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Dose Index Registry (DIR) Features

Since 2011, the American College of Radiology’s Dose Index Registry (DIR) has helped clinicians and facilities improve the safety and quality of patient care by collecting CT dose indices through automated data transmission and leveraging that data to provide performance feedback reports and establish national peer comparisons. 

One of eight registries that comprise the National Radiology Data Registry (NRDR), the DIR has data on over 182 million exams from nearly 2400 facilities as of December 2022. After anonymization at the site, exam data are transmitted automatically from scanners and fluoroscopes, reducing errors while collecting data daily.

In addition to supporting performance improvement, DIR data can be used to explore a variety of topics for presentations and publications to advance the science and practice of radiology.  View DIR publications on the NRDR Publications Portal page on the ACR website.

Hear from DIR Committee Chair, A. Kyle Jones, PhD about how participating in the DIR can help your practice ensure high-quality radiologic care for your patients and about his personal experience as a clinician engaged in the registry.  Watch now..

The DIR has embarked on a significant expansion to enable dose data collection and performance reporting for more modalities. The DIR Fluoroscopy module now enables facilities to submit interventional fluoroscopy dose indices data and review performance reports.  

Expansion plans call for the DIR to be comprised of four modalities: DIR Computed Tomography (CT), DIR Fluoroscopy (Fluoro) for both interventional and diagnostic procedures, DIR Digital Radiography (DIR DR), and DIR Nuclear Medicine (Nuc Med). Facilities already participating in the DIR CT module can submit data to the new modules at no additional cost.

Note: See the DIR Start-up Guide Knowledge Base article for step-by-step instructions on how to participate in the DIR CT and DIR Flouro modules.

To learn more about the available features and new developments for each module, click on the logo below.

Credit and Recognition

  • The DIR is certified as a Practice Quality Improvement (PQI) project for the American Board of Radiology Maintenance of Certification (MOC) Part IV Programs. Because DIR data are collected at the facility level, participation applies to all radiologists and medical physicists at a facility who choose to participate in the project.

  • The DIR also helps facilities qualify for designation as an ACR Diagnostic Imaging Center of Excellence (DICOE), allowing radiology practices to communicate their dedication to, and success in, delivering superior diagnostic imaging and patient care.

  • DIR participation meets the Joint Commission dose benchmark requirement.

  • DIR participation can help clinicians participating in the Centers for Medicare and Medicaid Services (CMS) Merit-Based Incentive Payment System (MIPS) program meet MIPS reporting requirements via participation in the ACR’s Qualified Clinical Data Registry (QCDR).

Ease of Use

As part of the NRDR suite of registries, the DIR utilizes the same Physician and User dictionaries as other NRDR registries so that information need only be entered once, regardless of the number of registries in which a facility participates.

DIR data can be transmitted directly from scanners, fluoroscopes, and x-ray devices—or from your PACS or Radiation Dose Index Monitoring System—via ACR Connect + DIR Link software. The software setup works with a wide variety of scanners, fluoroscopes, and x-ray devices and has successfully retrieved dose data from more than 900 different models from all major, and some smaller, manufacturers. Participants work with the ACR Connect Support team to install ACR Connect + DIR Link. 


The annual DIR participation fee that includes all DIR modalities is based on the number of physicians practicing at a facility and the number of sites included in that facility.  For facilities already participating in the General Radiology Improvement Database (GRID) no additional fee is required to participate in DIR. See the Registration and Participation Fees Knowledge Base article for more information.

Getting Started

The DIR Start-up Guide describes a   step-by-step process for DIR participation—from assembling your team to reviewing your reports.

Already an NRDR participant? Add the DIR to your facility registration. Only one registration is required to participate in any of the DIR modules.

Need Help? 

NRDR Support offers several ways you can get answers to the questions you have about registry participation.   

Last reviewed: 05/06/2021

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