Diagnostic imaging

X-ray overdoses alleged in Ontario

TORONTO – In addition to criticizing the accuracy of Ontario’s reported wait-time data for diagnostic imaging, Ontario’s auditor general also claimed there are dosing problems when patients are given CT exams.

Auditor general Jim McCarter pointed to CT scans for children, saying that in many instances they were being conducted using adult settings, resulting in high doses of X-ray radiation.

“We found that the medical practitioners, quite frankly, were not as aware as they should be. And we found that in half the scans we looked at ... the radiation levels were much too high for the children,” McCarter said.

“It’s really important that you dial down the radiation level when you’re doing a CT scan of a child.” The auditor general added that his staff has spoken with the “hospital sector” to say this is something “to be more aware of.”

He also questioned shorter wait times for Workplace Safety and Insurance Board clients who were referred for CT and MRI scans. “We found situations where they were basically going to the front of the line because the workers compensation here in Ontario pays the hospital $1,200.”

The implication is that cash-strapped hospitals fast-track these patients to get payment for the procedures. “We just questioned if that was appropriate or not,” McCarter said.

McCarter said his new legal authority to probe into these areas of public spending made the audit process a new experience. “For the first year we were able to go in and look at hospitals, community colleges, children’s aid societies, crown-controlled corporations and we found a number of concerns right across the whole sector,” McCarter told Canada AM’s Seamus O’Regan earlier this month.

The Ontario government changed the legislation last year, allowing the auditor’s office to open the books in many organizations that had previously been closed to the annual audit of public spending.

“I’m hoping when they look at some of the recommendations that we made ... they’ll look back and say it’s a good thing we got the auditor to get in a have a look at these organizations,” McCarter said.

For its part, the Ontario Hospital Association (www.oha.com) issued a statement following the auditor general’s report. It read in part:

“The number one priority for Ontario’s hospitals is the safety of their patients and staff. We want to reassure patients, their families, and the public that CT scans have been, and remain, a safe and valuable diagnostic tool. In fact, as the Auditor General noted in his report, “(the three) hospitals we visited had general radiological policies based on the ALARA (As Low As Reasonably Achievable) principle”.

“As a result, the risk of harmful effects on patients who undergo these procedures is generally very low.

“At the same time, Ontario’s hospitals share the Auditor General’s concerns and are reviewing his recommendations very carefully. We agree with the Auditor General that standards and methods based on international and national best practices are needed to ensure that CT scanners are used in an appropriately uniform manner across Ontario. In fact, Ontario’s hospitals were the first to raise radiation dosage from diagnostic imaging procedures as an issue.

“In September 2006, Ontario’s Ministry of Health and Long-Term Care established a Diagnostic Imaging Safety Committee (DISC) made up of clinical experts to develop specific recommendations regarding how CT scanners can be used safely, effectively, and in keeping with the ALARA principle. A full report is expected in February of 2007.

“We expect that this report will provide further guidance to the healthcare sector in this area. In advance of the completion of this work, the OHA is recommending that all Ontario hospitals performing CT/MRI scans review their policies and practices, especially with respect to paediatric protocols, to ensure compliance with recommended manufacturer settings for the equipment.”