \n  </td>\n</tr>\n \n\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n  <td class=\"content-container\">\n    \n    <em>Description</em>: Library FHIRHelpers\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"http://hl7.org/fhir/uv/cql/STU2/Library-FHIRHelpers.html\">http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1</tt>\n    \n  </td>\n</tr>\n \n\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n  <td class=\"content-container\">\n    \n    <em>Description</em>: Library USCommon\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"https://build.fhir.org/ig/HL7/us-cql-ig/Library-USCoreCommon.html\">http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot</tt>\n    \n  </td>\n</tr>\n \n\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n  <td class=\"content-container\">\n    \n    <em>Description</em>: Library FHIRCommon\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"http://hl7.org/fhir/uv/cql/STU2/Library-FHIRCommon.html\">http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0</tt>\n    \n  </td>\n</tr>\n \n\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n  <td class=\"content-container\">\n    \n    <em>Description</em>: Library AlaraCommonFunctions\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <code>https://madie.cms.gov/Library/AlaraCommonFunctions|2.1.000</code>\n    <br/>\n    <em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/AlaraCommonFunctions|2.1.000</tt>\n    \n  </td>\n</tr>\n \n\n \n\n \n\n \n\n \n\n\n  \n  \n\n\n\n\n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"data-requirements\"> </a>Data Requirements</th>\n\n\n</tr>\n  \n  \n  \n<tr>\n  <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n  <td class=\"content-container\">\n    <em>Type</em>: Patient\n    <br/>\n  \n    <em>Profile(s)</em>: \n  \n    <code>http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient</code>\n    <br/>        \n  \n   \n   \n    <em>Must Support Elements</em>: ombCategory, detailed, text\n    <br/>\n   \n   \n  </td>\n</tr>\n\n<tr>\n  <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n  <td class=\"content-container\">\n    <em>Type</em>: Patient\n    <br/>\n  \n    <em>Profile(s)</em>: \n  \n    <a href=\"http://hl7.org/fhir/R4/patient.html\">Patient</a>\n    <br/>        \n  \n   \n   \n    <em>Must Support Elements</em>: birthDate\n    <br/>\n   \n   \n  </td>\n</tr>\n\n<tr>\n  <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n  <td class=\"content-container\">\n    <em>Type</em>: Observation\n    <br/>\n  \n    <em>Profile(s)</em>: \n  \n    <code>http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-clinical-result</code>\n    <br/>        \n  \n   \n   \n    <em>Must Support Elements</em>: code, status, effective, value, value.unit, value.value\n    <br/>\n   \n  \n    <em>Code Filter(s)</em>: \n    <br/>\n  \n  \n    <span class=\"tab-one\"><em>Path</em>: code</span>\n    <br/>\n  \n  \n  \n  \n    <span class=\"tab-one\"><em>Code(s)</em>: \n    \n      \n      <a href=\"https://loinc.org/96914-7\">LOINC: 96914-7</a> (CT dose and image quality category)\n      \n    \n    </span>\n    <br/>\n  \n  \n   \n  </td>\n</tr>\n\n<tr>\n  <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n  <td class=\"content-container\">\n    <em>Type</em>: Observation\n    <br/>\n  \n    <em>Profile(s)</em>: \n  \n    <code>http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-clinical-result</code>\n    <br/>        \n  \n   \n   \n    <em>Must Support Elements</em>: status, code, value, value.unit, value.value\n    <br/>\n   \n   \n  </td>\n</tr>\n\n<tr>\n  <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n  <td class=\"content-container\">\n    <em>Type</em>: Encounter\n    <br/>\n  \n    <em>Profile(s)</em>: \n  \n    <a href=\"http://hl7.org/fhir/R4/encounter.html\">Encounter</a>\n    <br/>        \n  \n   \n   \n    <em>Must Support Elements</em>: type, status, period\n    <br/>\n   \n  \n    <em>Code Filter(s)</em>: \n    <br/>\n  \n  \n    <span class=\"tab-one\"><em>Path</em>: type</span>\n    <br/>\n  \n  \n  \n    <span class=\"tab-one\"><em>ValueSet</em>:</span> <a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a>\n    <br/> \n  \n  \n  \n   \n  </td>\n</tr>\n\n<tr>\n  <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n  <td class=\"content-container\">\n    <em>Type</em>: Coverage\n    <br/>\n  \n    <em>Profile(s)</em>: \n  \n    <code>http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-coverage</code>\n    <br/>        \n  \n   \n   \n    <em>Must Support Elements</em>: type, period\n    <br/>\n   \n  \n    <em>Code Filter(s)</em>: \n    <br/>\n  \n  \n    <span class=\"tab-one\"><em>Path</em>: type</span>\n    <br/>\n  \n  \n  \n    <span class=\"tab-one\"><em>ValueSet</em>:</span> <a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer Type</a>\n    <br/> \n  \n  \n  \n   \n  </td>\n</tr>\n\n  \n  \n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"parameters\"> </a>Parameters</th>\n\n\n</tr>\n  \n  \n  <tr>\n  \n\n<th scope=\"row\" class=\"row-header\"/>\n\n\n  <td class=\"content-container\">\n    <table>\n      <thead>\n        <tr>\n          <td><em>Name</em></td>\n          <td><em>Use</em></td>\n          <td><em>Card.</em></td>\n          <td><em>Type</em></td>\n          <td><em>Documentation</em></td>\n        </tr>\n      </thead>\n      <tbody>\n      \n        <tr>\n          <td>Measurement Period</td>\n          <td>In</td>\n          <td>0..1</td>\n          <td>Period</td>\n          <td/>\n        </tr>\n      \n        <tr>\n          <td>SDE Sex</td>\n          <td>Out</td>\n          <td>0..1</td>\n          <td>Coding</td>\n          <td/>\n        </tr>\n      \n        <tr>\n          <td>Numerator</td>\n          <td>Out</td>\n          <td>0..