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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 nearly 120 million CT exams from more than 2,200 facilities as of February 2021. After anonymization at the site, exam data are transmitted automatically from CT scanners, 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.

The DIR is Expanding!

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

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

Note: See the new DIR Start-up Guide Knowledge Base article for step-by-step instructions for 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 a logo below.


Note: For the next phase of DIR expansion, the ACR is recruiting facilities to participate in a DIR-DR pilot. If you are interested in supporting this effort, please submit your contact information here

Credit and Recognition

  • The DIR is certified as a Practice Quality Improvement (PQI) project for 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 and devices—or from your PACS—via the ACR’s TRIAD™ software. TRIAD works with a wide variety of scanners and devices and has successfully retrieved dose data from more than 900 different models from all major, and some smaller, manufacturers. Participants can install TRIAD on their systems or can work with an ACR-certified software partner. See the Knowledge Base article TRIAD Set up and Configuration Overview for details.


The annual participation fee for the DIR is based on the number of physicians practicing at a facility and the number of sites included in that facility.  There is no additional fee to submit registry data for more than one modality. 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 a 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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