The Vancouver Island Health Authority (VIHA) and St. Joseph’s General Hospital are reviewing radiology studies interpreted by a radiologist at St. Joseph’s General Hospital on Vancouver Island, British Columbia.

The review process consists of carrying out secondary reads of scans, analyzing the results and notifying patients and physicians as required and as appropriate, according to VIHA.

Since the need for a review was first announced on Feb. 14, VIHA and St. Joseph’s have been working with Doug Cochrane, MD, the provincial patient safety and quality officer and chair of the British Columbia Patient Safety and Quality Council to determine the scope of the review and timelines of scans to include.

Cochrane advised that the initial review focus on CT scans performed from August 2009 to January 2011. The review only includes scans read by the one specific radiologist and if required, the review could be extended further back in time.

CT scans are the primary focus of the review. While there is no indication of any pattern of errors made in other modalities read by this radiologist at this time, a quality assurance review will be undertaken to assure patients that these scans were read correctly, according to a release issued by VIHA. This process will take place following the CT review.

The initial review of CT scans currently under way impacts 2,723 CT scans, involving 2,490 patients. Secondary reads of impacted CT scans began in mid-February. These secondary reads are being carried out by fully qualified and credentialed VIHA radiologists who are performing the reads in an anonymous fashion; that is, they do not have access to the original CT scan report. The secondary read report is then sent, along with the original report read by the Comox radiologist, to a third radiologist. This third radiologist acts as an adjudicator by reviewing both scans and determining if a discrepancy exists. Discrepancies are assessed on a scale varying from no discrepancy up to a discrepancy that could be clinically significant and is likely to alter follow up and treatment.

As assessments are completed, patients or next of kin will be notified by registered mail. The patient’s family physician and the physician who ordered the CT scan will be notified by fax and by registered mail or courier. If needed, changes to treatment processes will be discussed and developed involving the patient and their physician(s).

It is anticipated the review of the 2,723 scans and notification process will be completed by March 31 at the latest. St. Joseph’s and VIHA will make public the number of reviews where discrepancies were noted, and the number of reviews where these discrepancies are significant.

The reviews follow an investigation launched earlier in February after two health authorities reported issues around the quality of CT scan and obstetrical ultrasound readings performed by two radiologists.

The initial issues relate to one full-time radiologist and one temporary radiologist who practiced briefly but lacked either the appropriate credentials or experience to analyze CT scans. Both Vancouver Coastal Health and Fraser Health have begun notifying a total of almost 3,400 patients and their doctors as part of their internal investigation into these matters. While comprehensive reviews undertaken in both health authorities have confirmed that in the majority of cases, patient care has not been compromised, roughly 140 cases were identified as requiring further follow-up between doctors and their patients. Prior to practicing in the Fraser Valley, the temporary radiologist also practiced for several weeks in another area, involving approximately 200 cases. However, family physicians linked to those patients were immediately informed and an internal quality review performed by four experienced radiologists confirmed that patient care was not affected.

Neither of the radiologists implicated in these matters is currently practicing in British Columbia. While initial follow-up with health authorities and the College of Physicians and Surgeons suggest these occurrences are unique to the two radiologists involved, the fact that these incidents have been identified in approximately the same time frame raises serious questions that need to be addressed quickly.

The initial review is a 30-day process. The British Columbia Patient Safety and Quality Council also will complete a second review to examine all aspects of the known incidents. In particular and in the interest of preventing similar occurrences in the future, the review will include:

• A comprehensive fact framework including a description of the incidents in question;
• Analysis of the response by health authorities when they learned of the issue;
• A review of the health authority physician credentialing and privileges including the role played by the College of Physicians and Surgeons; and
• Any further issues that arise during the course of the review.

Findings from this more extensive work will be made public within six months, according to the council.