The following is a guest blog by Robert Fleming, Product Management Director, Diagnostics, Nuance Healthcare.
Beginning July 1, 2012 the state of California will require that facilities performing CT scans record the dose of radiation in the radiology report or attach the protocol page (that includes the dose of radiation) to the radiology report. In addition, facilities will soon be required to report to the California Department of Public Health any adverse events in the administration of radiation. The details of this new law, Senate Bill 1237, are available here: http://www.leginfo.ca.gov/pub/09-10/bill/sen/sb_1201-1250/sb_1237_bill_20100623_amended_asm_v97.pdf.
This bill was created in reaction to a number of very unfortunate events where a significant number of patients were inappropriately exposed to high doses of radiation from CT scans. Over the coming months, as California radiology facilities adjust to these new reporting requirements, the rest of the country will be watching closely to determine if they will follow suit.
Increased public awareness regarding the risks and benefits of diagnostic scans is a good thing. Americans get the most medical radiation in the world, even more than those in other rich countries. In addition, the U.S. accounts for half of the most advanced procedures that use radiation, and the average American’s dose has grown six-fold over the last few decades.
One of the other outcomes of the California legislation is discussion over the most appropriate dose information to include in the radiology report. As documented in SB1237, radiation dose is defined as the computed tomography index volume (CTDI vol) and dose length product (DLP). However, CTDI is not a direct measure of patient dose. CTDI is an index, representing radiation dose in an imaging “phantom.” Phantoms are specially designed objects that are scanned or imaged in the field to evaluate, analyze, and tune the performance of various imaging devices. CTDI is a good measure of scanner output, and is used when comparing different protocols. CTDI will differ based on patient size, so for the same examination a larger patient will have a larger CTDI vol than a smaller patient. In addition, there are two standard sizes of phantoms – 16cm and 32cm – typically used for head and body.
Starting July 1, 2012 radiology facilities will start recording CTDI vol and DLP in their radiology reports, meeting the letter of the law as documented in SB1237. However, the ongoing discussion amongst radiology thought leaders in California will result in recommended best practices for documenting radiation dose, and including information that provides the highest value to the ordering clinician and ultimately, the patient.
Nuance Healthcare’s Diagnostics Team has been working closely with a number of our California customers and several dose management vendors to offer several options for complying with SB1237. In PowerScribe 360 | Reporting, the interpreting radiologist can easily dictate the dose information into the report without workflow interruption. In addition, the dose information can be automatically merged into the report template if the data has been manually entered into the system by the technologist or received electronically from the RIS or a dose management system.
What are your thoughts on this? Will we quickly see other states follow California’s lead? In the coming months, we’ll share insights and lessons learned from some of our California customers who are ahead of the curve when it comes to complying with this new mandate.
Categories: Radiology Reporting
Tags: radiation dosage