*</td>\n          <td>Resource</td>\n          <td/>\n        </tr>\n      \n        <tr>\n          <td>Denominator</td>\n          <td>Out</td>\n          <td>0..*</td>\n          <td>Resource</td>\n          <td/>\n        </tr>\n      \n        <tr>\n          <td>SDE Payer</td>\n          <td>Out</td>\n          <td>0..*</td>\n          <td>Resource</td>\n          <td/>\n        </tr>\n      \n        <tr>\n          <td>Initial Population</td>\n          <td>Out</td>\n          <td>0..*</td>\n          <td>Resource</td>\n          <td/>\n        </tr>\n      \n        <tr>\n          <td>SDE Ethnicity</td>\n          <td>Out</td>\n          <td>0..1</td>\n          <td>Resource</td>\n          <td/>\n        </tr>\n      \n        <tr>\n          <td>Denominator Exclusion</td>\n          <td>Out</td>\n          <td>0..*</td>\n          <td>Resource</td>\n          <td/>\n        </tr>\n      \n        <tr>\n          <td>SDE Race</td>\n          <td>Out</td>\n          <td>0..1</td>\n          <td>Resource</td>\n          <td/>\n        </tr>\n      \n      </tbody>\n    </table>\n  </td>\n</tr>\n\n  \n  \n\n<tr>\n  <th colspan=\"2\" scope=\"row\" class=\"row-header\">Generated using version 0.5.4 of the sample-content-ig Liquid templates</th>\n</tr>\n\n    </tbody>\n  </table>\n</div>"
      },
      "contained" : [
        {
          "resourceType" : "Library",
          "id" : "effective-data-requirements",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "248153007",
                "display" : "Male (finding)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "248152002",
                "display" : "Female (finding)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "96914-7",
                "display" : "CT dose and image quality category"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "96912-1",
                "display" : "Calculated CT global noise"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "96913-9",
                "display" : "Calculated CT size-adjusted dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31752-1",
                "display" : "Abdomen and Pelvis Low Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31753-9",
                "display" : "Abdomen and Pelvis Routine Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31754-7",
                "display" : "Abdomen and Pelvis High Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31755-4",
                "display" : "Cardiac Low Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31756-2",
                "display" : "Cardiac Routine Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31758-8",
                "display" : "Chest Low Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31759-6",
                "display" : "Chest Routine Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31761-2",
                "display" : "Cardiac High Dose or Chest High Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31762-0",
                "display" : "Head Low Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31763-8",
                "display" : "Head Routine Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31764-6",
                "display" : "Head High Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31765-3",
                "display" : "Extremity"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31766-1",
                "display" : "Neck or Cervical Spine"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31767-9",
                "display" : "Thoracic or Lumbar Spine"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31768-7",
                "display" : "Simultaneous Chest and Abdomen and Pelvis"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31851-1",
                "display" : "Simultaneous Thoracic and Lumbar Spine"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31769-5",
                "display" : "Simultaneous Head and Neck Routine Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA31770-3",
                "display" : "Simultaneous Head and Neck High Dose"
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-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/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 1
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "Qualified Scan"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Qualified Scan\":\n  [ObservationClinicalResult: \"CT dose and image quality category\"] CTScanResult\n    where CTScanResult.status in { 'final', 'amended', 'corrected' }\n      and CTScanResult.effective.toInterval ( ) 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/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "Qualified Scan Without Inpatient Encounter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Qualified Scan Without Inpatient Encounter\":\n  \"Qualified Scan\" QualifiedCTScan\n    without [Encounter: \"Encounter Inpatient\"] InpatientEncounter\n      such that InpatientEncounter.status ~ 'finished'\n        and InpatientEncounter.period ends during day of \"Measurement Period\"\n        and QualifiedCTScan.effective.toInterval ( ) starts during InpatientEncounter.period"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 3
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "Qualified Scan With Values"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Qualified Scan With Values\":\n  \"Qualified Scan Without 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/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "Numerator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Numerator\":\n  \"Qualified Scan With Values\" CTScanWithValues\n    where CTScanWithValues.ctScanQualifies ( )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 5
