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Dose Index Registry (DIR) Startup Guide

Thank you for your interest in joining the Dose Index Registry (DIR)! This step-by-step start-up guide is intended to help you to get underway with submitting your data and obtaining helpful feedback information.

The DIR is expanding beyond CT to include the additional modalities of fluoroscopy, digital radiography, and nuclear medicine. This guide covers participation in both DIR Computed Tomography (CT), in operation since 2011, and the recently introduced DIR Fluoroscopy (Fluoro) module. The following steps pertain to getting underway with either module and include links to articles in the National Radiology Data Registry (NRDR) Knowledge Base.  

The NRDR Team welcomes suggestions for how we can improve this guide and your overall experience with DIR start up and ongoing participation. Please send your suggestions and comments to

Acknowledgments:  Thank you to the authors of the article "A diagnostic medical physicist’s guide to the American College of Radiology Fluoroscopy Dose Index Registry," published in the Journal of Applied Clinical Medical Physics upon which this guide is based.

I. Assemble Your Team

A wide array of expertise will ensure a successful launch and continued operation of the DIR at your institution. Key team members and their roles are described briefly in this section.

  • NRDR administrative roles: Review the NRDR administrative roles within a Corporate Account to determine which DIR team members at your site should be assigned specific administrative roles for one—or both—of the DIR modules.

  • Additional highly recommended roles: While not official NRDR roles, identifying the right personnel to carry out the following responsibilities is key to DIR implementation and ongoing participation success. Some personnel likely could serve on both the DIR CT and DIR Fluoro teams. Other roles are more specialized to the modality, e.g., the physician champion and technologist.  

    • Physician Champion: coordinates and directs the implementation process. Consider recruiting a champion who serves on a radiation protocol (or similar) committee or is involved with quality improvement efforts

    • Diagnostic Medical Physicist: facilitates effective communication among the other key team members and is key to the successful implementation of any of the DIR modules given their domain knowledge in radiation dosimetry, informatics, and basic clinical knowledge

    • Information Technology (IT) Specialist: interfaces with multiple hospital systems/applications and servers and is familiar with imaging informatics

    • DIR Link Administrator: Supports set up and maintenance of the DIR Link application.  Both this role and the role of IT Specialist may be played by the same individual

    • Lead Technologist: manages the mapping of site-specific facility clinical procedure names to the ACR Common lexicon or the RadLex Playbook ID (RPID) based on the technologists’ in-depth understanding of the specific modality

II. Complete the Application Process and Create an NRDR Account

If your facility wishes to participate in DIR and doesn't currently participate in any other registries, you will need to complete the application process. The NRDR Knowledge Base article

The Application Process provides step-by-step instructions.

Note: If a facility already has an NRDR account, only an addendum to the existing participation agreement is needed to register for the DIR. If a site is already participating in the DIR CT module and wishes to add another DIR module (Fluoro, Digital Radiography, or Nuclear Medicine), an agreement addendum is not required. No additional registration or fees are required for a facility currently participating in the DIR CT module or in the General Radiology Improvement Database (GRID).

III. Get Your Team Signed Up with ACR Login

Team members who will need to access the NRDR portal for account set up activities and to review reports, will need to have ACR Login credentials. ACR Login enables users to enter their login credentials one time on a single page to access all their ACR Login applications. 

Certain ACR Login applications, such as NRDR, require Multifactor Authentication (MFA). MFA necessitates users entering an additional piece of information when logging in for enhanced data security, making it harder for user accounts to become compromised.

Read the Knowledge Base article ACR Login and Multifactor Authentication for more information.

IV. Install ACR Connect and Configure DIR Link 

Upon completing the DIR registration and account setup requirements, the next step is the installation of ACR Connect, a software system designed to process data for use in ACR-sponsored programs through a common platform. DIR Link is one of the applications of ACR Connect and enables the collection, de-identification, and transmission of data securely from CT scanners and fluoroscopes at one or more facilities to the DIR database. DIR Link can support all facilities within an NRDR Corporate Account.

View the DIR Link Knowledge Base articles for basic information and technical instructions.

