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When is a radiographic error simply an error and when is it malpractice?

Victor Lewin - Monday, October 16, 2017

Approximately 4% of radiographic interpretations rendered by radiologists in their daily practice contain errors.[1] Most of these errors however are either minor, or if serious, are found and corrected with sufficient timeliness that any potential harm to the patient is avoided. Nonetheless, radiological errors do harm patients, as treating physicians who’ve ordered the diagnostic testing rely on the radiological interpretation for diagnosis and treatment planning.

A plaintiff is required to prove four things in order for a radiologist (or any physician) to be found liable in medical negligence:

  1. a physician-patient relationship;
  2. the radiologist must have breached the standard of care (i.e. committed a negligent act);
  3. the negligent act must have caused injury to the plaintiff-patient; and
  4. the patient must have sustained an injury/damages as a result.

In malpractice cases, issues two and three are the most contentious and difficult to prove.

Nearly 75% of all medical malpractice lawsuits pursued against diagnostic radiologists claim negligence related to errors in diagnosis. Though certain radiographic errors result from a radiologists’ negligent conduct, others are simply a reality of the unavoidable “human factor” at play in the review of films and diagnostic images. Errors in perception by radiologists’ review of images occur in the absence of negligence, and some abnormalities will inevitably be missed.

Negligence occurs when the degree of error exceeds the acceptable norm; not merely when there is an error. Perfection is not the standard of care of any physician, including radiologists.

The focus of attention in medical malpractice cases involving radiological negligence should thus be on issues such as proof of competence, habits of practice (such as interpretation of images in a rushed and hurried manner), proper reporting, requests for more imaging if images are insufficiently clear to provide a diagnosis or exclude one, and the use of proper techniques.   

In cases alleging missed radiologic diagnosis, the question is not only whether the radiologist missed an abnormal finding. Rather, the issue is whether missing the abnormal finding is acceptable within the usual and customary standards of the radiology community. This determination, by judge and jury alike, is far from simple, and will be informed by testimony from various medical witnesses from both the plaintiff and defendant.

While the distinction between human error and negligence in radiologic medical malpractice cases remains elusive, the miss of an abnormal finding that can be seen retrospectively on radiographs - particularly where that miss has grave consequences on the plaintiff-patient - makes a persuasive case for a jury to find a radiologist, who is supposed to be highly-trained and is well-paid to detect all abnormalities, negligent.

[1] Borgstede JP et al “RADPEER quality assurance program: a multifacility study of interpretive disagreement rates” J Am Coll Radiol 2004;1, 212-217

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