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Seely JM, Payant L, Zhang C, Aslanova R, Chothia S, MacIntyre A, Trop I, Yang Q, Garber G, Patlas M. Medico-Legal Cases in Breast Imaging in Canada: A Trend Analysis. Can Assoc Radiol J 2024; 75:369-376. [PMID: 37542396 DOI: 10.1177/08465371231193366] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023] Open
Abstract
Purpose: Breast imaging accounts for a large proportion of medico-legal cases involving radiologists in several countries and may be a disincentive to breast imaging. As this has not been well studied in Canada, we evaluated the key medico-legal issues of breast imaging in Canada and their implications for health care providers and patient safety. Methods: In collaboration with Canadian Medical Protective Association (CMPA), we obtained information from the medico-legal repository, including civil-legal, medical regulatory authority (College) and hospital complaints occurring between 2002-2021. Canadian Classification of Health Interventions (CCI) codes were used for breast imaging and biopsy. Trend analysis was done comparing cases involving breast imaging/biopsy to all cases where a radiologist was named. Results: Radiologists were named in 3108 medico-legal cases, 188 (6%, 188/3108) of which were CCI coded for breast imaging or biopsy. Factors related to radiologists were most frequent (64%, 120/188), followed by team (23.4%, 44/188) and system (6.9%, 13/188). Equal representation of male and female radiologists was found (IRR = 1.22; 95% CI: .89, 1.56). In a 10-year test window from 2006 - 2015 we identified an increasing trend for all cases involving radiologists (P = 0,0128) but a decreasing trend for cases coded with breast imaging or biopsy (P = 0,0099). Conclusions: A significant decrease in cases involving breast imaging were found from 2006-2015, accounting for 6% of the medico-legal cases. The lower risk of breast imaging medico-legal issues may encourage more radiologists in breast imaging.
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Affiliation(s)
- Jean M Seely
- Division of Breast Imaging, Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Laura Payant
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Cathy Zhang
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Rana Aslanova
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Sharon Chothia
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Anna MacIntyre
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Isabelle Trop
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Qian Yang
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Gary Garber
- Department of Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Patlas
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Huhtanen JT, Nyman M, Sequeiros RB, Koskinen SK, Pudas TK, Kajander S, Niemi P, Löyttyniemi E, Aronen HJ, Hirvonen J. Discrepancies between Radiology Specialists and Residents in Fracture Detection from Musculoskeletal Radiographs. Diagnostics (Basel) 2023; 13:3207. [PMID: 37892028 PMCID: PMC10605667 DOI: 10.3390/diagnostics13203207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: The aim of this study was to compare the competence in appendicular trauma radiograph image interpretation between radiology specialists and residents. (2) Methods: In this multicenter retrospective cohort study, we collected radiology reports from radiology specialists (N = 506) and residents (N = 500) during 2018-2021. As a reference standard, we used the consensus of two subspecialty-level musculoskeletal (MSK) radiologists, who reviewed all original reports. (3) Results: A total of 1006 radiograph reports were reviewed by the two subspecialty-level MSK radiologists. Out of the 1006 radiographs, 41% were abnormal. In total, 67 radiographic findings were missed (6.7%) and 31 findings were overcalled (3.1%) in the original reports. Sensitivity, specificity, positive predictive value, and negative predictive value were 0.86, 0.92, 0.91 and 0.88 respectively. There were no statistically significant differences between radiology specialists' and residents' competence in interpretation (p = 0.44). However, radiology specialists reported more subtle cases than residents did (p = 0.04). There were no statistically significant differences between errors made in the morning, evening, or night shifts (p = 0.57). (4) Conclusions: This study found a lack of major discrepancies between radiology specialists and residents in radiograph interpretation, although there were differences between MSK regions and in subtle or obvious radiographic findings. In addition, missed findings found in this study often affected patient treatment. Finally, there are MSK regions where the sensitivity or specificity is below 90%, and these should raise concerns and highlight the need for double reading and should be taken into consideration in radiology education.
