Know thy dose

March 14, 2013
by Brendon Nafziger, DOTmed News Associate Editor
Since last summer, California’s 2,500 to 3,000 radiologists have been doing things a bit differently. On July 1, the California dose-reporting law (SB-1237) went into effect. Among other things, it requires radiologists to report the radiation dose from CT scans in patients’ reports. This means reporting the computed tomography index volume (CTDI vol) and doselength product (DLP), clipping the unit’s protocol page onto the interpretive report, and sending the data straight to PACS, if the machine is able to do that.

“When they actually dictate their interpretive report, it was not common for radiologists to dictate the dose,” Bob Achermann, the executive director of the California Radiology Society, tells DOTmed Business News about the change.

The immediate prompt for the bill was likely an incident that came to light more than three years ago. Cedars Sinai in Los Angeles had inadvertently exposed patients to eight times the recommended dose during brain perfusion CT scans, causing some patients to suffer hair loss and radiation burns.

The incident also occurred during a period that saw heightened public and scientific interest in medical radiation. For the past decade researchers had been uncovering what they claim are links between CT exposure, especially in childhood, and future cancers. A study by David Brenner of Columbia University published in a 2007 issue of the New England Journal of Medicine said that CT scans could account for 1.5 to 2 percent of all cancers in the United States.

Although these studies are not without their critics, they have helped create a climate characterized by “radiation hysteria,” in the words of one speaker at the Radiological Society of North America’s annual meeting in November.

Hysteria or not, the rest of the country might follow California’s lead. While the Golden State is, so far, the only one with the dose-reporting statute, legislatures and health departments in the other 49 have been looking over the bill, according to Neil Singh, a consultant with Ascendian Healthcare. “We know that all of the other states have asked for a copy of the California mandate,” he tells DOTmed News. “(Nothing’s) out in stone yet, but it’s coming.”

Vendors respond
Vendors are also making a big push for software to help providers manage their dose. At RSNA 2012, three announcements came out around this. One is that Bayer Healthcare (which owns Medrad) bought, for an undisclosed sum, Radimetrics, which makes the eXposure dose-tracking program. Agfa and Sectra also both said they were bringing out their own dose-monitoring software, to compete with ones already on the market from Radimetrics, GE and PACSHealth.

As copy on Radimetrics’ website – “beyond simple compliance” – makes clear, the goal of these is not so much to increase compliance with the California law in particular, but more to enable clinics or hospitals to make sure equipment is functioning and to enable benchmarking. That is, helping customers monitor and track their dose to see how they stack up against their peers.

Ascendian, which in 2011 began offering “enterprise dose reduction” consulting services, says the pull of these services and programs is three-pronged: dose-lowering is the right thing to do; imaging centers want to stay ahead of lawmakers and lawyers, who might see radiation as a juicy malpractice area; and it’s good for marketing. “Who doesn’t want bragging rights?” Singh asks.

“One exam is easy”
How do these products work? Sectra’s product, called DoseTrack, pulls specific DICOM data from compatible units. The software has been in the works since 2008, well before California’s law was even a thought in some state congressman’s mind. It was developed in part by Matt Nilsson, a professor at Lund University in the southern region of Sweden called Scania, near Denmark.

“Sweden is a very health concerned country,” Sectra President Dr. Torbjörn Kronander tells DOTmed News. “We want a means of collecting and tracking dose records all over the county (Scania), especially for tracking equipment, so we know if equipment should be replaced because it’s giving too much radiation.”

Now employed at nine networked hospitals in Sweden, it’s currently undergoing review by the Food and Drug Administration. A “pioneer” site will set up the service in a few months, but Sectra hasn’t made it public yet.

“It will help hospitals with providing information to patients with how much radiation they got and accumulated over different exams,” Kronander says. “(Capturing) one exam is easy, but this means an institution, a group, can give an accumulated dose recording to a patient.”