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator\":\n  \"Qualified Scan With Values\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 6
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  [USQualityCore.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/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 8
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial Population"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial Population\":\n  \"Qualified Scan Without Inpatient Encounter\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 9
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-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/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 11
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator Exclusion"
                },
                {
                  "url" : "statement",
                  "valueString" : "// TODO: Note that this used to use a .coding contains \"Full Body\", presumably to allow for other codings, so long as at least Full Body is present\n// But that is the definition of concept equivalent within CQL, so it should be the same to just use the ~ operator. Please confirm.\ndefine \"Denominator Exclusion\":\n  \"Qualified Scan With Values\" CTScanWithValues\n    where ( CTScanWithValues.value as FHIR.CodeableConcept ) ~ \"Full Body\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 12
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-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/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1206FHIRCTOQR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 14
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToString"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function ToString(value string): value.value"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 15
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "USCoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns the sex element as defined for the USCore patient profile\n*/\ndefine fluent function sex(patient Patient):\n  patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 16
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "ext"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns the single extension (if present) on the given resource with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given resource with the specified url.\n*/\ndefine fluent function ext(domainResource DomainResource, url String):\n  singleton from domainResource.exts(url)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 17
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "exts"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns any extensions defined on the given resource with the specified url\n*/\ndefine fluent function exts(domainResource DomainResource, url String):\n  domainResource.extension E\n    where E.url = url\n    return E"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 18
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToString"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function ToString(value uri): value.value"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 19
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToString"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function ToString(value ObservationStatus): value.value"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 20
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "toInterval"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in FHIR, allowing this function to be used across any resource.\n\nThe input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.\nIf the input is a Period, the result is a DateTime Interval.\nIf the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.\nIf the input is an instant, the result is a DateTime Interval beginning and ending on that instant.\nIf the input is a string, an error is raised indicating a single interval cannot be computed from a string.\nIf the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,\nand ending immediately prior to when the patient was the given Age plus one year.\nIf the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given\nby the low end of the Range, and ending immediately prior to when the patient was the Age given by the\nhigh end of the Range plus one year.\n\nNOTE: Due to the\ncomplexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used\nwith a Timing or String.\n*/\ndefine fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):\n  case\n    when choice is FHIR.dateTime then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n    when choice is FHIR.Period then\n      FHIRHelpers.ToInterval(choice as FHIR.Period)\n    when choice is FHIR.instant then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]\n    when choice is FHIR.Age then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)\n    when choice is FHIR.Range then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)\n    when choice is FHIR.Timing then\n      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')\n    when choice is FHIR.string then\n      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n    else\n      null as Interval<DateTime>\n  end"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 21
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToDateTime"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function ToDateTime(value dateTime): value.value"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 22
