Getting it right: are regulation and registries for CT radiation dose in children the answer?

Recently, the state of California enacted a law requiring radiologists to record the radiation dose that each patient receives for a CT scan. Failure to do so is penalized by law. This law becomes effective in July 2012. By July 2013, every facility that performs CT scans must become accredited by one of three professional groups. This report discusses the role that legislation is playing in the practice of medicine in regard to CT practice. Inherent in this discussion is the assumption that pediatric radiologists know the right dose that a child should receive for a specific clinical indication. But do we really know the answer to this? Compared to the European radiology community, the United States radiology community lags in this regard. This paper defines diagnostic reference levels (DRL) and reviews the history of DRL in the United States compared to that in the European community and the progress by the American College of Radiology's National Radiology Data Registry (NRDR) to establish national registries. The establishment of the first pediatric Quality Improvement Registry in CT Scans in Children (QuIRCC) and its progress to date will be discussed.