Note: New facilities registering for the DIR in 2021 will be permitted to send only records using the Radiation Dose Structured Report (RDSD). Secondary capture image data can be sent in addition to the RDSR but will not be accepted as the sole means of transmission. For now, facilities that have previously sent secondary capture as their sole transmission method can still do so; however, the registry intends to discontinue secondary capture later in 2021.

V. Validate Your Data

Data transfer between a DIR participating facility and the DIR Central Server can be interrupted for a variety of reasons.  Therefore, as described below, facilities should undertake the quality assurance process of data validation to minimize missing time periods, modalities, or procedure types in the data submitted from Facilities to the DIR Central Server.

Note: Each DIR module offers reports to support both initial and periodic data validation. To learn more check out the DIR Data Quality Checks article.

  • Initial data validation

Initial data validation focuses on ensuring that data from a newly set up DIR modality(ies) are being received and processed by the DIR Central Server, i.e., verification that the full anonymized Radiation Dose Structured Report (RDSR), with the modalities’ Station Name(s), are being received and included within the NRDR database.

  • Periodic data validation

Periodically, e.g., quarterly, facilities should compare actual procedure volumes to procedure volumes reported in NRDR-DIR reports for the respective facility(ies) for a specific time period. If total procedure volumes match and the Station Name of each connected system is represented, it is likely that no further comparison is needed. If there is a mismatch, comparisons at the level of Station Name or even Study Description/Requested Procedure Description may be required for troubleshooting. 

  • Facility process health monitoring

Implementing process health monitoring is another strategy to consider for minimizing interruptions in the data flow from the facility to the DIR Link application. For example, automated email alerts that notify the site administrator if there is a failure to transfer data from PACS or an RDIM to DIR Link would support optimal data flow. The local facility informatics architecture will dictate which types of facility process health monitoring can be implemented.

VI. Map Clinical Procedure/Exam Name

DIR participating facilities have their own internal facility exam or procedure “names” (a.k.a. procedure description, study description, etc.). To allow for exams and procedures that are named differently across DIR facilities to be analyzed and compared for benchmarking feedback reports (“apples to apples comparison”), DIR participants must map their exams and procedures to a standardized terminology.

CT exams are mapped, or “tagged” using RadLex Playbook IDs (RPIDs) and fluoro procedures are tagged using ACR Common™ procedure names. Detailed knowledge of the exams and procedures is required for accurate mapping; therefore, it is recommended that a lead or senior technologist manage exam name mapping with support from a physicist or physician champion. 

The Knowledge Base articles below provide detailed information about the mapping process. 

VII. Manage Device Profiles for DIR Fluoroscopy

DIR Fluoro participants complete a device profile for each fluoroscope that sends Radiation Dose Structured Reports (RDSR) files to the DIR Central server, to accurately report and assess practice patterns. The device profile contains important information such as year of manufacture, classification (e.g. single plane interventional, or remote radiography and fluoroscopy), and single point dose index correction factor. 


Correct setup of fluoroscopy device profiles enables the most meaningful comparison of benchmarking data for DIR Fluoro participants and provides valuable information for the fluoroscopy community. Consult the Managing Device Profiles Knowledge Base article for more information. 

VIII. Readiness Checklist

Print the readiness check list


DIR Team Members Identified and Have ACR Login and MFA Set up


  • Physician Champion identified


  • Diagnostic Medical Physicist identified


  • IT Specialist identified


  • DIR Link Administrator identified (may be the same as above)


DIR Link Setup and Configuration


  • CT scanners and fluoroscopes to connect to the DIR identified


  • Physical or virtual server to run ACR Connect identified


  • CT scanner or fluoroscope configured to produce RDSR 


  • CT scanner or fluoroscope configured to transfer RDSR to appropriate network destination(s)


  • CT scanner or fluoroscope listed in the  configuration


Device Profile Setup (For DIR Fluoro only)


  • Add device information for each fluoroscope 


Map Exam | Clinical Procedure Names 


  • Review mapping options 


  • Complete initial mapping

Last reviewed: 05/06/2021DIR Link Enhanced Data Transmission

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