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What’s really behind XR-29 follow-up paper?

Posted by Vikki Harmonay on Mon, Aug 17, 2015 @ 16:08 PM

Posted by Eyal Aharon of Medic Vision on July 16, 2015.  Atlantis Worldwide would like to share this post with you!  


Clarity. It is the cornerstone of good communication.

So when it comes to the hot topic of the XR-29 standard that affects so many imaging departments and practices, why are so many communications on the topic not clear?

Not only are the original recommendations of the National Electrical Manufactures Association (NEMA) standard XR 29-, also known as the MITA Smart Dose Standard, almost anything but clear, but the follow-up paper issued by MITA last month (“Is your CT smart dose compliant”) adds more confusion. And this time, it is not so much that the words are confusing, but rather it is the intent of the paper that leaves one with many questions.

In theory, the subject of the recent MITA paper should have a simple and straight forward, yes or no answer to the question it poses - - Is your CT compliant? MITA could provide a list of CT scanners, consoles and related software versions that meet (or do not meet) the XR-29 requirement. Wouldn’t it be nice to get such list that would allow any CT operator to quickly verify if their CT scanner is in compliance or not? But instead, a reader of the MITA paper goes through over the more than 1,000 words, and still can’t answer the subject’s question.

Instead of giving straight answers, MITA (seemingly) makes a noticeable effort to convince the reader that they should be wary of alternative 3rd party solutions - solutions that can very well be cost effective and meet their needs.  Here are few examples:

-       “An accessory or external software application not integrated into the firmware of the CT system cannot meet the Dose Check requirements”

-       “Commercial and open source software attempts to perform optical character recognition and text parsing … do not achieve compliance.”

One should ask why the Alliance of Medical Imaging elects to invoke uncertainty and fear about potential 3rd party solutions instead of just providing a clear, plain answer to the subject question. Is the cat afraid that someone’s stealing his milk?

Since the MITA follow-up paper has been released, I have read it, and re-read it. I have also talked with many of you during my travels to hear your perspective and understand how this impacts you. So far the feedback is pretty much divided equally between confusion, concern for unbudgeted items and frustration at unclear answers.

For those of you who I have not spoken with, I offer some questions for you to consider:

What do you think? Is the MITA Smart Dose follow-up paper truly for the protection and benefit of hospitals? Is the goal to help assure optimal compliance and investment in the best technologies for the benefit of care? Or does it hurt hospitals and imaging practices by applying pressure to replace their existing CT scanners – at a cost of over $300,000 a unit?

- Do you manage one of the thousands CT scanners (one third of the more than 13,000 existing CT scanners in the U.S.) that MITA declared that shall be replaced to meet XR-29 requirements?  

- Do we have the budget? That’s an overall expenditure of almost $2 billion by healthcare systems.

- Do you use and are you considering proven, 3rd party products that provide full compliance with XR-29 requirements are available for a fraction – just 10% – of that price?

While MITA has elected to not be clear, let us as the CT imaging community come together and be very clear about our thoughts and suggestions to MITA Smart Dose and the pressures being applied in the follow-up paper. With strength in numbers, let’s communicate to CMS and NEMA – in no uncertain terms – that being pressured to make unnecessary investments is not what is best for healthcare. Let’s take a stand and make our concerns heard. Share your comments with me on my blog, on forums on LinkedIn and contact NEMA. It’s only by making our voices heard that real meaningful change can occur.

For more information contact Jeff Weiss at 212-366-9100 or

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Topics: SafeCT