Radiological Errors/ Discrepancies -- Taking stock
Salient points across the countries , literature, studies, modalities and others: By Dr MGK Murthy
1. Approximately 1 billion radiological examinations are performed annually across the world
2. An average real time errors in daily practice is estimated at 3-5% (i.e.40 million discrepancies in an year)
3. 75%of Radiology malpractice claims pertain to diagnostic errors.( Diagnostic errors in US hospitals contribute 40-80 000 deaths per year, apart from many more non lethal incidents).
4. In view of the prevalent proactive societal actions, most radiologists prefer false +ve reading from safety point of view .
5. Diagnostic errors = missed/ wrong/ delayed as detected by some subsequent definitive test/ finding by the same test .
Radiology errors = failure to detect/ interpret/ communicate the results / suggest an appropriate followup test
6. Opinion = A view held about a particular subject or point ; A judgement formed OR belief ( Terminology of "Error" is being actively replaced with" Discrepancy", a more appropriate term )
7. Some classify discrepancies in to 2 varieties (a) Cognitive (failure to notice) (74%) (b) System failure (processes/ Equipment/Team failure etc)(60%) , or at times both
where as some others group them as
(a) cognitive (failure to detect/ notice ) (20-40%) (b) Perceptive (60-80%) (picked up retrospectively and debated in hind sight bias etc)
8. Studies involving modalities suggest X-rays leading in the discrepancies (54%) / CTs (30.5%)/MRIs (11.4%). Ironically not much difference in discrepancies exist between with (77%) and without clinical data (80%)
9. MGH study involving CT Abdomen gave 26% Inter observer discrepancies Vs 32% intra observer discrepancies ( Blinding up the scans , prior reported by few of the participants) . Oncological CT studies suggested discrepancies of 21-30%.
10. Structured formatting reporting as suggested remedy by few , surprisingly has not been preferred by clinicians in the studies (who are comfortable with free style conventional dictation method of organ based paragraphs )
12. Suggested remedies to reduce discrepancies are pretty standard like clinico- Radiology or clinic- pathology meets/ Peer review/ information technology enabled tools/ Computer Aided Diagnosis / limiting workload (more than 20 cases of CT per day resulted in more discrepancies) / Education etc
13. It is a misnomer to think Experts(in a field) do not make mistakes. "An expert is someone who is 50 miles from home, and has no responsibility for implementing the advice he gives and shows slides "= Ed Meese , US Attorney General 1985-88
14. "Finally Errors of Judgement must occur in the practice of an art , which consists largely in balancing probabilities " and all effort will continue towards this hypothetical Zero terminus
.(presuming it exists)
Radiological Errors/ Discrepancies -- Taking stock Reviewed by Sumer Sethi on Tuesday, April 04, 2017 Rating: