JACR: Key takeaways from breast imaging malpractice suits

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Breast imaging leads the way as a subspecialty when it comes to malpractice lawsuits, and using best clinical practices to reduce chances of litigation was the focus of an article published in the December edition of the Journal of the American College of Radiology. 


Elizabeth Kagan Arleo, MD, with the radiology department at New York-Presbyterian/Weill Cornell Medical Center, and co-authors distilled a number of teaching points from studying past breast imaging medical malpractice suits.  


“In breast imaging, the gap between the public perception that breast cancer is detectable, when present, 100 percent of the time and the reality of the limitations of modalities and inherent human imperfections has additionally fueled litigation claims,” Arleo and colleagues wrote. 


Looking to gain valuable insights for breast imaging specialists, the authors came up with the following lessons learned. They included: 



Patients recalled from routine screening mammography should be scheduled for full diagnostic workup in the original area of concern as well as any specific views that can assist in fully defining the finding, the authors wrote. 


Palpable masses 

Arleo and colleagues recommend definite diagnoses in the cases of palpable masses.  


A palpable mass should not be declared a cyst unless ultrasound is performed and the finding meets all the criteria for a cystic lesion on ultrasound,” they wrote. 


Computerized system flares 

Paying special attention to computer-detection for calcification is essential, the team wrote. They suggest a second look anytime the computerized system detects a calcification.


“At times,” the authors wrote, “it may be the tip of the iceberg.”  



Arleo and team suggest that radiologists never accept suboptimal positioning of patients and that departure from positioning standards could result in undetected lesions. They also recommend not suggesting six-month follow ups on the basis of a screening exam, suggesting instead that the radiologist complete an initial workup. 


Do not ignore the subareolar region,” the authors added.  Even trivial-seeming masses in the subareolar region are more significant than elsewhere in the breast in terms of potential progression of disease. 


Administrative infrastructure 

With the case load radiologists face each day, missing unreported mammographic examinations is a potential pitfall.  


A large aspect of communication in breast imaging involves the administrative structure: hire the appropriate number of capable people to do the job,” Arleo and colleagues wrote. 


Reporting standards 

Consistent, logical reporting practices are very important when it comes lawsuits, as radiology reports become legal documents. 


Imaging and pathology concordance 

The authors urged that radiologists do not accept nonspecific pathologic reports or those that fail to fully explain the imaging appearance.


There needs to be harmony among the clinical setting, imaging findings, and pathology reporting to avoid potential problems or pitfalls,” they wrote.



Arleo and team emphasized the importance of a workspace free of visual and audio distractions. They also recommend setting realistic volume goals and enabling reliable reporting systems. 


Patient communication 

Finally, the authors encourage radiologists to interact with patients at any opportunity they have. 


With diagnostic mammography, there is more personal interaction, and this will always serve to minimize misunderstanding,” the team wrote.  Review a patient's images with her in the reading room or your office, and explain the rationale for the plan.