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Perfusion CT Scan Overdose Accusations Fly

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Any institution that does perfusion CT scans of the brain should right this minute check the settings on its machines and the training of its technologists. At least eight hospitals, plus manufacturers, regulators, patients, and, of course, lawyers, are complaining, arguing, investigating, and pointing fingers regarding excessive radiation doses during such scans.

The Los Angeles Times reported this week that, at two California hospitals where patients had received radiation overdoses, officials said they had programmed their scanners according to the specifications of the manufacturer, Toshiba.

Toshiba said it could not comment on specific cases because of an ongoing investigation by the U.S. Food and Drug Administration. Los Angeles County health officials who investigated one of the hospitals, Los Angeles County-USC Medical Center in Los Angeles, said technologists there had not been trained to keep track of radiation dose information.

Altogether, the New York Times reported,  at least 400 patients at eight U.S. hospitals received higher-than-expected doses of radiation. The other seven hospitals, according to the NY Times, are Glendale Adventist Medical Center in Glendale, California; Providence Saint Joseph Medical Center in Burbank, California; Cedars-Sinai Medical Center in Los Angeles; Bakersfield Memorial Hospital in Bakersfield, California; an unidentified hospital in San Francisco; South Lake Hospital in Clermont, Florida; and Huntsville Hospital in Huntsville, Alabama. The newspaper quoted government officials as saying that none of the overdoses could be attributed to scanner malfunctions.

All of the cases involved perfusion scans used to diagnose possible strokes. Perfusion scans involve high radiation doses anyway because, in order to show the amount and flow of blood in the brain, they scan the patient repeatedly before, during, and after the intravenous delivery of a contrast agent. But the patients at Huntsville Hospital received up to 13 times the amount of radiation generally used for such scans—the highest doses reported at any of the eight hospitals.

The NY Times reported that, according to an inquiry by GE Healthcare, the scanner manufacturer, Huntsville Hospital officials said they intentionally used high levels of radiation to get clearer images. The hospital declined to comment except to say that about 65 possible stroke patients had received too much radiation. Lawyers representing some of the patients put the number closer to 100.

However, the director of the Alabama Office of Radiation Control says that because the state does not define dosing limits, there’s “no such thing as an overdose.” Indeed, few standards exist for radiation doses, dosage-reporting rules, or training requirements in a field where technology is advancing so fast that regulators, administrators, radiologists, and technologists are all having a hard time keeping up.

“I cannot believe that this is not occurring in the rest of the country,” said Kathleen Kaufman, head of radiation management for the Los Angeles County Department of Public Health. “That’s why we are so keen on the rest of the states to go look at this.”

Some regulations and standards will probably emerge. But at least one thing is absolutely certain to result from this situation: lawsuits.

Related seminar: National Diagnostic Imaging Symposium

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