Misinterpreting a diagnostic scan is the number one cause of patient injury, according to a new study conducted by physician-owned medical malpractice insurer The Doctors Company.

Evaluating closed malpractice claims in both diagnostic and interventional radiology, the company found injuries took place the most in exams where misinterpretations occurred, which took place in 78 percent of cases — especially ones involving CT. It also looked at interventional radiology, where patient injuries occurred mostly due to technical performance.

“Since the CT scan has become so ubiquitous and widely available, it has evolved into an essential tool in many imaging-based diagnoses,” Dr. Bradley Delman, vice chair for quality in radiology in the Mount Sinai Health System told HCB News. “Unlike the two-dimensional X-ray, a CT scan provides three-dimensional perspective, and with recent advances in resolution and imaging quality, a single CT exam often contains many hundreds of images. A subtle finding among such a large data set may be harder to detect overall. In addition, unlike the MR that may be used to refine a specific diagnosis, CT has become much more of a screening tool than it had been in the past.”
Delman reviewed the study for The Doctors Company along with other physician experts to form an accurate and unbiased understanding of what led to patient injuries. The most common type of misinterpretation was undiagnosed malignancy. CT scans were performed in 34 percent of the 78 percent of cases where injury was caused by scan misinterpretation.

For interventional radiology, technical performance was responsible for patient injuries in 76 percent of cases, most of which involved patients experiencing poor outcomes following invasive procedures. Technical performance led to negative results in 65 percent of cases where the correct procedure was performed appropriately, while only 11 percent of claims were due to poor technique or incorrect body site.

Darrell Ranum, JD, CPHRM, vice president of the department of patient safety and risk management at The Doctors Company, chalks injuries in cases where procedures were appropriately executed up to risks of the operation.

“The taxonomy that we use from CRICO Strategies — a medical professional liability consulting firm — to code our claims include codes for technical performance where technical performance was questioned but found to be within the standard of care,” he told HCB News. “These events were identified as complications that were known to patients (informed consent process) as risks of the procedure. These cases made up 65 percent of interventional radiology cases. Only 11 percent of interventional radiology claims were found to have substandard care.”

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