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-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" : 23
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToDateTime"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function ToDateTime(value instant): value.value"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 24
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToDate"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function ToDate(value date): value.value"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 25
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToQuantity"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) \nvalue to a CQL Quantity\n@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity\nhas a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)\nan error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.\n@seealso: ToCalendarUnit\n*/\ndefine function ToQuantity(quantity FHIR.Quantity):\n    case\n        when quantity is null then null\n        when quantity.value is null then null\n        when quantity.comparator is not null then\n            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')\n        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'\n              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then\n            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }\n        else\n            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')\n    end"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 26
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToCalendarUnit"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Converts a UCUM definite duration unit to a CQL calendar duration\nunit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) \ntopic of the CQL specification.\n@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate\n*/\ndefine function ToCalendarUnit(unit System.String):\n    case unit\n        when 'ms' then 'millisecond'\n        when 's' then 'second'\n        when 'min' then 'minute'\n        when 'h' then 'hour'\n        when 'd' then 'day'\n        when 'wk' then 'week'\n        when 'mo' then 'month'\n        when 'a' then 'year'\n        else unit\n    end"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 27
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToString"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function ToString(value EncounterStatus): value.value"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 28
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-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" : 29
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToConcept"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 30
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-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" : 31
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-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" : 32
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-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" : 33
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-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 FHIR.CodeableConcept) ~ code\n    and ( Result.globalNoiseValue() >= noiseThreshold\n        or Result.sizeAdjustedValue() >= sizeDoseThreshold\n    )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 34
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToDecimal"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function ToDecimal(value decimal): value.value"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 35
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "USCoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define fluent function ethnicity(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E\n    return {\n      ombCategory: E.ext('ombCategory').value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 36
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "ext"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns the single extension (if present) on the given element with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given element with the specified url.\n*/\ndefine fluent function ext(element Element, url String):\n  singleton from element.exts(url)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 37
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "exts"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns any extensions defined on the given element with the specified url.\n*/\ndefine fluent function exts(element Element, url String):\n  element.extension E\n    where E.url = url\n    return E"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 38
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "USCoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define fluent function race(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E\n    return {\n      ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 39
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
            }
          ],
          "name" : "EffectiveDataRequirements",
          "status" : "active",
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/library-type",
                "code" : "module-definition"
              }
            ]
          },
          "relatedArtifact" : [
            {
              "type" : "depends-on",
              "display" : "USQualityCore model information",
              "resource" : "https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild"
            },
            {
              "type" : "depends-on",
              "display" : "USCore model information",
