BILL NUMBER: AB 510	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 16, 2012
	AMENDED IN SENATE  MARCH 29, 2012
	AMENDED IN ASSEMBLY  JANUARY 13, 2012
	AMENDED IN ASSEMBLY  JANUARY 4, 2012
	AMENDED IN ASSEMBLY  MARCH 31, 2011

INTRODUCED BY   Assembly Member Bonnie Lowenthal

                        FEBRUARY 15, 2011

   An act to amend Sections 115111, 115112, and 115113 of the Health
and Safety Code, relating to public health  , and declaring the
urgency thereof, to take effect immediately  .


	LEGISLATIVE COUNSEL'S DIGEST


   AB 510, as amended, Bonnie Lowenthal. Radiation control: health
facilities and clinics: records.
   Under existing law, the State Department of Public Health licenses
and regulates health facilities and clinics, as defined. Under
existing law, the Radiation Control Law, the department licenses and
regulates persons that use devices or equipment utilizing radioactive
materials. Under existing law, the department is authorized to
require registration and inspection of sources of ionizing radiation,
as defined. Existing law, commencing July 1, 2012, requires that a
facility using a computed tomography (CT) X-ray system record the
dose of radiation on every CT study produced. Existing law requires
that the displayed dose of radiation be verified annually by a
medical physicist to ensure the accuracy of the displayed dose unless
the facility is accredited. Violations of these provisions are a
crime.
   This bill would require the facility to record the dose of
radiation on every diagnostic CT study and would exempt specified CT
studies from being required to record the dose. This bill would
delete the exemption for accredited facilities and would authorize a
facility with an accredited CT X-ray system to elect not to annually
verify the displayed dose of radiation, as specified. Because
accredited facilities could now be subject to these provisions, and
because a violation of these provisions is a crime, the bill would
impose a state-mandated local program by expanding the scope of a
crime. The bill also would require the dose to be verified for the
facility's standard adult brain, adult abdomen, and pediatric brain
protocols.
   Existing law, commencing July 1, 2013, requires facilities that
furnish CT X-ray services to be accredited by an approved
organization, as specified.
   This bill would eliminate the requirement that the facilities be
accredited and instead would require the CT X-ray systems to be
accredited by an approved organization, as specified.
   Existing law, commencing July 1, 2012, requires a facility to
report the discovery of certain information about an event in which
the administration of radiation results in prescribed occurrences,
including the CT X-ray irradiation of an area of the body other than
that intended, within 5 business days of the discovery of the event,
to the department and the patient's referring physician.
   This bill would require instead a facility to report a CT X-ray
irradiation examination that does not include the intended area of
the body if specified dose values are exceeded. This bill would
provide that reporting is not required if adjacent body parts are
irradiated during the same treatment, unless specified does values
are exceeded. This bill would require that these reports be made
within 5 business days of the discovery of a therapeutic event and
within 10 business days of the discovery of a CT event.
   The bill would also make technical and clarifying changes.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason. 
   This bill would declare that it is to take effect immediately as
an urgency statute. 
   Vote:  majority   2/3  . Appropriation:
no. Fiscal committee: yes. State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 115111 of the Health and Safety Code is amended
to read:
   115111.  (a) Commencing July 1, 2012, subject to subdivision (e),
a person that uses a computed tomography (CT) X-ray system for human
use shall record the dose of radiation on every diagnostic CT study
produced during a CT examination. CT studies used for therapeutic
radiation treatment planning or delivery shall not be required to
record the dose.
   (b) The facility conducting the study shall send electronically
each CT study and protocol page that lists the technical factors and
dose of radiation to the electronic picture archiving and
communications system.
   (c) (1) Until July 1, 2013, the displayed dose shall be verified
annually by a medical physicist for the facility's standard adult
brain, adult abdomen, and pediatric brain protocols, to ensure the
displayed doses are within 20 percent of the true measured dose
measured in accordance with subdivision (f).
   (2) A facility that has a CT X-ray system that is accredited by an
organization that is approved by the federal Centers for Medicare
and Medicaid Services, an accrediting agency approved by the Medical
Board of California, or the State Department of Public Health may
elect not to perform the verification described in paragraph (1).
   (d) Subject to subdivision (e), the radiology report of a CT study
shall include the dose of radiation by either recording the dose
within the patient's radiology report or attaching the protocol page
that includes the dose of radiation to the radiology report.
   (e) The requirements of this section shall be limited to CT
systems capable of calculating and displaying the dose.
   (f) For the purposes of this section, dose of radiation shall be
defined as one of the following:
   (1) The computed tomography index volume (CTDI vol) and dose
length product (DLP), as defined by the International
Electrotechnical Commission (IEC) and recognized by the federal Food
and Drug Administration (FDA).
   (2) The dose unit as recommended by the American Association of
Physicists in Medicine.
   (g) For purposes of this section, "CT X-ray system" means the same
as provided in Section 892.1750 of Title 21 of the Code of Federal
Regulations.
  SEC. 2.  Section 115112 of the Health and Safety Code is amended to
read:
   115112.  Commencing July 1, 2013, CT X-ray systems shall be
accredited by an organization that is approved by the federal Centers
for Medicare and Medicaid Services, an accrediting agency approved
by the Medical Board of California, or the State Department of Public
Health.
  SEC. 3.  Section 115113 of the Health and Safety Code is amended to
read:
   115113.  (a) Except for an event that results from patient
movement or interference, a facility shall report to the department
an event in which the administration of radiation results in any of
the following:
   (1) Repeating of a CT examination, unless otherwise ordered by a
physician or a radiologist, if one of the following dose values are
exceeded:
   (A) 0.05 Sv (5 rem) effective dose.
   (B) 0.5 Sv (50 rem) to an organ or tissue.
   (C) 0.5 Sv (50 rem) shallow dose to the skin.
   (2) A CT X-ray irradiation examination that does not include the
intended area of the body by the ordering physician or a radiologist
if one of the following dose values are exceeded:
   (A) 0.05 Sv (5 rem) effective dose.
   (B) 0.5 Sv (50 rem) to an organ or tissue.
   (C) 0.5 Sv (50 rem) shallow dose to the skin.
   (3) CT or therapeutic exposure that results in unanticipated
permanent functional damage to an organ or a physiological system,
hair loss, or erythema, as determined by a qualified physician.
   (4) A CT or therapeutic dose to an embryo or fetus that is greater
than 50 mSv (5 rem) dose, that is a result of radiation to a known
pregnant individual unless the dose to the embryo or fetus was
specifically approved, in advance, by a qualified physician.
   (5) Therapeutic ionizing irradiation of the wrong individual or
the wrong treatment site. Reporting is not required if adjacent body
parts are irradiated during the same treatment, unless they exceed
the values in paragraph (6) of this subdivision.
   (6) The total dose from therapeutic ionizing radiation delivered
differs from the prescribed dose by 20 percent or more. A report
shall not be required pursuant to this paragraph in any instance
where the dose administered exceeds 20 percent of the amount
prescribed in a situation where the radiation was utilized for
palliative care for the specific patient. The radiation oncologist
shall notify the referring physician that the dose was exceeded.
   (b) The facility shall, no later than five business days after the
discovery of a therapeutic event described in paragraphs (3) to (6),
inclusive, of subdivision (a) and no later than 10 business days
after discovery of an event described in paragraphs (1) to (4),
inclusive, of subdivision (a), provide notification of the event to
the department and the referring physician of the person subject to
the event and shall, no later than 15 business days after discovery
of an event described in subdivision  (a)   (a),
 provide written notification to the person who is subject to
the event.
   (c) This section shall become inoperative on the effective date of
the act that added this subdivision, and shall remain inoperative
until July 1, 2012.
  SEC. 4.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
   SEC. 5.    This act is an urgency statute necessary
for the immediate preservation of the public peace, health, or safety
within the meaning of Article IV of the Constitution and shall go
into immediate effect. The facts constituting the necessity are:
 
   In order to protect the health and safety of Californians and
ensure that these facilities fully comply with the reporting
requirements that go into effect on July 1, 2012, it is necessary for
this act to take effect immediately.