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Affiliation(s)
- Jarno T. Huhtanen
- Faculty of Health and Well-Being, Turku University of Applied Sciences, 20520 Turku, Finland
- Department of Radiology, University of Turku, 20014 Turku, Finland; (S.K.); (P.N.)
| | - Mikko Nyman
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland; (M.N.); (R.B.S.); (H.J.A.); (J.H.)
| | - Roberto Blanco Sequeiros
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland; (M.N.); (R.B.S.); (H.J.A.); (J.H.)
| | - Seppo K. Koskinen
- Terveystalo Inc., Jaakonkatu 3, 00100 Helsinki, Finland; (S.K.K.); (T.K.P.)
| | - Tomi K. Pudas
- Terveystalo Inc., Jaakonkatu 3, 00100 Helsinki, Finland; (S.K.K.); (T.K.P.)
| | - Sami Kajander
- Department of Radiology, University of Turku, 20014 Turku, Finland; (S.K.); (P.N.)
| | - Pekka Niemi
- Department of Radiology, University of Turku, 20014 Turku, Finland; (S.K.); (P.N.)
| | | | - Hannu J. Aronen
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland; (M.N.); (R.B.S.); (H.J.A.); (J.H.)
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland; (M.N.); (R.B.S.); (H.J.A.); (J.H.)
- Department of Radiology, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, 33100 Tampere, Finland
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York T, Franklin C, Reynolds K, Munro G, Jenney H, Harland W, Leong D. Reporting errors in plain radiographs for lower limb trauma-a systematic review and meta-analysis. Skeletal Radiol 2022; 51:171-182. [PMID: 34143230 PMCID: PMC8626392 DOI: 10.1007/s00256-021-03821-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Plain radiographs are a globally ubiquitous means of investigation for injuries to the musculoskeletal system. Despite this, initial interpretation remains a challenge and inaccuracies give rise to adverse sequelae for patients and healthcare providers alike. This study sought to address the limited, existing meta-analytic research on the initial reporting of radiographs for skeletal trauma, with specific regard to diagnostic accuracy of the most commonly injured region of the appendicular skeleton, the lower limb. METHOD A prospectively registered, systematic review and meta-analysis was performed using published research from the major clinical-science databases. Studies identified as appropriate for inclusion underwent methodological quality and risk of bias analysis. Meta-analysis was then performed to establish summary rates for specificity and sensitivity of diagnostic accuracy, including covariates by anatomical site, using HSROC and bivariate models. RESULTS A total of 3887 articles were screened, with 10 identified as suitable for analysis based on the eligibility criteria. Sensitivity and specificity across the studies were 93.5% and 89.7% respectively. Compared with other anatomical subdivisions, interpretation of ankle radiographs yielded the highest sensitivity and specificity, with values of 98.1% and 94.6% respectively, and a diagnostic odds ratio of 929.97. CONCLUSION Interpretation of lower limb skeletal radiographs operates at a reasonably high degree of sensitivity and specificity. However, one in twenty true positives is missed on initial radiographic interpretation and safety netting systems need to be established to address this. Virtual fracture clinic reviews and teleradiology services in conjunction with novel technology will likely be crucial in these circumstances.
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Affiliation(s)
- Thomas York
- grid.425213.3Guys and St Thomas’ NHS Trust, St Thomas’ Hospital, London, UK
| | - Christopher Franklin
- grid.451052.70000 0004 0581 2008London Northwest University Healthcare NHS Trust, London, UK
| | - Kate Reynolds
- grid.451052.70000 0004 0581 2008London Northwest University Healthcare NHS Trust, London, UK
| | - Greg Munro
- grid.451052.70000 0004 0581 2008London Northwest University Healthcare NHS Trust, London, UK
| | - Heloise Jenney
- grid.451052.70000 0004 0581 2008London Northwest University Healthcare NHS Trust, London, UK
| | - William Harland
- grid.451052.70000 0004 0581 2008London Northwest University Healthcare NHS Trust, London, UK
| | - Darren Leong
- grid.451052.70000 0004 0581 2008London Northwest University Healthcare NHS Trust, London, UK
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Tarkiainen T, Turpeinen M, Haapea M, Liukkonen E, Niinimäki J. Investigating errors in medical imaging: medical malpractice cases in Finland. Insights Imaging 2021; 12:86. [PMID: 34184113 PMCID: PMC8238384 DOI: 10.1186/s13244-021-01011-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/06/2021] [Indexed: 12/01/2022] Open
Abstract
Objective The objectives of the study were to survey patient injury claims concerning medical imaging in Finland in 1991–2017, and to investigate the nature of the incidents, the number of claims, the reasons for the claims, and the decisions made concerning the claims. Materials and methods The research material consisted of patient claims concerning imaging, sent to the Finnish Patient Insurance Centre (PVK). The data contained information on injury dates, the examination code, the decision code, the description of the injury, and the medical grounds for decisions. Results The number of claims included in the study was 1054, and the average number per year was 87. The most common cause was delayed diagnosis (404 claims, 38.3%). Most of the claims concerned mammography (314, 29.8%), radiography (170, 16.1%), and MRI (162, 15.4%). According to the decisions made by the PVK, there were no delays in 54.6% of the examinations for which claims were made. About 30% of all patient claims received compensation, the most typical reason being medical malpractice (27.7%), followed by excessive injuries and injuries caused by infections, accidents and equipment (2.7%). Conclusion Patient injury in imaging examinations and interventions cannot be completely prevented. However, injury data are an important source of information for health care. By analysing claims, we can prevent harm, increase the quality of care, and improve patient safety in medical imaging.
