Facts about Malpractice in Radiology
"I would give great praise to the physician whose mistakes are small, for perfect accuracy is seldom to be seen. Hippocrates, On Ancient Medicine, IX (tr. By Francis Adams)"
Facts and Commentary by Dr MGK Murthy
1."Errors" "Wrongs" "faults"in Radiology, as perceived is a result of skewed assumption that Perfection is possible , propagated by public ,media, and ironically by some clinicians themselves.
2. Radiologist usually makes decisions under conditions of uncertainty(Titrating the data available)
3. Radiological answers to a question are often not binary(Normal/Abnormal) (Cancer/ No cancer) / (yes/No) etc
4. Erros in Radiology should be better labelled as discrepancy (Opinion is defined as conclusion arrived at , after some weightages of evidence, by an expert, but is subject to debate or suggestion)
5.Unlike physical examination/ endoscopy/ Surgery, Radiology picture is a permanent record and is subject to retrospective debates / opinions (71% lung cancer nodules on screening radiograph were actually identified on previous X rays , reported as normal for an example, 30% of visible findings on Barium enema were actually missed .)
6.An average inter observer difference of 10-20% cases in all modalities was observed by a large study in USA
7. A retrospective study in 2001 (of 20 years data) concluded an average error rate of 2-20% across all modalities . This compares favourably with a Mayo clinic study in year2000, finding clinical diagnosis was missed on average of 26% when compared to Autopsy findings
8. Availability of relevant clinical data showed a significant decrease in error rates (23% missed findings in the absence of data , while compared to only20% when data was made available amongst the experienced faculty for chest X-rays )
9. Prolonged attention to a particular area (called Visual Dwell) (study done on X-rays) has produced increase in both false positives and negatives
10. A viewing time of less than 4 secs for each radiograph has increased errors, amongst all
11. Various radiology expert bodies have conveyed to courts in USA, regarding the concept of necessary fallibility in Radiology and each complaint is being viewed with relevant question of "whether standard of care that is expected in the given situation has been delivered or not "
12. It is estimated appx 10 million Radiological examinations are performed per day in the world (unconfirmed and subject being wrong) , of which 90% are Chest and Abdominal X-rays
13.Indian reports suggest 100 million X-rays per year (Cf-USA exposes 2 billion X-rays per annum) and 10% repeats as acceptable and 50% not being acceptable , with grey zone in between
14.An article in reputed journal claims 53% X-rays across all continents as of poor quality and not readable
15. WHO estimates appx 30% of patients who seek medical advice need imaging to arrive at a diagnosis , and 80% of them can be decided up on with the help of Xray/ USG. Another 9% would benefit from CT and 4% by MRI, with the rest needing multiples/ others
16. The urgent need of the societies =====complete replacement of world Xray Technology with Digital X-rays , including Retrofitting, extendable to critical care units with Wifi technology
17. Such a complex scenario demands Radiologists to be ever vigilant , and keep abreast of ever expanding knowledge base
Errors in judgement must occur in the practice of an art which consists largely in balancing probabilities. Sir William Osler (1849-1919)
Facts about Malpractice in Radiology Reviewed by Sumer Sethi on Friday, March 25, 2016 Rating: