07 Dec California Dose Legislation: National Implications

Radiology Business Journal | November 15 – Arnold Schwarzenegger, California’s governor, signed a new radiation patient protection law in October 2010 that mandates strict procedures and reporting requirements for CT scanners and radiation-therapy procedures, as well as the reporting of radiation overdoses to the state’s Department of Public Health (DPH).

Whether the law prompts similar measures in other states (or at the federal level) remains to be seen. Robert Achermann, executive director of the California Radiological Society (CRS), says, “I’ve had calls from other states where the issue is being raised. Even though the incidents that drove this issue were from California, it is an issue of nationwide interest.”

Rumblings are also being heard in Washington, DC, but Dave Adler, director of government relations for the American Society for Radiation Oncology, says, “I think everything, right now, is on hold,” attributing the lack of activity earlier this year to the midterm congressional election. How soon any action might be taken, now that the election is over, is unknown.

The California radiation-protection law stems from findings by the DPH that over 260 patients were exposed to eight times the normal dose of radiation during CT perfusion scans at Cedars–Sinai Medical Center in Los Angeles. A review found that similar incidents had occurred throughout California, including at Los Angeles County–USC Medical Center, at Glendale Adventist Medical Center, and at Bakersfield Memorial Hospital.

First of Its Kind

Parts of the California law, particularly the recording of each dose of radiation, make it the first state law of its kind in the nation. As of July 2012, those using CT systems must record the dose of radiation on every study by putting it in the radiology report or attaching the protocol page to the radiology report. The displayed dose must be verified annually by a medical physicist to ensure that it is within 20% of the true measured dose. Facilities that do CT studies must send each CT study and protocol page that lists the technical factor and radiation dose to a PACS.

In addition, health facilities must report to the DPH events that meet certain requirements, including CT irradiation of a body part other than the one intended, but only if certain radiation-dose requirements are exceeded. Definitions of other events are outlined in the law, a summary of which can be found at http://www.acr.org/HomePageCategories/News/ACRNewsCenter/California-State-Senate-Bill-1237.aspx. Starting in July 2013, all facilities that offer CT studies must become accredited by an organization approved by CMS.

Achermann notes that the law could have been a lot worse without the involvement of the CRS in the legislative process.

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