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Affiliation(s)
- Tarja Tarkiainen
- Department of Diagnostic Radiology, Research Unit of Medical Imaging, Physics and Technology, Oulu University Hospital, Oulu, Finland.
| | - Miia Turpeinen
- Administrative Centre, Research Unit of Biomedicine, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Esa Liukkonen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology, Research Unit of Medical Imaging, Physics and Technology, Oulu University Hospital and University of Oulu, Oulu, Finland
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5
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Kwee RM, Kwee TC. Medical disciplinary jurisprudence in alleged malpractice in radiology: 10-year Dutch experience. Eur Radiol 2020; 30:3507-3515. [PMID: 32064563 PMCID: PMC7248030 DOI: 10.1007/s00330-020-06685-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/28/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE To systematically investigate the frequency and types of allegations related to radiology practice handled by the Dutch Medical Disciplinary Court in the past 10 years. METHODS The Dutch Medical Disciplinary Court database was searched for verdicts concerning radiology practice between 2010 and 2019. The association between the number of verdicts and time (years) was assessed by Spearman's rho. Other data were summarized using descriptive statistics. RESULTS There were 48 verdicts (mean 4.8 per year). There was no significant association between the number of verdicts and time (Spearman's rho < 0.001, p = 0.99). Most allegations were in breast imaging and musculoskeletal radiology (each 18.8%), followed by interventional radiology, head and neck imaging, and abdominal imaging (each 12.5%), neuroradiology and vascular imaging (each 10.4%), and chest imaging (4.2%). There were 46 allegations against radiologists (95.8%) and 2 against residents (4.2%). The most common allegation (37.5%) was error in diagnosis. In 20.8% of verdicts, the allegation was judged (partially) founded; disciplinary measures were warnings (n = 8) and reprimands (n = 2). An appeal was submitted by the patient in 11 cases and by the radiologist in 3 cases. All appeals by patients were rejected, whereas 2 of the 3 appeals by radiologists were granted and previously imposed disciplinary measures were reversed. CONCLUSION Allegations against radiologists at the Dutch Medical Disciplinary Court are relatively few, their number has remained stable over the past 10 years, and a minority were judged to be (partially) founded. We can learn from the cases presented in this article, which may improve patient care. KEY POINTS • The frequency of allegations against radiologists at the Dutch Medical Disciplinary Court is relatively low and has not exhibited any temporal change over the past 10 years. • These allegations reflect patient dissatisfaction, but this infrequently equals malpractice. • Knowledge of the circumstances under which these allegations have arisen may improve patient care.
