Radiology malpractice cases most often involve cancer-related diagnostic errors

Oncology is the most common culprit of radiology malpractice cases involving diagnostic allegations and more often involves high-severity harm, new research published May 28 suggests.

While only a shade under 4% of all imaging nationally is cancer-related, researchers found 44% of radiologic cases involving a disputed diagnosis were oncologic in nature, “particularly worrisome,” they explained Friday in JACR.

Paired with the fact that anywhere between 40,000 and 4 million individuals in the U.S. will suffer serious, misdiagnosis-related injury each year, the authors said something needs to be done.

“Based on our findings, actions to address diagnostic error as it pertains to oncologic imaging are warranted,” Andrew B. Rosenkrantz, MD, section chief of Abdominal Imaging at NYU Langone Health’s Department of Radiology, and colleagues added.

A large database made up of medical malpractice claims from both captive and commercial insurers across the U.S. shows cancers account for the greatest proportion of high-severity, diagnostic errors (37.8%), followed by vascular events and infections.

Wanting to know more about radiology’s role, the authors searched that same database, keying in on malpractice claims between 2008 and 2017.

Over a 10-year period, radiology was primarily responsible for 3.9% of all claims (2,582 of 66,061) and 12.8% involving diagnostic allegations (1,756 of 13,695).

Furthermore, oncology accounted for 44% of radiology cases with diagnostic allegations, a larger percentage than any other medical condition. And in cases disputing a rads’ diagnosis, harm occurred in 79% of cancer cases but only 42% of nononcologic situations, the authors noted.

Misinterpreting images was a factor in 80% of oncologic radiology malpractice suits involving diagnostic allegations. Mammography was most commonly involved, with CT and MRI both listed.

Rosenkrantz et al. did find a positive association between paid claims and subsequent advanced imaging utilization on a state-by-state level. In fact, each added paid claim over five years was associated with an average of 1,389 additional exams the following year. That did not include nuclear medicine or interventional rad claims.

Based on this, reducing cancer-related malpractice claims may also limit wasteful imaging, the authors noted.

To do bring down claims, Rosenkrantz and co-authors put forth a number of suggestions, including more oncologic imaging fellowships, subspecialty certification pathways in oncology imaging, better leveraging teleradiology solutions, and AI applications, among other ideas.

“We believe these initiatives would promote consistently high-quality imaging services and safer, less error-prone care for oncology patients across all practice settings, including community settings, in which a large volume of oncologic imaging is performed,” the authors concluded.

Read the entire study published in the Journal of the American College of Radiology here.

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