              "resource" : "http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived"
            },
            {
              "type" : "depends-on",
              "display" : "FHIR model information",
              "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1"
            },
            {
              "type" : "depends-on",
              "display" : "Library SDE",
              "resource" : "https://madie.cms.gov/Library/SupplementalDataElements|6.1.000"
            },
            {
              "type" : "depends-on",
              "display" : "Library FHIRHelpers",
              "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1"
            },
            {
              "type" : "depends-on",
              "display" : "Library USCommon",
              "resource" : "http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot"
            },
            {
              "type" : "depends-on",
              "display" : "Library FHIRCommon",
              "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0"
            },
            {
              "type" : "depends-on",
              "display" : "Library AlaraCommonFunctions",
              "resource" : "https://madie.cms.gov/Library/AlaraCommonFunctions|2.1.000"
            },
            {
              "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" : "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://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient"
              ],
              "mustSupport" : [
                "ombCategory",
                "detailed",
                "text"
              ]
            },
            {
              "type" : "Patient",
              "profile" : [
                🔗 "http://hl7.org/fhir/StructureDefinition/Patient"
              ],
              "mustSupport" : [
                "birthDate"
              ]
            },
            {
              "type" : "Observation",
              "profile" : [
                "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-clinical-result"
              ],
              "mustSupport" : [
                "code",
                "status",
                "effective",
                "value",
                "value.unit",
                "value.value"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "code" : [
                    {
                      "system" : "http://loinc.org",
                      "code" : "96914-7",
                      "display" : "CT dose and image quality category"
                    }
                  ]
                }
              ],
              "dateFilter" : [
                {
                  "path" : "effective",
                  "valuePeriod" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                        "valueExpression" : {
                          "language" : "text/cql-identifier",
                          "expression" : "Measurement Period"
                        }
                      }
                    ]
                  }
                }
              ]
            },
            {
              "type" : "Observation",
              "profile" : [
                "http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-clinical-result"
              ],
              "mustSupport" : [
                "status",
                "code",
                "value",
                "value.unit",
                "value.value"
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/StructureDefinition/Encounter"
              ],
              "mustSupport" : [
                "type",
                "status",
                "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://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-coverage"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
                }
              ]
            }
          ]
        }
      ],
      "extension" : [
        {
          "id" : "supplementalDataGuidance",
          "extension" : [
            {
              "url" : "guidance",
              "valueString" : "For every patient evaluated by this measure also identify payer, race, ethnicity and sex"
            },
            {
              "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",
          "valueCanonical" : "#effective-data-requirements"
        }
      ],
      "url" : "https://madie.cms.gov/Measure/CMS1206FHIRCTOQR",
      "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" : "CMS1206FHIR"
        },
        {
          "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:65c110b9-5f5f-46a5-a10c-81e1341f901f"
        },
        {
          "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:00b911d5-a1d2-458a-a8bf-cacc92ec7210"
        },
        {
          "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" : "1206FHIR",
          "assigner" : {
            "display" : "CMS"
          }
        }
      ],
      "version" : "1.1.000",
      "name" : "CMS1206FHIRCTOQR",
      "title" : "Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults - Facility OQRFHIR\n",
      "status" : "active",
      "experimental" : false,
      "date" : "2026-01-16T18:18:12+00:00",
      "publisher" : "Alara Imaging, Inc.",
      "contact" : [
        {
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.alaracare.com/our-commitment"
            }
          ]
        }
      ],
      "description" : "This measure is an episode of care measure that 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 non-inpatient care settings (including emergency settings) are eligible. This dQM 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 dQM. Additional details are included in the Guidance (Usage) field.\n",
      "usage" : "The level of aggregation for this dQM is the facility. A parallel dQM 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, dQMs 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 dQM can consume. This dQM 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 dQM. 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 dQM 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 dQM is written and maintained by Alara Imaging, Inc. However, any software vendor capable of calculating and reporting this dQM 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 dQM 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\n\\[LA31753-9 (=Abdomen and Pelvis, Routine Dose), 29, 644\\];\n\n\\[LA31754-7 (=Abdomen and Pelvis, High Dose), 29, 1260\\];\n\n\\[LA31755-4 (=Cardiac Low Dose), 55, 93\\];\n\n\\[LA31756-2 (=Cardiac Routine Dose), 32, 576\\];\n\n\\[LA31758-8 (=Chest Low Dose), 55, 377\\];\n\n\\[LA31759-6 (=Chest Routine Dose), 49, 377\\];\n\n\\[LA31761-2 (=Chest High Dose or Cardiac High Dose), 49, 1282\\];\n\n\\[LA31762-0 (=Head Low Dose), 115, 582\\];\n\n\\[LA31763-8 (=Head Routine Dose), 115, 1025\\];\n\n\\[LA31764-6 (=Head High Dose), 115, 1832\\];\n\n\\[LA31765-3 (=Upper or Lower Extremity), 73, 320\\];\n\n\\[LA31766-1 (=Neck or Cervical Spine), 25, 1260\\];\n\n\\[LA31767-9 (=Thoracic or Lumbar Spine), 25, 1260\\];\n\n\\[LA31768-7 (=Combined Chest, Abdomen and Pelvis), 29, 1637\\];\n\n\\[LA31851-1 (=Combined Thoracic and Lumbar Spine), 25, 2520\\];\n\n\\[LA31769-5 (=Combined Head and Neck, Routine Dose), 25, 2285\\];\n\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 dQM 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 dQM is an episode-based measure and should be reported for each eligible CT scan performed in a hospital outpatient setting.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS1206v3. 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).\n",
      "copyright" : "The translation software was written and will be updated and maintained by Alara Imaging, Inc. 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 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\\].\n",
      "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" : [
        {
          "type" : "citation",
          "citation" : "Berrington de Gonzalez A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071-2077.\n"
        },
        {
          "type" : "citation",
          "citation" : "Board of Radiation Effects Research Division on Earth and Life Sciences National Research Council of the National Academies. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2, Washington, D.C.: The National Academies Press; 2006.\n"
        },
        {
          "type" : "citation",
          "citation" : "Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A. 2003;100(24):13761-13766.\n"
        },
        {
          "type" : "citation",
          "citation" : "Demb J, Chu P, Nelson T, et al. Optimizing Radiation Doses for Computed Tomography Across Institutions: Dose Auditing and Best Practices. JAMA Intern Med. 2017;177(6):810-81.\n"
        },
        {
          "type" : "citation",
          "citation" : "Dieguez G, Ferro C, Pyenson B. Milliman Research Report: A Multi-Year Look at the Cost Burden of Cancer Care. April 11, 2017. https://www.milliman.com/en/insight/2017/a-multi-year-look-at-the-cost-burden-of-cancer-care\n"
        },
        {
          "type" : "citation",
          "citation" : "Halliburton SS, Abbara S, Chen MY, et al. SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr. 2011;5(4):198-224.\n"
        },
        {
          "type" : "citation",
          "citation" : "Hong JY, Han K, Jung JH, Kim JS. Association of Exposure to Diagnostic Low-Dose Ionizing Radiation With Risk of Cancer Among Youths in South Korea. JAMA Netw Open. 2019;2(9):e1910584.\n"
        },
        {
          "type" : "citation",
          "citation" : "Hricak H, Brenner DJ, Adelstein SJ, et al. Managing Radiation Use in Medical Imaging: A Multifaceted Challenge. Radiology. 2010.\n"
        },
        {
          "type" : "citation",
          "citation" : "Image Wisely 2020. The American College of Radiology and the Radiological Society of North America formed the Joint Task Force on Adult Radiation Protection to address concerns about the surge of public exposure to ionizing radiation from medical imaging. The Joint Task Force collaborated with the American Association of Physicists in Medicine and the American Society of Radiologic Technologists to create the Image Wisely campaign with the objective of lowering the amount of radiation used in medically necessary imaging studies and eliminating unnecessary procedures. https://www.imagewisely.org/\n"
        },
        {
          "type" : "citation",
          "citation" : "IMV 2019 CT Market Outlook Report, https://imvinfo.com/ct-departments-seek-workflow-improvements-to-address-increased-ct-utilization/\n"
        },
        {
          "type" : "citation",
          "citation" : "Kanal KM, Butler PF, Sengupta D, Bhargavan-Chatfield M, Coombs LP, Morin RL. U.S. Diagnostic Reference Levels and Achievable Doses for 10 Adult CT Examinations. Radiology. 2017;284(1):120-133.\n"
        },
        {
          "type" : "citation",
          "citation" : "Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011 Jan 19;103(2):117-28. doi: 10.1093/jnci/djq495. Epub 2011 Jan 12. Erratum in: J Natl Cancer Inst. 2011 Apr 20;103(8):699. PMID: 21228314.\n"
        },
        {
          "type" : "citation",
