DIR Phases Out Secondary Capture

When will the DIR stop accepting secondary capture images?

The Dose Index Registry (DIR) will phase out accepting secondary capture image files as the DIR Link is implemented. The secondary capture phase-out began in January 2021, with the requirement that all new facilities registering for the DIR submit exam data from Radiation Dose Structured Reports (RDSRs).  The goal is to accept only RDSR files by the end of 2023 and to accommodate facilities experiencing extenuating circumstances, when possible.  

What are the benefits of upgrading in order to submit RDSR files? 

With the implementation of the XR-29 standard on CT scanners in 2016, most scanners and fluoroscopy systems now produce RDSRs as compared to when the ACR first launched the DIR in 2011 and accepted secondary capture image files. Technological changes over the past 10 years have resulted in many benefits of RDSR data over secondary capture image data to include:

1. Improved dose accuracy: As opposed to secondary capture image data, the RDSR includes all information related to the x-ray tube output that has an impact on the radiation dose to the patient. For example, an RDSR includes the information for any rejected or repeated image acquisitions. Also, each fluoroscopy event is included in the RDSR as a distinct irradiation event. The recording of exposure information after each irradiation event independent of any image creation avoids the issue of “lost” dose-related details due to image rejection or deletion and the creation of duplicate dose records due to copying of images.

2. Less storage space and processing time: No standard method exists to decouple the image data from the exposure information. Therefore, for secondary capture image files, the exposure information must be accompanied by the image data, resulting in vast increases in storage space and transmission time.

3. Protocol optimization opportunities:  RDSR data serves as a valuable tool to optimize image acquisition protocols. For example, after modification of CT protocols for a certain type of acquisitions, e.g., contrast-enhanced abdominal CT, follow up by analysis of RDSR data on several patients spanning a certain period can provide information on whether the expected optimization was achieved.

4. Transition to enhanced data submission technology: In 2022, the ACR will begin to roll out a new and enhanced version of TRIAD, called DIR Link, which will only receive RDSR files. DIR Link features enhanced automation, security, and data analysis capabilities.  

How do I confirm if my facility is sending secondary capture image or RDSR files?

First, confirm if any scanners under your corporate account, or associated with your facility, are sending secondary capture image files. To do this:

1. Log in to the NRDR portal

2. In the left menu, under Interactive Reports, select the CT Standardized Dose Index report

3. In the Exam Search tab of the report, select the Corporate Account you want to check across all facilities.

   1. You can also select a specific facility using the Facility filter. 

4. A summary report pie chart presents a breakdown of file types being sent from scanners within your corporate account, or selected facilities, during the data range you designate

5. In the pie chart example, you can see the facilities for the selected corporate account are sending secondary capture image data for 13.2% of the files submitted to the DIR.

If one or more facilities within your corporate account are sending secondary capture image files, you can determine which scanners by doing the following:

1. Follow steps 1 and 2 above.

2. Select the Boxplot by Scanner report tab along the top menu.

3. The dots represent individual exams, and all red dots indicate the scanner is transmitting secondary capture image files to the DIR.  Unless the scanner’s software is updated by [what date] dose information from the two scanners as represented in the image below will not be accepted in the DIR.

What do I need to do about scanners that only produce secondary capture image files?

As referenced above, most modern CT scanners have the capability to send RDSR files.  If you find that your scanner is sending secondary capture files, there is configuration in the CT scanner console that needs to be done. The following bullet points may be helpful:

• If you work within a large healthcare system, you may need to work with your IT support personnel and CT vendor or service provider to enable sending RDSR files across all scanners submitting data to the DIR.

• If you work within a smaller community setting or free-standing imaging center, your field service engineer may be able to help you make the setting change on your scanners.

• Switching to RDSR from secondary capture may be a process, as some CT console software requires configuration at the protocol or series level. So consider planning the process as a quality improvement project, starting with just a few protocols, preferably those with the highest frequencies.

• Personnel who may be able to assist in addition to CT service engineers include your medical physicist and chief or QC technologist(s).

Questions or concerns?

Please contact the National Radiology Data Registry support team at nrdrsupport@acr.org.