Have you ever been sitting in a dentist’s chair looking up at an X-ray of your mouth and wondered how they can distinguish between so many shades of grey and determine that you have a small cavity forming? The answer, of course, is a lot of training and practice.
Now picture a medical professional responsible for identifying abnormalities in all parts of the human body by examining medical imaging that ranges from X-Rays, to ultrasounds, to fluoroscopy, to CT scans, to MRIs. It’s little wonder that radiologists require five years of closely-supervised study after completing medical school to be accredited as a specialist in diagnostic radiology.
Nevertheless, despite this extensive training, radiological errors are “uncomfortably common.” Research suggests the day-to-day rate of radiology errors is between three to five percent and targeted studies have found much higher rates.
With so many errors, you might anticipate radiologists would be subject to frequent medical malpractice lawsuits. But this is not necessarily the case. In this blog post I examine what radiological errors mean, outline the types of errors, and explain how these errors may impact medical malpractice cases.
“Error,” “Discrepancy,” or “Uncertainty”?
When speaking about radiological errors, it’s important to note that terms used can have a range of meanings, and the word “error” is itself contentious.
Generally, an error refers to an incorrect or inaccurate action or judgement. This definition would imply there is an objectively right or wrong answer with no room for disagreement. While some medical errors clearly fall into this category, within radiology (and other forms of diagnostic medicine) there can often be reasonable disagreement among experts when interpreting data based on available facts and context.
Writing in the journal Imaging Insights, radiologist Adrian P. Brady suggests the word “discrepancy” is more applicable in this situation. An interpretive radiological error, therefore, is considered to be “any discrepancy in interpretation that deviates substantially from a consensus of one’s peers.”
According to the National Academy of Medicine, “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient” is the appropriate definition for a “diagnostic error.” Any type of radiological error may contribute to a delayed or wrong diagnosis, as a “diagnosis is an iterative process that solidifies as more information becomes available.”
Types of Radiological Errors.
A variety of classification systems for radiological errors have been proposed over time, but the most commonly accepted in the field employs 12 types of errors identified by Young W. Kim and Liem T. Mansfield.
- False-positive/over-reading errors (identifying abnormalities when they are none)
- Faulty-reasoning errors (abnormalities identified are associated with a false clinical entity often due to cognitive biases)
- Lack of knowledge errors (an abnormality is noticed but incorrectly interpreted due to inadequate knowledge/experience)
- Under-reading errors (a detectable and undeniable abnormality goes unidentified)
- Communication errors (an abnormality is identified and accurately reported, but individual or systemic issues prevent the finding from being communicated effectively)
- Technique-related errors (low technical quality, inaccuracies during image acquisition, or the wrong technique or modality reduces or eliminates the probability of detecting a abnormality that is present)
- Prior examination-related errors (failure to consult and compare previous exams)
- History-related errors (the radiologist receives inadequate or incorrect information about a patient’s clinical history)
- Location-related errors (an abnormality is evident within examination limits but outside the purposefully examined area)
- Satisfaction of search (once one abnormality is identified, other potential findings are overlooked due to satisfaction of the assessment and loss of motivation)
- Complications (unanticipated occurrences during or after procedures or adverse events related to a procedure)
- Satisfaction of report (wrong assessments in earlier reports are repeated based on undue confidence in their accuracy)
Broadly, these errors can be categorized as:
- Technique or image acquisition errors (technical factors obscure/mimic pathology, inappropriate study, incomplete study)
- Perceptual errors (under-reading, satisfaction or search or report, history, location, image manipulation)
- Cognitive/interpretive errors (over-reading, faulty reasoning, lack of knowledge, complications, satisfaction of report)
- Communication errors
Common Radiological Errors, Negligence and Medical Malpractice.
Among the broad categories, perceptual errors appear to be most common by a wide margin. In Kim and Mansfield’s study, under-reading and satisfaction of search were the radiological errors encountered most frequently, at 42 percent and 22 percent of all errors, respectively. Faulty reasoning (nine per cent), location (seven percent), satisfaction of report (six percent) and failure to consult prior imaging (five percent) were other common errors.
While less common, cognitive/interpretative errors still account for a significant portion of radiological errors. Nevertheless, not all radiological errors are evidence of negligence.
