Radiologists are the sixth most common type of physician to be sued in a medical malpractice case. In cases that end up in court, the most common claim is errors in diagnosis. Of those errors, the most frequently missed diagnoses involved breast cancer, lung cancer, and bone fractures.
Radiologists are specially trained to interpret all kinds of diagnostic imaging, from x-rays to CT scans, from MRIs to angiograms. Neuroradiologists have additional training to interpret studies involving the brain.
Diagnostic radiologists never see their patients. Instead, they’re usually situated in a dark room somewhere, often outside the hospital or even in another state. Software systems link scanning equipment at the hospital to the interpreting radiologist’s computer.
The software loads a queue of images from radiology studies of different patients, sorted by the urgency of the physician order. Images awaiting interpretation are typically sorted from super-stat (now) to stat (as soon as possible) to routine. The software also provides limited information on each study, usually including the patient name, age, and a few words or phrase about the clinical indication for the study.
Unanswered questions & best guesses
As a Houston, Texas medical malpractice attorney, I’ve been alarmed to find that some radiologists simply give up when they’re unsure about a finding. It’s easy to pick up the phone and call the ordering doctor for more information about the patient, or to ask questions, but they just won’t do it.
For example, I handled a case last year involving care that was provided at a hospital in Humble, Texas. A neuroradiologist was working from home when a new set of images popped up on her screen for interpretation. It was a brain CT scan without contrast, and the only clinical information that was provided was “headache with dizziness and giddiness.”
At the deposition, we learned that the hospital’s electronic medical record system had a pull-down menu. The emergency (ER) physician testified that “headache with dizziness and giddiness” wasn’t completely accurate for the patient, but it was the closest option. The real reason that the ER doctor ordered the brain CT scan was to see if there were signs of a stroke or some other cerebrovascular abnormality.
Our medical experts testified that the neuroradiologist completely botched her interpretation of the brain CT scan. I think this played a big part in the decision-making of the ER doctor and consulting neurologist physician to eliminate stroke is a potential cause of the patient’s severe, unrelenting headache that had been going on for a few days. As you might’ve guessed, they were wrong and my client had a massive stroke shortly after he was discharged from the hospital that day.
But let’s get back to the neuroradiologist. One of the things that neuroradiologists are supposed to look for on the head CT is edema, or swelling. That’s a sign of trouble, and it could mean that the patient was suffering from a dissected cerebral blood vessel or even an early stroke.
When I took the deposition of the neuroradiologist, we spent a lot of time going over and over what she thought she saw on the CT scan. She repeatedly testified that she saw some “artifact,” but didn’t know at the time what it was.
Artifact refers to a distorted image on a CT or MRI scan. It can be caused by the patient’s position or even slight movement. Part of the radiologist’s job is to distinguish artifact from real images. If a study is too corrupted with artifact that it isn’t of diagnostic quality, the radiologist must recommend re-scanning the patient.
The defendant neuroradiologist explained that she deals with this situation every day. She said, “At the point of reading that study, I have to make the determination if it’s artifact or a real finding.” When it came to my client, she conceded that she “was not sure on that day if what I was looking at was artifact or a true finding.”
Even though the neuroradiologist what unsure of what she was seeing, she proceeded to make some tragic choices. She chose not to pick up the phone and call the ER physician to get more information. She chose not to recommend another scan because of a potential artifact concern. She chose not to recommend and advocate for an MRI, which has higher resolution to aid in diagnosis.
Instead, the neuroradiologist chose to give her best diagnostic guess, without going through the proper process. As a result, my client ended up with a stroke that could’ve been avoided, and his life will never be the same.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.