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Advancing Quality Improvement

For a decade, the National Radiology Data Registry has been building a trove of benchmarking information to help practices improve patient care and make metrics-driven business decisions.

NRDR 10th Anniversary logo

 This year, the National Radiology Data Registry (NRDR®), is celebrating its tenth anniversary. Over the past decade, NRDR has evolved to stay relevant in the changing healthcare environment.

NRDR is a set of databases used to track radiology quality. These databases vary in the type of information they hold, from the Dose Index Registry® (DIR) to the National Mammography Database (see below for the complete list of registries under NRDR). Practices contribute a standardized set of information based on each database’s requirements — whether its levels of radiation dose, turnaround times, screening mammography audit information, or other measures. NRDR then aggregates and provides comparative feedback data based on participating facilities and practices around the country. The benchmarking information enables quality and practice leaders to make data-driven decisions to improve their practices and optimize patient care.

A Unique Niche

The idea of a national registry for radiology was based on the creation of the National Oncologic Pet Registry in 2006. At that time, CMS did not reimburse for PET scans, recalls Jeffrey C. Weinreb, MD, FACR, professor of radiology and biomedical imaging at Yale School of Medicine, who served as the first chair of the NRDR steering committee. CMS required practices to participate in a clinical quality registry as a condition of reimbursement for certain types of PET scans. CMS was looking to the registry to show that the use of PET scans informed a physician’s decision about treatment, which would demonstrate that they were a valuable tool.

“With that model and nascent infrastructure in place,” says Laura Coombs, PhD, senior director of informatics and the ACR Data Science Institute™, “we recognized that we had an opportunity to set up a radiology quality registry, much like the registries that already existed with other specialties, such as those in cardiology and thoracic surgery.”

And so, NRDR officially began. In 2008, the ACR created two practice-based registries (CT Colonography Registry ™ and the General Radiology Improvement Database), followed by the National Mammography Database in 2009 and the (DIR) in 2011. More recently, the Lung Cancer Screening Registry® (which is approved by CMS to meet the quality reporting requirements for Medicare CT lung cancer screening reimbursement) and the collaborative ACR/ Society of Interventional Radiology (SIR) Interventional Radiology Registry™ were added to the NRDR umbrella.

More Than Meets the Eye

That’s the simple history of NRDR, but there’s much more to the registry. How does NRDR help practices and their patients? “These registries are valuable tools that allow practices to track quality measures over time and gauge their performance,” says Mythreyi B. Chatfield, PhD, executive vice president of ACR’s Quality and Safety department and former senior director of data registries. “The longer you use NRDR, the more valuable it becomes as a tool and a database. We can see longer trends and practices
 Adds Weinreb, “By comparing their results to industry-wide metrics, radiologists can show how they’re committed to quality improvement.” That applies not only to comparing themselves to other practices or individual radiologists using the system, but to radiologists across the same hospital system, says Wendy Lomers, CPA, MBA, of Acclaim Radiology Management, who frequently aids practices in their NRDR efforts. “One of the best things about NRDR is its ability to pull together physician practice data across facilities.”

Quality First

NRDR has also moved along with the times. “The era of value-based care is upon us, and practices are navigating advanced payment models and the Merit-Based Incentive Payment System (MIPS),” says Judy Burleson, senior director of ACR Quality Management Programs. “NRDR has been approved as a qualified clinical data registry (QCDR) by CMS since 2014. This means that radiologists or their groups can use NRDR measures to fulfill reporting requirements for the MIPS Quality Performance (QP) category.” The QP category includes several types of measures to gauge clinician performance: process measures (what doctors and other clinicians do to maintain or improve health), outcome measures (how a healthcare service or intervention influences the health status of patients), and high-priority measures (which track a variety of aspects of care, from appropriate use to patient experience).

One of the big benefits to using NRDR for MIPS QP reporting is the collection of data over time with regular feedback, which can support higher-quality performance. The team of experts operating the registry helps members understand their data and report strategically. The focus on scientific methods to measure and benchmark performance has opened doors for more measures for physicians to use. “Initially, many groups were disenchanted with the Quality Payment Program because radiologists were having a difficult time finding enough measures to satisfy the requirements. But when CMS allowed QCDRs to track quality data and allowed these metrics to earn credit under the MIPS QP category, it improved the opportunity for radiologists to successfully participate” says Lomers.

Although it’s been ten years, the NRDR team doesn’t plan on slowing down any time soon, says Chatfield. They’re constantly looking for more ways to make the experience smoother and to adapt as healthcare changes. Lomers has seen those changes and expects more to come, especially in value- based plans like MIPS: “Quality care will be changing for all physicians, but ACR and NRDR will be there to guide the radiologists through these changes, especially as they relate to radiology and imaging.”


Looking to get involved? Find out which registry suits your needs. Each offers additional quality measures to fulfill reporting requirements for MIPS.

Lung Cancer Screening Registry® ( helps clinicians monitor and demonstrate the quality of CT lung cancer screenings in their practices through periodic feedback reports that include peer and registry benchmarks.

Dose Index Registry® ( allows radiology practices to compare their CT dose indices to national and regional averages.

Interventional Radiology Registry™ ( allows clinicians to access objective measures regarding the quality of facility processes and outcomes in comparison to similar facilities nationwide.

National Mammography Database ( uses data already collected under the Mammography Quality Standards Act of 1992 to create reports that benchmark facility and physician performance and exceed the FDA’s audit data collection requirements.

General Radiology Improvement Database ( allows physicians to access and compare datasets of process measures (e.g., turnaround times, wait times) and outcomes (e.g., adverse incidents) that help participants pinpoint problems, implement plans, and quantify results for general radiology practices.

CT Colonography Registry™ ( helps participants promote quality of care for patients undergoing CT colonography by providing benchmarks such as rate of adequacy of diagnostic and screening examination, rate of colonic perforation, and the true positive rate.

 By Meghan Edwards, freelance writer, ACR Press

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