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Affiliation(s)
- Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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6
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Zukotynski KA, Niederkohr RD, Greenspan BS, Prior JO, Schöder H, Seltzer MA, Rohren EM, Yoo DC. An International Survey of PET/CT Clinical Reporting. J Nucl Med 2019; 60:478-479. [PMID: 30877176 DOI: 10.2967/jnumed.118.223073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/11/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Ryan D Niederkohr
- Department of Nuclear Medicine, Kaiser Permanente Medical Center, Santa Clara, California
| | | | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A Seltzer
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Eric M Rohren
- Department of Radiology, Baylor College of Medicine, Houston, Texas; and
| | - Don C Yoo
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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7
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Hulson O. Litigation claims in relation to radiology: what can we learn? Clin Radiol 2018; 73:893-901. [DOI: 10.1016/j.crad.2018.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/24/2018] [Indexed: 12/22/2022]
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8
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Fitzgerald T. Commentary on: Non-interpretive radiology: an Irish perspective. Clin Radiol 2018; 73:499-500. [DOI: 10.1016/j.crad.2017.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/15/2017] [Indexed: 10/17/2022]
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9
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Structured Reporting in Radiology. Acad Radiol 2018; 25:66-73. [PMID: 29030284 DOI: 10.1016/j.acra.2017.08.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 11/20/2022]
Abstract
Radiology reports are vital for patient care as referring physicians depend upon them for deciding appropriate patient management. Traditional narrative reports are associated with excessive variability in the language, length, and style, which can minimize report clarity and make it difficult for referring clinicians to identify key information needed for patient care. Structured reporting has been advocated as a potential solution for improving the quality of radiology reports. The Association of University Radiologists-Radiology Research Alliance Structured Reporting Task Force convened to explore the current and future role of structured reporting in radiology and summarized its finding in this article. We review the advantages and disadvantages of structured radiology reports and discuss the current prevailing sentiments among radiologists regarding structured reports. We also discuss the obstacles to the use of structured reports and highlight ways to overcome some of those challenges. We also discuss the future directions in radiology reporting in the era of personalized medicine.
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10
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Moores BM. A REVIEW OF THE FUNDAMENTAL PRINCIPLES OF RADIATION PROTECTION WHEN APPLIED TO THE PATIENT IN DIAGNOSTIC RADIOLOGY. RADIATION PROTECTION DOSIMETRY 2017; 175:1-9. [PMID: 27614298 DOI: 10.1093/rpd/ncw259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Abstract
A review of the role and relevance of the principles of radiation protection of the patient in diagnostic radiology as specified by ICRP has been undertaken when diagnostic risks arising from an examination are taken into account. The increase in population doses arising from diagnostic radiology over the past 20 years has been due to the widespread application of higher dose CT examinations that provide significantly more clinical information. Consequently, diagnostic risks as well as radiation risks need to be considered within the patient radiation protection framework. Justification and optimisation are discussed and the limitations imposed on patient protection by employing only a radiation risk framework is highlighted. The example of radiation protection of the patient in breast screening programmes employing mammography is used to highlight the importance of defined diagnostic outcomes in any effective radiation protection strategy.
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Affiliation(s)
- B Michael Moores
- Integrated Radiological Services Ltd., Unit 188, Century Building, Brunswick Business Park, Liverpool, UK
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11
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Igra MS, Connolly DJA. Virtual special issue - neuroradiology. Clin Radiol 2016; 71:1223-1225. [PMID: 27726851 DOI: 10.1016/j.crad.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
Affiliation(s)
- M S Igra
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.
| | - D J A Connolly
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
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12
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Pow RE, Mello-Thoms C, Brennan P. Evaluation of the effect of double reporting on test accuracy in screening and diagnostic imaging studies: A review of the evidence. J Med Imaging Radiat Oncol 2016; 60:306-14. [DOI: 10.1111/1754-9485.12450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/26/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Richard E Pow
- Medical Radiation Sciences; Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
| | - Claudia Mello-Thoms
- Medical Radiation Sciences; Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
| | - Patrick Brennan
- Medical Radiation Sciences; Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
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Craciun H, Mankad K, Lynch J. Risk management in radiology departments. World J Radiol 2015; 7:134-138. [PMID: 26120383 PMCID: PMC4473307 DOI: 10.4329/wjr.v7.i6.134] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/01/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Medical imaging and interventional radiology sustained prompt changes in the last few years, mainly as a result of technology breakthroughs, rise in workload, deficit in workforce and globalization. Risk is considered to be the chance or possibility of incurring loss or of a negative event happening that may cause injury to patients or medical practitioners. There are various causes of risks leading to harm and injury in radiology departments, and it is one of the objectives of this paper to scrutinize some of the causes. This will drive to consideration of some of the approaches that are used in managing risks in radiology. This paper aims at investigating risk management in radiology, and this will be achieved through a thorough assessment of the risk control measures that are used in the radiology department. It has been observed that the major focus of risk management in such medical setting is to reduce and eliminate harm and injury to patients through integration of various medical precautions. The field of Radiology is rapidly evolving due to technology advances and the globalization of healthcare. This ongoing development will have a great impact on the level of quality of care and service delivery. Thus, risk management in radiology is essential in protecting the patients, radiologists, and the medical organization in terms of capital and widening of the reputation of the medical organization with the patients.
