dQM QICore Content Implementation Guide
2025.0.0 - CI Build

dQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2025.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/dqm-content-qicore-2025/ and changes regularly. See the Directory of published versions

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

Official URL: https://madie.cms.gov/Measure/CMS1206FHIRCTOQR Version: 1.0.000
Active as of 2025-08-25 Responsible: Alara Imaging, Inc. Computable Name: CMS1206FHIRCTOQR
Other Identifiers: Short Name: CMS1206FHIR (use: usual, ), UUID:65c110b9-5f5f-46a5-a10c-81e1341f901f (use: official, ), UUID:00b911d5-a1d2-458a-a8bf-cacc92ec7210 (use: official, ), Endorser: 3663e (use: official, ), Publisher: 1206FHIR (use: official, )

Copyright/Legal: 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].

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.

Metadata
Title Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults - Facility OQRFHIR
Version 1.0.000
Short Name CMS1206FHIR
GUID (Version Independent) urn:uuid:65c110b9-5f5f-46a5-a10c-81e1341f901f
GUID (Version Specific) urn:uuid:00b911d5-a1d2-458a-a8bf-cacc92ec7210
CMS Identifier 1206FHIR
CMS Consensus Based Entity Identifier 3663e
Effective Period 2026-01-01 through 2026-12-31
Steward (Publisher) Alara Imaging, Inc.
Developer University of California San Francisco
Description This measure 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.
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].
Disclaimer The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. Alara Imaging, Inc., the University of California San Francisco, and its members and users shall not be responsible for any use or accuracy of the Measure or any code contained within the Measure. THE MEASURE AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.
Rationale Diagnostic imaging using CT occurs in more than a third of acute care hospitalizations in the U.S. (Vance et al., 2013) and greater than 90 million scans are performed annually in the U.S. (IMV, 2019). There is marked observed variation in the radiation doses used to perform these exams (Smith-Bindman et al., 2019). The inconsistency in how CT exams are performed represents a significant, unnecessary, and modifiable iatrogenic health risk, as there is extensive epidemiological and biological evidence that suggests exposure to radiation in the same range as that routinely delivered by CT increases a person's risk of developing cancer (Board of Radiation Effects, 2006; 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).
Clinical Recommendation Statement The measure aligns with numerous evidence- and consensus-based clinical guidelines asking radiologists to track, optimize, and lower CT radiation doses, guidelines that have been written by the American College of Radiology (Kanal 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.
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.
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.
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.
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.
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
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.
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.
Citation Hricak H, Brenner DJ, Adelstein SJ, et al. Managing Radiation Use in Medical Imaging: A Multifaceted Challenge. Radiology. 2010.
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/
Citation IMV 2019 CT Market Outlook Report, https://imvinfo.com/ct-departments-seek-workflow-improvements-to-address-increased-ct-utilization/
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.
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.
Citation National Cancer Institute Cancer Statistics. https://www.cancer.gov/about-cancer/understanding/statistics accessed May 25, 2021
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.
Citation Pierce DA, Preston DL. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiation research. 2000;154(2):178-186.
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.
Citation Shuryak I, Sachs RK, et al. Cancer risks after radiation exposure in middle age. J Natl Cancer Inst. 2010;102(21):1628-1636.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Guidance (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.

TRANSLATION SOFTWARE

As a radiology measure, the measure derives standardized data elements from structured fields within both the electronic health record (EHR) and the radiology electronic clinical data systems, including the Radiology Information System (RIS) and the Picture Archiving and Communication System (PACS). Primary imaging data including Radiation Dose Structured Reports and image pixel data are stored in the PACS in Digital Imaging and Communications in Medicine (DICOM) format, a universally adopted standard for medical imaging information. Because of limitations in their specifications and format, 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.

CODING

The translation software will create three variables required for measure computation including the CT Dose and Image Quality Category (LOINC(R) Code 96914-7), the Calculated CT Global Noise (LOINC(R) Code 96912-1) and the Calculated CT Size-Adjusted Dose (LOINC(R) Code 96913-9). These variables are defined in the Definition field above. These transformed data elements can be stored in the EHR.

MEASURE CALCULATION

The measure will evaluate each included CT exam based on allowable thresholds that are specified by the CT Dose and Image Quality Category. An exam is considered out of range if either the Calculated CT Global Noise or the Calculated CT Size-Adjusted Dose is out of range for the CT Dose and Image Quality Category. Exams will be evaluated against their corresponding threshold, shown below with the following format: [Category shorthand (=CT Dose and Image Quality Category), threshold for the Calculated CT Global Noise in Hounsfield units, threshold for the Calculated CT Size-Adjusted Dose in dose length product].

