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California might be the first state to require health care providers to record and report patient dose exposure from CT scans, but it probably won't be the last.

"The legislation is spreading," Shawn McKenzie, CEO of Ascendian Healthcare Consulting, headquartered in Sacramento, Calif., told attendees Tuesday at this year's AHRA conference in Orlando, Fla.



In his talk, McKenzie explained why radiology administrators should be prepared for increasing oversight into radiation safety and dose management, a topic that has been gaining national attention.

At the center of the story is McKenzie's own home state, which was rocked by a series of recent CT overexposure incidents. In 2008, Cedar-Sinai Medical Center in Los Angeles exposed more than 250 patients to excessive radiation during perfusion scans. That same year at a Humboldt County hospital, a two-year-old boy received nearly 150 scans in just over an hour, according to reports.

Patient advocates demanded swift action. And in 2010, California lawmakers passed SB 1237, requiring providers to record patient dose exposure on every CT scan, and report scans that exceed safe dosage levels to the state. Most provisions of the law went into effect last month.

But McKenzie said this isn't the end of the road for dose reporting.

Although he didn't mention any by name, he did say other states will likely follow California's lead in passing similar legislation. In addition, the American College of Radiology and the Joint Commission have been making dose monitoring a part of their agenda. Exposure guidelines are being updated and compiled by the ACR and the Commission is looking into ways to incorporate spot checks related to recording dose as part of their facility reviews.

Invest in software

For those health care centers planning to set up a radiation safety program, radiation dose software is a priority, McKenzie said.

"The software is out there that can do this," he said. Some programs can manage dose thresholds, aggregate dose management, alert administrators when thresholds have been exceeded, and even reduce dose on the actual modality. McKenzie said technology is only going to become more refined as reporting requirements become more widespread.

Even without buying software, he said organizations need to be aware of the move to improve dose reporting and work to get their centers up to snuff. Ways to prepare for new requirements include standardizing exam protocols, involving the whole team in a safety program, educating the community and technologists about radiation dose, and most importantly, getting radiologists to become more "consultative," as patients come in with more questions and concerns.

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