Rad errors causes and cures india 9 23

1. RADIOLOGIC ERRORS:
CAUSES AND CURES
Society for Emergency Radiology,
Third Annual Meeting
Bengaluru, India September 23-25, 2016

2. Leonard Berlin, MD, FACR
Department of Radiology
Skokie Hospital, Skokie, IL
Professor of Radiology
Rush University Medical College
and
University of Illinois
Chicago, IL

4. Defining Medical Errors
“We are failing to properly distinguish between an
error and a complication….Hospital-acquired
infection and pulmonary embolism are not
necessarily medical errors….Many complications
are unavoidable patient-related
comorbidities….There is a difference between
error, bad results, and unintended
consequences.”
Medscape, 5-26-16

5. Medical Malpractice Lawsuits in
the USA
BEFORE 1950: Errors of COMMISSION
(The doctor did something wrong)
AFTER 1950: Errors of OMISSION
(The doctor failed to do something right)

6. Amer Med News, 3-20-06

7. X-ray Accuracy
Error Rate
Chest 30% Garland 59
Chest 25% Tuddenham 62
Chest 30% Yerushalmy 69
Colon 32% Cooley 60
Bone 30% U of Mo. 76
GI 30% U of Mo. 76
Misc 41% Herman 75
Misc 25-32% Renfrew 92

8. Percent Of Lung Cancers Found
On Retrospective Review Of Chest
X-rays
University of Southern
California
1960 48%
Harvard 1975 70%
University of California,
San Diego
1981 40%
Mayo Clinic 1983 90%
Sloan Kettering 1984 65%
Columbia Presbyterian 1992 73%

9. Percent of Breast Cancers Found
On Retrospective Review of
Mammograms
University of Arizona 1993 75%
Yale University 1994 63%

10. X-ray Accuracy
Error Rate, More Recent
Lung nodules 30% Sarnel 99
Lung CA CT 53% White 96
Renal CA CT 25% Siegel 99
Misc CA CT 37% Gullub 99
Pulm Angio Embol 36% Van Beek 96
Mammogram 67% Burhenne 2000
Sonography 23% Hertzberg 99
MRI 39% Wakeley 95

11. Rates of Error in Imaging
Interpretation in a Group of
Hospitals
Review of over 11,000 images read by 35
radiologists
4.4% mean rate of interpretation error
Siegle et al. TX Med Cntr, Acad Radiol 1998;5:148

12. Error Rate Among Radiology
Residents: CT and MRI of Head,
Neck and Spine
• 5 year study, Univ. of FL
• 21,796 cases
• Read by resident, checked by staff rad
• Overall error rate 3.9%
Sistrom, Acad Rad 2008;15:934

13. Retrospective (Research) Error Rate:
30% Range
*************************************************
Everyday “Real-time” Error Rate:
3-4%
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A Distinction

14. Simple vs Clinically
Significant Errors
• A major distinction between simple errors and
clinically significant errors must be made.

15. Radiographic Errors
Perceptual: 70%
Cognitive: 30%
(misinterpretation)

19. 19
Initial

20. 20
Next day

21. 21Initial Scout Image

24. Alliterative Errors
• Occur because radiologists read reports
of previous exams and are more apt to
adopt same opinions
• Attributed to tendency and need to
conform to their peers or their own
previous conclusions

25. Negligence
A breach of the
standard of care

26. Standard of Care (International)
To conduct oneself as would a reasonably
prudent physician under the same or
similar circumstances, i.e., not necessarily
ideal, perfect, extraordinary, excellent.

27. Standard of Care (International)
Continued
The Question is not: “Has the radiologist missed
an X-ray finding or made an erroneous
interpretation?
The Question is: “Has the radiologist missed an
X-ray finding or made an erroneous interpretation
which could have been missed or made by an
ordinary radiologist, practicing in a reasonable
manner?

28. Hindsight Bias
The tendency for people with
knowledge of the actual outcome of
any event to believe falsely that they
would have predicted the outcome.

29. Outcome Bias
The tendency for people to
attribute blame more readily when
the outcome of an event is serious
than when the outcome is
comparatively minor

30. Errare humanum est, perseverare
autem diabolicum.
To err is human, but to persist in
error is diabolical.
Anonymous

31. In the 66 years since radiologic errors were
first acknowledged, the error rates have not
decreased appreciably. This must not
dissuade us from making every effort to
reduce them now. Yes, to do so is a
daunting challenged but it is one from which
we cannot simply shrug our shoulder and
walk away.

32. Reducing Errors
• Possess sufficient knowledge of modality of image
• Take a second look when possible
• Seek additional patient history and discuss with
referring physician when possible
• Ensure prompt transmission of imaging reports to
ordering physician (and to the patient?)
• Expend sufficient time for interpreting and reporting
• Be cautious about voice recognition, templates, and
proofreading to the extent possible

33. Beware:
Errors when interpreting plain
radiographs occur more often
than when interpreting CT, MRI

34. 3/11/2010 5:48PM

35. Should You Worry About
Radiation from CT Scans?
• Risk of cancer from CT scans are unproved and
overemphasized.
• The risk of dying from cancer that is not detected is
thousands of times greater than from radiation.
Boodman, Washington Post, 1-5-16

36. 36

38. LAWYERS vs. DOCTORS
WE CANNOT AVOID
ACRIMONY,
EVEN WHEN WE TRY...

39. Two attorneys boarded an airline
flight. One sat in the window
seat, the other sat in the middle
seat.

40. RSNA Malpractice 4

42. Just before takeoff, a radiologist
got on and took the aisle seat
next to the two attorneys.

44. The radiologist kicked off his
shoes wiggled his toes and was
settling in.

45. Just then, the attorney in the
window seat said, “I think I’ll
get up and get a coke.” “No
problem,” said the radiologist
“I’ll get it for you.”

46. RSNA Malpractice 5

47. While the radiologist was
gone, one of the attorneys
picked up one of the
radiologist’s shoe and spat in
it.

49. When the radiologist returned
with the coke the other attorney
said, “that looks good, I think I’ll
have one too.” Again, the
radiologist obligingly went to
fetch the coke.

50. RSNA Malpractice

51. While the radiologist was gone,
the other attorney picked up the
other shoe...

53. …and spat in it,
in even a larger quantity.

55. The radiologist returned and they
all sat back and enjoyed the
flight.

56. RSNA Malpractice 5

58. As the plane was landing, the
radiologist slipped his feet into
the shoes and knew immediately
what had happened.

60. “How long must this go on?
asked the radiologist . This
fighting between our
professions? This hatred?
This animosity….

61. This spitting in shoes and
pissing in cokes?

62. Manneken Pis is a landmark
small bronze sculpture in
Brussels, depicting a naked
little boy urinating into a
fountain’s basin. It was
designed by Hieronymus
Duquesnoy the Elder and
put in place almost 400
years ago - in 1618 or 1619.