[LA31752-1 (=Abdomen and Pelvis, Low Dose), 64, 598];

[LA31753-9 (=Abdomen and Pelvis, Routine Dose), 29, 644];

[LA31754-7 (=Abdomen and Pelvis, High Dose), 29, 1260];

[LA31755-4 (=Cardiac Low Dose), 55, 93];

[LA31756-2 (=Cardiac Routine Dose), 32, 576];

[LA31758-8 (=Chest Low Dose), 55, 377];

[LA31759-6 (=Chest Routine Dose), 49, 377];

[LA31761-2 (=Chest High Dose or Cardiac High Dose), 49, 1282];

[LA31762-0 (=Head Low Dose), 115, 582];

[LA31763-8 (=Head Routine Dose), 115, 1025];

[LA31764-6 (=Head High Dose), 115, 1832];

[LA31765-3 (=Upper or Lower Extremity), 73, 320];

[LA31766-1 (=Neck or Cervical Spine), 25, 1260];

[LA31767-9 (=Thoracic or Lumbar Spine), 25, 1260];

[LA31768-7 (=Combined Chest, Abdomen and Pelvis), 29, 1637];

[LA31851-1 (=Combined Thoracic and Lumbar Spine), 25, 2520];

[LA31769-5 (=Combined Head and Neck, Routine Dose), 25, 2285];

[LA31770-3 (=Combined Head and Neck, High Dose), 25, 3092]

EXCLUSIONS

CT scans with missing patient age or missing CT Dose and Image Quality Category (LOINC(R) 96914-7) are excluded from the initial population. CT scans with a missing Calculated Global Noise value or a missing Calculated CT Size-Adjusted Dose value are not included in the denominator. CT scans assigned a CT Dose and Image Quality Category (LOINC(R) 96914-7) value using the LOINC(R) answer list (LL5824-9) of full body (LA31771-1) are excluded from the denominator. These exams are included in the initial population because they have a non-missing CT Dose and Image Quality Category but are then removed as a Denominator Exclusion in the 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.

This 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).
Measure Group (Rate) (ID: Group_1)
Summary Patients aged 18 years and older that have a CT Dose and Image Quality Category and were not performed in a hospital inpatient setting
Basis Observation
Scoring [http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion']
Type [http://terminology.hl7.org/CodeSystem/measure-type#intermediate-outcome: 'Intermediate Outcome']
Rate Aggregation None
Improvement Notation [http://terminology.hl7.org/CodeSystem/measure-improvement-notation#decrease: 'Decreased score indicates improvement']
Initial Population ID: InitialPopulation_1
Description:

All CT scans in adults aged 18 years and older at the start of the measurement period that have a CT Dose and Image Quality Category and were not performed in a hospital inpatient setting, that ends during the measurement period, and not part of an inpatient hospitalization.

Logic Definition: Initial Population
Denominator ID: Denominator_1
Description:

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

Logic Definition: Denominator
Denominator Exclusion ID: DenominatorExclusion_1
Description:

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

Logic Definition: Denominator Exclusion
Numerator ID: Numerator_1
Description:

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

Logic Definition: Numerator
Supplemental Data Guidance For every patient evaluated by this measure also identify payer, race, ethnicity and sex
Supplemental Data Elements
Supplemental Data Element ID: sde-ethnicity
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Ethnicity
Logic Definition: SDE Ethnicity
Supplemental Data Element ID: sde-payer
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Payer
Logic Definition: SDE Payer
Supplemental Data Element ID: sde-race
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Race
Logic Definition: SDE Race
Supplemental Data Element ID: sde-sex
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Sex
Logic Definition: SDE Sex
Measure Logic
Primary Library https://madie.cms.gov/Library/CMS1206FHIRCTOQR
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population 
define "Initial Population":
  "Qualified Scan Without Inpatient Encounter"
Denominator 
define "Denominator":
  "Qualified Scan With Values"
Denominator Exclusion 
define "Denominator Exclusion":
  "Qualified Scan With Values" CTScanWithValues
    where ( CTScanWithValues.value as Concept ).codes contains "Full Body"
Numerator 
define "Numerator":
  "Qualified Scan With Values" CTScanWithValues
    where CTScanWithValues.ctScanQualifies ( )
Logic Definitions
Logic Definition Library Name: SupplementalDataElements 
define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end
Logic Definition Library Name: SupplementalDataElements 
define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "SDE Sex":
  SDE."SDE Sex"
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "Qualified Scan":
  [ObservationClinicalResult: "CT dose and image quality category"] CTScanResult
    where CTScanResult.status in { 'final', 'amended', 'corrected' }
      and CTScanResult.effective.toInterval ( ) ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of "Measurement Period") >= 18
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "Qualified Scan Without Inpatient Encounter":
  "Qualified Scan" QualifiedCTScan
    without [Encounter: "Encounter Inpatient"] InpatientEncounter
      such that InpatientEncounter.status ~ 'finished'
        and InpatientEncounter.period ends during day of "Measurement Period"
        and QualifiedCTScan.effective.toInterval ( ) starts during InpatientEncounter.period
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "Qualified Scan With Values":
  "Qualified Scan Without Inpatient Encounter" CTScan
    where CTScan.globalNoiseValue ( ) is not null
      and CTScan.sizeAdjustedValue ( ) is not null
      and CTScan.value is not null
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "Numerator":
  "Qualified Scan With Values" CTScanWithValues
    where CTScanWithValues.ctScanQualifies ( )
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "Denominator":
  "Qualified Scan With Values"
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "SDE Payer":
  SDE."SDE Payer"
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "Initial Population":
  "Qualified Scan Without Inpatient Encounter"
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "SDE Ethnicity":
  SDE."SDE Ethnicity"
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "Denominator Exclusion":
  "Qualified Scan With Values" CTScanWithValues
    where ( CTScanWithValues.value as Concept ).codes contains "Full Body"
Logic Definition Library Name: CMS1206FHIRCTOQR 
define "SDE Race":
  SDE."SDE Race"
Logic Definition Library Name: AlaraCommonFunctions 
/* Note since the units has a special character in it this must be escaped in the CQL */
define fluent function "globalNoiseValue"(Result ObservationClinicalResult ):
  singleton from ( Result.component C
      where Result.status in { 'final', 'amended', 'corrected' }
        and C.code ~ "Calculated CT global noise"
        and ( C.value as Quantity ).unit = '[hnsf\'U]'
      return (C.value as Quantity).value
  )
Logic Definition Library Name: AlaraCommonFunctions 
define fluent function "sizeAdjustedValue"(Result ObservationClinicalResult ):
  singleton from ( Result.component C
      where Result.status in { 'final', 'amended', 'corrected' }
        and C.code ~ "Calculated CT size-adjusted dose"
        and ( C.value as Quantity ).unit = 'mGy.cm'
      return (C.value as Quantity).value
  )
Logic Definition Library Name: AlaraCommonFunctions 
define fluent function "ctScanQualifies"(Result ObservationClinicalResult ):
  Result.qualifies("Abdomen and Pelvis Low Dose", 64, 598)
    or Result.qualifies("Abdomen and Pelvis Routine Dose", 29, 644)
    or Result.qualifies("Abdomen and Pelvis High Dose", 29, 1260)
    or Result.qualifies("Cardiac Low Dose", 55, 93)
    or Result.qualifies("Cardiac Routine Dose", 32, 576)
    or Result.qualifies("Chest Low Dose", 55, 377)
    or Result.qualifies("Chest Routine Dose", 49, 377)
    or Result.qualifies("Cardiac High Dose or Chest High Dose", 49, 1282)
    or Result.qualifies("Head Low Dose", 115, 582)
    or Result.qualifies("Head Routine Dose", 115, 1025)
    or Result.qualifies("Head High Dose", 115, 1832)
    or Result.qualifies("Extremity", 73, 320)
    or Result.qualifies("Neck or Cervical Spine", 25, 1260)
    or Result.qualifies("Thoracic or Lumbar Spine", 25, 1260)
    or Result.qualifies("Simultaneous Chest and Abdomen and Pelvis", 29, 1637)
    or Result.qualifies("Simultaneous Thoracic and Lumbar Spine", 25, 2520)
    or Result.qualifies("Simultaneous Head and Neck Routine Dose", 25, 2285)
    or Result.qualifies("Simultaneous Head and Neck High Dose", 25, 3092)
Logic Definition Library Name: AlaraCommonFunctions 
define fluent function "qualifies"(Result ObservationClinicalResult, code System.Code, noiseThreshold Decimal, sizeDoseThreshold Decimal ):
  (Result.value as Concept) ~ code
    and ( Result.globalNoiseValue() >= noiseThreshold
        or Result.sizeAdjustedValue() >= sizeDoseThreshold
    )
Logic Definition Library Name: FHIRHelpers 
define function ToString(value uri): value.value
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }
Terminology
Code System Description: Code system SNOMEDCT
Resource: http://snomed.info/sct
Canonical URL: http://snomed.info/sct
Code System Description: Code system LOINC
Resource: http://loinc.org
Canonical URL: http://loinc.org
Value Set Description: Value set Encounter Inpatient
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Value Set Description: Value set Payer Type
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Direct Reference Code Display: Male (finding)
Code: 248153007
System: http://snomed.info/sct
Direct Reference Code Display: Female (finding)
Code: 248152002
System: http://snomed.info/sct
Direct Reference Code Display: CT dose and image quality category
Code: 96914-7
System: http://loinc.org
Direct Reference Code Display: Calculated CT global noise
Code: 96912-1
System: http://loinc.org
Direct Reference Code Display: Calculated CT size-adjusted dose
Code: 96913-9
System: http://loinc.org
Direct Reference Code Display: Abdomen and Pelvis Low Dose
Code: LA31752-1
System: http://loinc.org
Direct Reference Code Display: Abdomen and Pelvis Routine Dose
Code: LA31753-9
System: http://loinc.org
Direct Reference Code Display: Abdomen and Pelvis High Dose
Code: LA31754-7
System: http://loinc.org
Direct Reference Code Display: Cardiac Low Dose
Code: LA31755-4
System: http://loinc.org
Direct Reference Code Display: Cardiac Routine Dose
Code: LA31756-2
System: http://loinc.org
Direct Reference Code Display: Chest Low Dose
Code: LA31758-8
System: http://loinc.org
Direct Reference Code Display: Chest Routine Dose
Code: LA31759-6
System: http://loinc.org
Direct Reference Code Display: Cardiac High Dose or Chest High Dose
Code: LA31761-2
System: http://loinc.org
Direct Reference Code Display: Head Low Dose
Code: LA31762-0
System: http://loinc.org
Direct Reference Code Display: Head Routine Dose
Code: LA31763-8
System: http://loinc.org
Direct Reference Code Display: Head High Dose
Code: LA31764-6
System: http://loinc.org
Direct Reference Code Display: Extremity
Code: LA31765-3
System: http://loinc.org
Direct Reference Code Display: Neck or Cervical Spine
Code: LA31766-1
System: http://loinc.org
Direct Reference Code Display: Thoracic or Lumbar Spine
Code: LA31767-9
System: http://loinc.org
Direct Reference Code Display: Simultaneous Chest and Abdomen and Pelvis
Code: LA31768-7
System: http://loinc.org
Direct Reference Code Display: Simultaneous Thoracic and Lumbar Spine
Code: LA31851-1
System: http://loinc.org
Direct Reference Code Display: Simultaneous Head and Neck Routine Dose
Code: LA31769-5
System: http://loinc.org
Direct Reference Code Display: Simultaneous Head and Neck High Dose
Code: LA31770-3
System: http://loinc.org
Direct Reference Code Display: Full Body
Code: LA31771-1
System: http://loinc.org
Dependencies
Dependency Description: QICore model information
Resource: http://hl7.org/fhir/Library/QICore-ModelInfo
Canonical URL: http://hl7.org/fhir/Library/QICore-ModelInfo
Dependency Description: Library SDE
Resource: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000
Canonical URL: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000
Dependency Description: Library FHIRHelpers
Resource: https://madie.cms.gov/Library/FHIRHelpers|4.4.000
Canonical URL: https://madie.cms.gov/Library/FHIRHelpers|4.4.000
Dependency Description: Library QICoreCommon
Resource: https://madie.cms.gov/Library/QICoreCommon|4.0.000
Canonical URL: https://madie.cms.gov/Library/QICoreCommon|4.0.000
Dependency Description: Library AlaraCommon
Resource: https://madie.cms.gov/Library/AlaraCommonFunctions|1.10.000
Canonical URL: https://madie.cms.gov/Library/AlaraCommonFunctions|1.10.000
Data Requirements
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Must Support Elements: extension, url
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result
Must Support Elements: code, status, status.value, effective, value, value.unit, value.value, value.codes
Code Filter(s):
Path: code
Code(s): http://loinc.org#96914-7: 'CT dose and image quality category'
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result
Must Support Elements: status, code, value, value.unit, value.value, value.codes, status.value
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, status, status.value, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Data Requirement Type: Coverage
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
Must Support Elements: type, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Generated using version 0.4.8 of the sample-content-ig Liquid templates