Why quality assurance?

Quality assurance programs in radiology are essential and each radiologist must be committed to exert comprehensive efforts toward excellent quality control. Identification and evaluation of a radiological problem, corrective action, and good record keeping are essential features of a well-managed quality assurance program. This paper discusses the background and impact of these programs on providing safe radiologic services to patients.

Medico-legal opinion: radiology and vicarious liability

Vicarious liability in Canadian law implies additional responsibilities which parallel the benefits of a partnership, and the benefits of employer--employee relationships. It promotes optimum patient care, together with avenues for loss distribution in situations where negligence occurs. Radiologists, as persons in charge, are expected to exercise due care and skill in maintaining the quality of care which patients receive during all phases of the professional relationship. They are expected to provide the patient with a reasonable standard of care and skill, irrespective of whether the radiologist chooses to deal with the patient directly, or through a partner or employee. This is the same common sense requirement which all of us expect when we contract with a builder or mechanic who employs others to do part of the work. It is not reasonable to expect a patient to entrust his or her health on any other basis.

Radiology and the law of negligence

Canadian law expects all persons to behave reasonably in all phases of their lives. An individual who behaves reasonably has nothing to fear from the courts. The determination of what constitutes reasonable behaviour in medicine involves a common-sense approach to the rights and responsibilities of medical and non-medical members of the community. Every day thousands of Canadians trust Canadian radiologists with their lives and livelihoods. That trust demand no less care than the courts ask for. The meeting of this standard requires constant attention. Where there is prudence, forethought, and a good patient-physician relationship, there should be few negligence suits.

The radiologist, the patient and Canadian law

A knowledge of basic medico-legal principles is necessary to the practice of medicine. The professional relationships with radiologists undertake with patients, employees, colleagues and hospitals are all founded on mutual consent and governed by a multitude of laws and regulations. The principal forms of legal proceedings which involve radiologists are criminal, civil and disciplinary actions. The discussion in this article is focused on the law relating to consent. The consent of the patient, which may be expressed or implied, is necessary in all phases of the doctor-patient reltionship. The amount of information which must be provided to allow a patient to give informed consent varies from case to case. It is affected by the risk and potential benefit of the procedure, the demand of the patient for information and many other factors. Obtaining informed consent not only helps protect the radiologist from legal action but also allows for a better doctor-patient relationship.

Quality Assurance in diagnostic radiology: an irreverent view of a sacred cow: annual oration in honor of Albert Soiland, M.D

The problem of federal regulation of radiologic practice is examined via an in-depth analysis of the Proposed Recommendations for Diagnostic Radiology Facility Quality Assurance Programs as published in the Federal Register by the Commissioner of Food and Drugs. It is shown that the need for such recommendations is not established, that the program proposed by the Commissioner is potentially burdensome for the radiologist, that it does not address the most significant causes of unnecessary patient irradiation, and that the benefits expected to derive from it are, in fact, negligible. This is not to denigrate the value of well-conceived quality assurance efforts, and measures are suggested that might more reasonably be expected to reduce the radiation exposure of the public. The radiologist is urged to 1) conduct his practice in as faultless a manner as possible; and 2) exercise his right to respond to proposals of the federal regulatory agencies.

Does the "missed" radiographic diagnosis constitute malpractice?

Recent studies confirm that radiologists disagree as often as 50% of the time and that as many as 30% of pathological findings are "missed." Legally, "simple" errors are not considered to constitute malpractice, but "negligent" errors are; yet there are no practical guidelines to help the courts or the medical profession distinguish between the two. A practical "standard of radiological practice" must be developed, possibly by the various radiological societies, so that the courts may more easily distinguish true negligence from "simple" errors. It is also suggested that review panels be organized to render a medical opinion as to whether or not they conform to standard radiological practice.

Visual assessment of total heart volume and specific chamber size from standard chest radiographs

Ten radiologists at three levels of training visually assessed total heart and individual chamber size in 95 adults of both sexes with well defined cardiac diagnoses. Overall accuracy was highest for total heart size (82.2% correct), followed by left ventricular size, left atrial size and right heart size 79.6%, 75.0%, and 72.8%, respectively. Right heart and left atrial enlargement had a statistically significant negative effect on visual assessment of other chambers (P less than .05). Attempts to subclassify left ventricular enlargement into hypertrophy and hypertrophy and dilatation groups proved unsuccessful. While 63% of the hypertrophy group was detected as abnormal, only 24.3% were correctly subclassified as hypertrophy. For the hypertrophy and dilatation group, the corresponding values were 82% and 70%, respectively. Oblique views were useful in assessing left ventricular size only when inexperienced observers were included in the group of evaluators (P less than .05). A statistically significant improvement in assessment of normal left ventricular size and overall left atrial size was noted with experience (P less than .01 and P less than .05, respectively).

Radiology for the people

The general population of developing nations has not received sufficient radiological diagnostic services. Surveys will pinpoint the areas of greatest need. The best course seems to be to provide many basic diagnostic units of simple design rather than only a few sophisticated centers. The role of the radiologist is to oversee physician-technician training, equipment design, and system development. Only with a well-planned, comprehensive approach can the benefits of modern radiology reach the greatest number of people.

Things are as they are, not as they should be

As more departments of oncology are established in the United States, some radiologists are voicing concern about the possible loss of identity and administrative freedom in these centers. A realistic assessment of this question must involve the advantages to the patient, the teaching potential to medical students, and the recruitment of bright students. Collaboration with other specialists need not result in the total loss of professional and administrative independence.