          "citation" : "National Cancer Institute Cancer Statistics. https://www.cancer.gov/about-cancer/understanding/statistics accessed May 25, 2021\n"
        },
        {
          "type" : "citation",
          "citation" : "Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499-505.\n"
        },
        {
          "type" : "citation",
          "citation" : "Pierce DA, Preston DL. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiation research. 2000;154(2):178-186.\n"
        },
        {
          "type" : "citation",
          "citation" : "Preston DL, Ron E, Tokuoka S, et al. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiation research. 2007;168(1):1-64.\n"
        },
        {
          "type" : "citation",
          "citation" : "Shuryak I, Sachs RK, et al. Cancer risks after radiation exposure in middle age. J Natl Cancer Inst. 2010;102(21):1628-1636.\n"
        },
        {
          "type" : "citation",
          "citation" : "Smith-Bindman R, Lipson J, Marcus R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169(22):2078-2086.\n"
        },
        {
          "type" : "citation",
          "citation" : "Smith-Bindman R, Moghadassi M, Wilson N, et al. Radiation Doses in Consecutive CT Examinations from Five University of California Medical Centers. Radiology. 2015;277(1):134-141.\n"
        },
        {
          "type" : "citation",
          "citation" : "Smith-Bindman R, Wang Y, Chu P, et al. International variation in radiation dose for computed tomography examinations: prospective cohort study. BMJ. 2019;364:k4931.\n"
        },
        {
          "type" : "citation",
          "citation" : "Smith-Bindman R, Chu P, Wang Y, et al. Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography: A Randomized Clinical Trial. JAMA Intern Med. 2020 May 1;180(5):666-675.\n"
        },
        {
          "type" : "citation",
          "citation" : "Stecker MS, Balter S, Towbin RB, et al. Guidelines for patient radiation dose management. J Vasc Interv Radiol. 2009;20(7 Suppl):S263-273.\n"
        },
        {
          "type" : "citation",
          "citation" : "U.S. Food and Drug Administration. FDA White Paper: Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging. 2019; https://www.fda.gov/radiation-emitting-products/initiative-reduce-unnecessary-radiation-exposure-medical-imaging/white-paper-initiative-reduce-unnecessary-radiation-exposure-medical-imaging.\n"
        },
        {
          "type" : "citation",
          "citation" : "Vance EA, Xie X, Henry A, Wernz C, Slonim AD. Computed tomography scan use variation: patient, hospital, and geographic factors. Am J Manag Care. 2013 Mar 1;19(3):e93-9. PMID: 23534948.\n"
        },
        {
          "type" : "citation",
          "citation" : "Writing Committee M, Hirshfeld JW, Jr., Ferrari VA, et al. 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. J Am Coll Cardiol. 2018.\n"
        },
        {
          "type" : "citation",
          "citation" : "Writing Committee M, Hirshfeld JW, Jr., Ferrari VA, et al. 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. J Am Coll Cardiol. 2018.\n"
        },
        {
          "type" : "citation",
          "citation" : "Writing Committee M, Hirshfeld JW, Jr., Ferrari VA, et al. 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. J Am Coll Cardiol. 2018.\n"
        }
      ],
      "library" : [
        🔗 "https://madie.cms.gov/Library/CMS1206FHIRCTOQR"
      ],
      "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.\n",
      "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; Hong, 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 et al., 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 et al., 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 et al., 2017; Smith-Bindman et al., 2019), modeling of the cancer risk associated with CT at different ages of exposure (Berrington de Gonzalez et al., 2009), and costs of cancer care (Dieguez, Ferro, \\& Pyenson, 2017; Mariotto, Yabroff, Shao, Feuer, \\& Brown, 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).\n",
      "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 et al., 2017), cardiovascular imaging societies (Hirshfeld et al., 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.\n",
      "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" : "intermediate-outcome",
                    "display" : "Intermediate Outcome"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
              "valueString" : "None\n"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                    "code" : "decrease",
                    "display" : "Decreased score indicates improvement"
                  }
                ]
              }
            }
          ],
          "description" : "Patients aged 18 years and older that have a CT Dose and Image Quality Category and were not performed in a hospital inpatient setting\n",
          "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 not performed in a hospital inpatient setting, that ends during the measurement period, and not part of an inpatient hospitalization.\n",
              "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\n",
              "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\n",
              "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\n",
              "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\n",
          "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\n",
          "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\n",
          "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\n",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Sex"
          }
        }
      ]
    }