Starting July 1, diagnostic radiologists in California will be required to include radiation dose levels in all CT reports. Industry response has been mainly positive, but there are still concerns about how the legislation will be enacted and the effect it will have on daily practice.
The current legislation requires radiologists to report all CT dose levels, including accidental overdoses, and mandates that medical physicists conduct an annual assessment of the dosage units in every protocol. These measures are in response to two significant overdose events at Cedar-Sinai Medical Center and Mad River Community Hospital in Aracata, Calif.
“What happened was a bad situation, so with that backdrop the response with this reporting legislation was reasonable,” said Bob Achermann, California Radiological Society (CRS) executive director. “It’s an effort to ensure radiology is doing its job correctly and that the industry is providing transparency.”
Radiology leaders anticipate the dose reporting will lead to future data mining opportunities about radiation exposure, public health effects, and long-term radiation responses.
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Under the law, medical physicists have 10 days to calculate and report the dose levels to the California Department of Public Health. CRS, however, supports legislation to amend the bill’s language, making it less burdensome on radiologists. For example, Achermann said, CRS wants to limit the number of reportable procedures to the four targeted by the American College of Radiology (ACR): adult abdominal and brain, as well as pediatric abdominal and brain. The organization also wants to exclude dose reporting for any ancillary radiation experienced by organs adjacent to the target and clarify language that calls for radiologists to dictate the dose level into the patient record.
While California is the first, and so far only, state to legislate dose reporting, the measure falls in line with the ACR’s Dose Index Registry (DIR) initiative. Launched less than a year ago, the registry already boasts more than 1 million nationwide dose reports that practices can access to compare their dose levels to colleagues across the country. But even a database as far-reaching as the DIR doesn’t negate the potential need for states to collate dose reports as well, said DIR chair Richard Morin.
“There are many reasons why it might be reassuring to maintain a local dose report,” Morin said. “There could be local parameters not addressed in the DIR. It could also be used to track the number of imaging exams per patient, especially in the cases of patients with repeat visits.”
Industry leader support, however, doesn’t mean local providers are eager to add another requirement to their daily to-do list. According to Johnson Lightfoote, MD, a neuro- and diagnostic radiologist with Pomona Valley Hospital in California, doctors are instinctively averse to new regulations.
“Many times, doctors’ initial response is, ‘I don’t need your rules, thank you very much,’” he said. “Anytime there are new regulations, the first response is no — there’s a natural resistance to the creation of additional rules, especially if it isn’t necessary.”
The regulation is redundant, he said, because current CT scanners already record dosages for all protocols. But many radiologists also worry that having a database of these values, especially accidental overdoses, would invite frivolous lawsuits.
“From a pure convenience standpoint, the obligation to report dose levels is a downside,” Lightfoote said. “The upside, though, is the incredible increase in transparency. Reporting levels makes us pay a little extra attention to what we’re doing.”