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Errors and malpractice lawsuits in radiology: what the radiologist needs to know. Radiol Med 2015; 120:779-84. [PMID: 26116141 DOI: 10.1007/s11547-015-0561-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 06/15/2015] [Indexed: 12/17/2022]
Abstract
All medical specialties dealing with patients include an intrinsic risk in exposing them to issues resulting from human errors. Radiology is not spared from this risk since it includes "decision-making under conditions of uncertainty." In medical imaging, the line between the word "error" and misdiagnosis or discrepancy is very difficult to demarcate, mainly because the diagnostic process is not a binary relation and it is not always possible to establish if a pathological condition is present or not. The error in radiology is strongly related to the diagnostic process; hence, it can be defined as a "diagnostic error" which represents the most common cause of medical malpractice suits against radiologists. In this paper, the authors described the features of errors occurring in radiology, trying to establish their impact and prevalence. Secondly, some data coming from different countries were compared in order to highlight the most frequent causes leading to malpractice lawsuits in radiology and how the phenomenon of malpractice in this field is represented worldwide.
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Goergen S, Schultz T, Deakin A, Runciman W. Investigating Errors in Medical Imaging: Lessons for Practice From Medicolegal Closed Claims. J Am Coll Radiol 2015; 12:988-97. [PMID: 26088122 DOI: 10.1016/j.jacr.2015.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/13/2015] [Accepted: 03/17/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE Radiology has lagged behind other disciplines in using medicolegal data to improve patient safety. The aim of this study was to characterize a sample of closed claims files to inform radiology practice and identify opportunities for system change. METHODS A retrospective analysis of 443 medicolegal closed claims provided to the Radiology Events Register. Data were provided by 2 medical defense organizations that provide medical indemnity insurance to Australian private practitioners. We calculated a procedural risk ratio (prevalence in the closed claims dataset divided by prevalence among all diagnostic imaging procedures reimbursed by the Australian Government over the corresponding timeframe) for each modality (CT, ultrasound, radiography, MRI, nuclear medicine) and some procedures. For each closed claim, the incident type was determined, and a classification of 12 patient safety fields was conducted. RESULTS Misdiagnosis (delay or failure to correctly read imaging) accounted for 62% of error types. Modalities and procedures at higher risk of leading to a claim were: mammography (risk ratio [RR] = 4.0, 95% CI 2.9-5.5); breast ultrasound (RR = 2.8, 95% CI 1.7-4.7); total MRI (RR = 3.4, 95% CI 2.0-5.6); total CT (RR = 1.9, 95% CI 1.5-2.5), and obstetrics and gynecology ultrasound (RR = 1.9, 95% CI 1.4-2.4). Lower-risk modalities and procedures were: cardiac ultrasound (RR = 0.1, 95% CI 0.0-0.8); radiography extremities (RR = 0.7, 95% CI 0.5-0.9); and total radiography (RR = 0.8, 95% CI 0.7-0.9). Information to inform patient safety classification was limited, with a mean of 5.8 ± 1.8 (SD) fields available. CONCLUSIONS Despite its limitations, medicolegal data deserve further attention from patient safety analysts.
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Affiliation(s)
- Stacy Goergen
- Monash University, Southern Clinical School, Clayton, Victoria, Australia; Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - Tim Schultz
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia; School of Psychology, Social Work and Social Policy, University of South Australia. Adelaide, South Australia, Australia.
