Radiology studies are invaluable diagnostic tools. Three of the most familiar types are:
X-rays. X-ray imaging uses electromagnetic radiation to create images of structures and tissues inside the body. X-rays are particularly useful in diagnosing bone fractures and tumors or other abnormal masses.
CT scans. Computed Tomography exams (or CT scans) combine a series of x-ray images taken from different angles and use computer processing to create cross-sectional (or even three dimensional) images of bones, organs, and other tissues.
MRIs. Magnetic Resonance Imaging (MRI) uses a powerful electromagnetic field and radio waves to create detailed images of organs, tissues and blood vessels in the body. Unlike x-rays and CT scans, MRIs do not use radiation. MRIs are often used in neuroradiology to diagnose injuries and conditions involving the central nervous system, including the brain and spinal cord.
When a patient undergoes a radiology study, the images are reviewed and interpreted by a physician who specializes in interpreting medical imaging known as a radiologist. The radiologist then prepares a report that is sent to the physician who ordered the test. The ordering physician is generally responsible for informing the patient of the results and ordering any necessary follow-up. Both the images and the report become a part of the patient’s medical record.
Medical malpractice cases arising from radiology studies generally take one of two forms: either (1) the radiologist fails to identify and report an abnormal finding that is visible on imaging; or (2) the radiologist sees and reports an abnormal finding, but the ordering physician fails to note or act appropriately on the radiologist’s report. The second type of malpractice will be apparent from the patient’s medical record, but the only way to investigate whether a finding was visible on imaging and missed is to obtain the images and have them reviewed by an appropriately credentialed radiologist.
Either type of negligence can cause a delay in diagnosis of the patient’s condition, which can be disastrous depending on the finding that was missed or not acted on appropriately. The failure to identify a suspicious mass on a mammogram (an x-ray of the breast) may result in a delay in diagnosis of breast cancer. The failure to identify a small bone fracture on a CT scan may result in the patient suffering a much larger fracture, requiring much more extensive surgery, rehabilitation and future complications that should have been avoided.
Regardless of the reason that a radiology study is ordered, medical standards of care require the radiologist to identify any abnormality that is visible on the study and the ordering physician to act on any abnormality identified by the radiologist. Occasionally, a radiologist may have “tunnel vision,” focusing only on those tissues or structures relevant to the clinical concern that prompted the imaging study. Likewise, an ordering physician may review only part of a radiology report and miss an important “incidental” finding noted by the radiologist. Both are common fact patterns in malpractice cases involving radiology studies.
Modern medical imaging systems sometimes create a digital trail (known as “metadata”) identifying who accessed a study, how much time that person spent viewing the images and/or drafting the report, and even which words of the report were unique to that patient as opposed to pre-filled from a template. Getting this information requires not just knowing where and how to look but dogged persistence in the face of stiff resistance from health care providers who do not want to disclose it. The effort is usually worth it – forensic metadata can be critically important evidence in certain cases.
Indeed, in some cases, it may not even be clear initially who bears responsibility for a misread. Radiology studies performed in large academic medical centers are often interpreted initially by physicians-in-training (medical residents or fellows) working under the direction and supervision of attending radiologists. At smaller hospitals, radiology studies may be reviewed remotely by radiologists who may be anywhere in the country; this practice is known as teleradiology. Some hospitals use teleradiology during overnight hours or on weekends.
If you suspect that you or someone you love was the victim of medical negligence involving a failure to identify or act appropriately on an abnormal finding on an x-ray, CT scan, MRI or any type of radiology study, you should contact the attorneys at Youman & Caputo for a free consultation. The attorneys at Youman & Caputo have a wealth of experience investigating and successfully litigating medical malpractice cases in Pennsylvania and New Jersey involving radiology studies. We work with highly qualified radiology and neuroradiology experts, and we routinely pursue forensic metadata to get answers to questions that other lawyers may not even think to ask.