Radiologist compliance with California CT dose reporting requirements: a single-center review of pediatric chest CT.

Abstract

Effective July 1, 2012, CT dose reporting became mandatory in California. We sought to assess radiologist compliance with this legislation and to determine areas for improvement. We retrospectively reviewed reports from all chest CT examinations performed at our institution from July 1, 2012, through June 30, 2013, for errors in documentation of volume CT dose index (CTDIvol), dose-length product (DLP), and phantom size. Reports were considered as legally compliant if both CTDIvol and DLP were documented accurately and as institutionally compliant if phantom size was also documented accurately. Additionally, we tracked reports that did not document dose in our standard format (phantom size, CTDIvol for each series, and total DLP). Radiologists omitted CTDIvol, DLP, or both in nine of 664 examinations (1.4%) and inaccurately reported one or both of them in 56 of the remaining 655 examinations (8.5%). Radiologists omitted phantom size in 11 of 664 examinations (1.7%) and inaccurately documented it in 20 of the remaining 653 examinations (3.1%). Of 664 examinations, 599 (90.2%) met legal reporting requirements, and 583 (87.8%) met institutional requirements. In reporting dose, radiologists variably used less decimal precision than available, summed CTDIvol, included only series-level DLP, and specified dose information from the scout topogram or a nonchest series for combination examinations. Our institutional processes, which primarily rely on correct human performance, do not ensure accurate dose reporting and are prone to variation in dose reporting format. In view of this finding, we are exploring higher-reliability processes, including better-defined standards and automated dose reporting systems, to improve compliance.