| | - Anita Deakin
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - William Runciman
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia; School of Psychology, Social Work and Social Policy, University of South Australia. Adelaide, South Australia, Australia
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16
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Zangari F. Riflessioni medico-legali sulla responsabilità del radiologo e dell’odontoiatra in caso di contenzioso. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)70272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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18
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Malpractice claims related to musculoskeletal imaging. Incidence and anatomical location of lesions. Radiol Med 2013; 118:1388-96. [PMID: 23801400 DOI: 10.1007/s11547-013-0953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 04/04/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE Failure to detect lesions of the musculoskeletal system is a frequent cause of malpractice claims against radiologists. MATERIALS AND METHODS We examined all the malpractice claims related to alleged errors in musculoskeletal imaging filed against Italian radiologists over a period of 14 years (1993-2006). RESULTS During the period considered, a total of 416 claims for alleged diagnostic errors relating to the musculoskeletal system were filed against radiologists; of these, 389 (93.5%) concerned failure to report fractures, and 15 (3.6%) failure to diagnose a tumour. CONCLUSIONS Incorrect interpretation of bone pathology is among the most common causes of litigation against radiologists; alone, it accounts for 36.4% of all malpractice claims filed during the observation period. Awareness of this risk should encourage extreme caution and diligence.
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Niederkohr RD, Greenspan BS, Prior JO, Schöder H, Seltzer MA, Zukotynski KA, Rohren EM. Reporting guidance for oncologic 18F-FDG PET/CT imaging. J Nucl Med 2013; 54:756-61. [PMID: 23575994 DOI: 10.2967/jnumed.112.112177] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The written report (or its electronic counterpart) is the primary mode of communication between the physician interpreting an imaging study and the referring physician. The content of this report not only influences patient management and clinical outcomes but also serves as legal documentation of services provided and can be used to justify medical necessity, billing accuracy, and regulatory compliance. Generating a high-quality PET/CT report is perhaps more challenging than generating a report for other imaging studies because of the complexity of this hybrid imaging modality. This article discusses the essential elements of a concise and complete oncologic (18)F-FDG PET/CT report and illustrates these elements through examples taken from routine clinical practice.
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Affiliation(s)
- Ryan D Niederkohr
- Department of Nuclear Medicine, Kaiser Permanente Medical Center, Santa Clara, CA, USA.
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Cannavale A, Santoni M, Mancarella P, Passariello R, Arbarello P. Malpractice in radiology: what should you worry about? Radiol Res Pract 2013; 2013:219259. [PMID: 23691316 PMCID: PMC3649698 DOI: 10.1155/2013/219259] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/14/2013] [Accepted: 03/15/2013] [Indexed: 12/26/2022] Open
Abstract
Over recent years the professional role of the radiologist has been evolved due to the increasing involvement in the clinical management of the patient. Radiologists have thus been increasingly charged by new duties and liabilities, exposing them to higher risks of legal claims made against them. Malpractice lawsuits in radiology are commonly related to inappropriate medical care or to the poor physician-patient relationship. In the present paper, we provide overview of the basic principles of the medical malpractice law and the main legal issues and causes of legal actions against diagnostic and interventional radiologists. We also address some issues to help radiologists to reduce risks and consequences of malpractice lawsuits. These include (1) following the standard of care to the best of their ability, (2) cautious use of off-label devices, (3) better communication skills among healthcare workers and with the patient, and (4) ensuring being covered by adequate malpractice insurance. Lastly, we described definitions of some medicolegal terms and concepts that are thought to be useful for radiologists to know.
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Affiliation(s)
- Alessandro Cannavale
- Department of Radiological Sciences, “Sapienza” University of Rome, 324 Viale Regina Elena, 00161 Rome, Italy
| | - Mariangela Santoni
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, “Sapienza” University of Rome, 336 Viale Regina Elena, 00161 Rome, Italy
| | - Paola Mancarella
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, “Sapienza” University of Rome, 336 Viale Regina Elena, 00161 Rome, Italy
| | - Roberto Passariello
- Department of Radiological Sciences, “Sapienza” University of Rome, 324 Viale Regina Elena, 00161 Rome, Italy
| | - Paolo Arbarello
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, “Sapienza” University of Rome, 336 Viale Regina Elena, 00161 Rome, Italy
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21
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Brown NI, Josey LB. Risky radiology: not so black and white. Med J Aust 2011; 194:428-9. [DOI: 10.5694/j.1326-5377.2011.tb03045.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 03/20/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Nicholas I Brown
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, QLD
| | - Lawrence B Josey
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, QLD
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Jones DN, Benveniste KA, Schultz TJ, Mandel CJ, Runciman WB. Establishing National Medical Imaging Incident Reporting Systems: Issues and Challenges. J Am Coll Radiol 2010; 7:582-92. [DOI: 10.1016/j.jacr.2010.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 03/17/2010] [Indexed: 10/19/2022]
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