For example, in one study leading sub-specialist radiologists were asked to interpret and then reinterpret a series of CT studies (including cases they had interpreted individually). Blind to patient outcomes, these specialists disagreed amongst themselves on almost one-third of the studies. Astoundingly, they also disagreed with their own initial interpretation more than a quarter of the time.
Michael A. Bruno, a professor of Radiology and Medicine at Penn State University College of Medicine, suggests this variation shouldn’t be taken as “proof that one or another radiologist has made an interpretive error; to the contrary, it merely illustrates the degree to which high levels of uncertainty and inherent variability in the process limits the conclusions of imaging tests.”
For a radiological error to be considered negligent, the action or interpretation would have to breach the standard of care expected of a radiologist of similar standing who is working within the same circumstances and has access to the same information. Even then, a radiological error due to negligence would only be actionable in a medical malpractice lawsuit if it caused harm to a patient and led to an adverse outcome that would not have occurred otherwise.
For example, if a radiologist clearly missed identifying an obvious cancerous growth on a scan that contributed to a misdiagnosis or delayed diagnosis, it would be evidence of negligence. But, if the cancerous growth was already inoperable at the time of the scan and/or the patient’s prognosis would have been poor even if it had been identified, a successful claim for damages would be unlikely.
What Makes a Strong Radiological Malpractice Case?
Circumstances vary greatly in every personal injury case, so if you or a loved one sustained a serious injury that you believe to be the result of medical negligence, it’s always worthwhile to contact us for a no cost, no obligation initial consultation.
In the course of our discussion, if we believe there is potential to make a successful claim on your behalf, usually we’ll ask you to obtain your medical records so that we can review them with medical experts.
For cases involving radiology, we might provide a radiologist with a series of images/scans (both normal and abnormal) of a particular area of the body without providing any patient details. If a radiologist identifies an abnormality in a patient’s scan without any accompanying information, it’s abundantly clear that an error occurred.
If nothing is identified or a radiologist identifies a potential problem, we might provide some additional information (the same information the treating radiologist had about the patient and their symptoms) to see if this context is critical to spotting an abnormality. In these instances, if our expert identifies something the treating radiologist did not, the question becomes whether missing the abnormality was due to reasonable uncertainty in interpreting the imaging itself or a clear failure on the part of the treating radiologist based on available information.
Finally, if our experts discover an abnormality, we ask them (or other medical experts) to help determine if this error directly resulted in significant harm and damages to the patient.
In one of our cases, a young university student was troubled with back pain and sent for an MRI by his doctor. A radiologist reported no abnormality after reviewing this scan. With pain persisting, a second MRI was ordered. A second MRI was done two months later with another radiologist reviewing this image and they too determined it was normal.
A year later, the young man returned to his doctor reporting worsening pain. A third MRI revealed a tumour impinging on his lower spine. The surgeon, who reviewed the third MRI went back to the previous images and identified that the tumour was present the year before.
Urgent surgery took place but because the tumour had been allowed to advance it became much more difficult to excise as nerves were impacted by this time. As a result of this missed diagnosis, the man now suffers from permanent erectile and bowel dysfunction.
In another case, a woman sustained a fractured wrist. Relying on the radiologist’s report, her family doctor told the patient that it was nothing to worry about. As a result, she continued normal activities and suffered permanent nerve damage as a result.
In both of these cases, general practitioners (who order radiological scans to rule out certain pathologies when making a diagnosis) did not review the images themselves, but rather relied on the radiologist’s reports. This situation is quite common as family doctors do not normally have access to these scans and/or the specialized skill necessary to conduct their own analysis. As a result, they are putting their trust (and the patient’s health) in the hands of a third party.
Help When You’re Hurt.
Radiologists are not held to a standard of perfection. But in some cases, a radiology error is clearly indefensible. And if that error caused you or a loved one great harm, you deserve fair compensation.
At Gluckstein Lawyers, our experienced medical malpractice lawyers have helped many people just like you obtain a sense of justice being done. With our commitment to full-circle client care, you can be sure we will treat you with great compassion and empathy as we tirelessly advocate on your behalf.
To learn more about your legal rights and options, contact us for an initial free consultation.