According to a study in the May 28 issue of the Journal of the American College of Radiology, oncologic imaging makes up 44 percent of malpractice cases in the field. These cases aren’t often about CT or MRI parts failure or malfunction—they are about allegations of diagnostic failure. Miscalculations cause harm to patients, and the article’s writers noted that diagnostic errors are on the rise.
The researchers examined data from the Comparative Benchmarking System of the Controlled Risk Insurance Company to confirm this observation. This database contains information on approximately 30 percent of medical malpractice claims in the U.S. The researchers looked at records from 2008 to 2017 and categorized claims by imaging modality. They also indicated if the claims were oncologic, non-oncologic, diagnostic, and non-diagnostic.
According to the investigators, diagnostic errors in oncology are likely to be more high-impact than for other conditions. They also reported that imaging misrepresentation was an issue in 80.7 percent of diagnostic allegations related to oncologic radiology. They also noted that of the total cases of oncologic radiology, 97.4 percent had diagnostic allegations, and 55 percent of the non-oncologic cases did. Below is a table summarizing their findings.
| Modality | All cases | Non-oncologic cases | Oncologic cases |
| CT | 28% | 33.4% | 21.9% |
| Mammography | 19.1% | 0.5% | 40.3% |
| MRI | 13.1% | 14.6% | 11.4% |
| Ultrasound | 13.7% | 14.7% | 12.5% |
| X-ray | 26.1% | 36.8% | 13.9% |
Mitigating diagnostic errors in cancer imaging is possible, according to the researchers. Some solutions include using teleradiology for centralizing interpretation, establishing networks of specialists for second opinions, and using artificial intelligence tools in practice, among others.
Preventing Errors in Radiology
Building better systems that improve learning and safety is the way to prevent medical errors. According to the U.S. Office of the Inspector General, some factors that contribute to diagnostic errors are time constraints, lack of staff training on what constitutes “harm,” lack of knowledge on what needs reporting, and belief that another person will do the reporting. It’s also necessary to accept that radiologists, even good ones, can make mistakes.
Many factors contribute to human error, including case complexity, caseload, the need for rapid reporting, and fatigue. Obtaining better imaging systems also helps, and implementing better tools does not have to equate with purchasing expensive machines. You can get high-quality CT and MRI parts secondhand from trustworthy dealers. Also, the use of something as simple as a checklist can prevent human error. According to the World Health Organization, using the WHO Surgical Safety Checklist would prevent half a million deaths annually. Incorporating diagnostic checklists would benefit radiologists, especially during complex or risky studies.
Introducing redundancy in interpreting error-prone examinations also helps. Radiologists can incorporate CAD or computer-aided detection software for some examinations like mammography or prostate MRI. CAD uses pattern recognition algorithms to tag areas with possible malignancy for closer inspection. Radiologists could also use real-time concurrence reviews of highly complex studies. However, “double-reading” of high-risk studies like mammography needs structured support, and it can be costly, and a difference in opinion could lead to more questions than answers.
Conclusion
Radiology is one of the most technology-dependent specialties in medicine. A facility can implement changes through system-level improvements like introducing better tools, diagnostic checklists, and automated critical results reporting, among others. These improvements can reduce radiologists’ error rate, foster a culture of learning, and improve patient outcomes.
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