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A series of CT imaging errors that left hundreds of patients with radiation overexposure at a Los Angeles hospital has prompted two leading radiologist groups to advocate for closer attention to dosage guidelines.

In statements released Monday, the American College of Radiology and the American Society of Neuroradiology suggest that hospitals look carefully at dosage protocols to ensure that patients are getting safe scans.



This announcement follows news that in 2008, during an 18-month period, around 206 patients at the Cedars-Sinai Medical Center in Los Angeles got eight times the recommended radiation dose from CT head scans, possibly because of the machine's faulty programming. The patients have now started a class action lawsuit against the hospital and GE Healthcare, the maker of the scanner. [See DM 10525]

With modern technology, guidelines are difficult

ACR admits that because of the complexity of modern CT scanners, it's hard to come up with scan acquisition parameters, or dose protocols, that will work for every scan. Currently, ACR has established dose reference levels for three of the most common exams, such as adult brain, adult abdomen and pediatric abdomen exams. But for rarer procedures such as the head CT perfusion exams done at Cedars-Sinai to help detect strokes, the ACR recommends following basic safety procedures. These include making sure all radiological staff are up-to-date on their training and regularly pass continuing education courses, as well as routine safety checks on all machines by medical physicists, radiologists and CT technologists.

ACR also advises against shutting off the dose estimate interface option on scanners, which can help alert scanner operators when dose values exceed normal ranges.

"The dose reporting interface provides an opportunity to review the overall scan parameter settings at a glance," Dianna Cody, M.D., the chair of ACR's CT physics accreditation group, tells DOTmed News. Some facilities deactivate the software, Dr. Cody notes, because they want to keep extra images off PACS archives or because they don't trust reported values.

Although ACR recommends radiologists and hospitals consult with their published dosage guidelines, a source there tells DOTmed News there is "no evidence" of a "systemic, nationwide problem" as hinted at in the FDA's October warning about the Cedars-Sinai debacle.

ACR's dose reference levels can be found here:

http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/med_phys/reference_levels.aspx

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