Original article
ACR CT Accreditation Program and the Lung Cancer Screening Program Designation

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Abstract

The ACR recognizes that low-dose CT for lung cancer screening has the potential to significantly reduce mortality from lung cancer in the appropriate high-risk population. The ACR supports the recommendations of the US Preventive Services Task Force and the National Comprehensive Cancer Network for screening patients. To be effective, lung cancer screening should be performed at sites providing high-quality low-dose CT examinations overseen and interpreted by qualified physicians using a structured reporting and management system. The ACR has developed a set of tools necessary for radiologists to take the lead on the front lines of lung cancer screening. The ACR Lung Cancer Screening Center designation is built upon the ACR CT accreditation program and requires use of Lung-RADS or a similar structured reporting and management system. This designation provides patients and referring providers with the assurance that they will receive high-quality screening with appropriate follow-up care.

Introduction

The American Cancer Society estimates that in 2014, a total of 224,210 people in the United States will be diagnosed with lung cancer, and 159,260 will die from the disease [1]. The National Lung Cancer Screening Trial, funded by The National Cancer Institute, demonstrated that low-dose CT (LDCT) screening reduces lung cancer mortality by 20% in high-risk patients age 55-74 years who have a 30–pack-year history of smoking, and does so cost effectively 2, 3, 4. In December 2013, the US Preventive Services Task Force (USPSTF) gave LDCT lung cancer screening a favorable grade-B rating after completion of extensive deliberation, analysis of the lung cancer screening literature, and additional commissioned modeling studies [5]. Under the 2010 Patient Protection and Affordable Care Act [6], the USPSTF recommendation triggers coverage by third-party payers for this lifesaving measure, starting in 2015.

The ACR strongly supports the use of LDCT for lung cancer screening and believes that the ability of this technique to reduce mortality depends on appropriate patient selection, the performance of high-quality, low–radiation exposure LDCT examinations interpreted by qualified physicians, and a structured reporting and management system as the foundation for quality reporting and outcomes monitoring. Building on extensive ACR experience with breast cancer screening, including the comprehensive widespread use of BI-RADS®, imaging accreditation, quality metrics, and both clinical and research registries, the ACR has focused on expeditiously bringing tools to practicing radiologists to promote the dissemination of high-quality lung cancer screening.

The ACR-Society of Thoracic Radiology (STR) Practice Parameter for the Performance and Reporting of Lung Cancer Screening Thoracic CT 2014 (Resolution 4) provides guidance on indications and contraindications, specifications of the examination, interpretation and reporting, documentation and communication, and equipment specifications [7]. The first edition of the ACR’s Lung-RADS presents a structured management, reporting, and audit schema for lung cancer screening practice and quality assurance (QA). In addition, the ACR has collected lung cancer screening resources on a single web page [8] for individuals, practices, and institutions. Provided links include the 2014 CT protocols from The American Association of Physicists in Medicine [9], and smoking cessation resources, an important component of any lung cancer screening program. Lastly, as part of the ACR suite of registries under the National Radiology Data Registry [10], the ACR will launch the Lung Cancer Screening Practice Registry in early 2015. Use of the registry will enable providers to perform clinical practice audits and compare their cancer detection rates, false positives, and positive predictive value rates against benchmarks similar to the standards used in mammography. Participation will be very useful for assuring quality in individual radiology practices.

The focus of the current article is to describe the ACR Lung Cancer Screening Center designation within its CT accreditation program, for which the ACR-STR Practice Parameter for the Performance and Reporting of Lung Cancer Screening Thoracic CT, the existing CT accreditation program, and Lung-RADS are foundational elements.

Section snippets

ACR Accreditation Program Overview

The ACR accreditation programs in diagnostic imaging began in 1987 with the mammography program, and in 1994, it was deemed a national accreditation body by the FDA under the Mammography Quality Standards Act. The ACR subsequently developed programs for MRI, ultrasound, CT, nuclear medicine, PET, stereotactic breast biopsy, breast ultrasound and biopsy, and breast MRI. The CT accreditation program was launched in 2002, with 6,870 facilities having achieved CT accreditation to date, including

ACR CT Accreditation

The objective of CT accreditation is to validate that the quality and safety of care provided is adequate and meets standards. Sites that have achieved ACR CT accreditation provide assurance to patients and referring providers that the quality of CT services is consistent with established standards. The areas of evaluation are personnel qualifications, quality control (QC), QA, and image quality. Sites must submit clinical exams, phantom images, and radiation dose information.

Lung Cancer Screening Center Designation

After the release of The National Lung Cancer Screening Trial results in 2012, a team of physicians and nurses at the Lung Cancer Alliance sought to create guidance for responsible lung cancer screening, with the goals of educating the at-risk public, and creating a framework for a culture and community of practice to promote responsible screening. The components of this National Framework for Excellence in Lung Cancer Screening and Continuum of Care were based on widely accepted best practices

Take-Home Points

  • The ACR strongly supports lung cancer screening with LDCT for high-risk patients age 55-80 years with a pack-year smoking history of ≥30.

  • The ACR CT accreditation, coupled with the new lung cancer screening designation, provides patients and providers with the assurance that their screening and follow-up will be of optimal quality.

  • Use of Lung-RADS will ensure appropriate management and follow-up, and guide practices in continuous quality improvement.

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