Page 32 - 2022 Risk Basics - Radiology

SVMIC Risk Basics: Radiology

The strong points included that the radiologist specifically identified
mastoiditis as a concern, and he advised clinical correlation.
The radiologist also noted that the post-contrast image “may be

beneficial” for further evaluation. Also, CT of the temporal bones

“may be beneficial” to further evaluate for boney coalescence.
However, the radiologist’s comments about “may be beneficial”
conveys something that is not absolute. The phrase is similar to

recommending the test. The way the clinician interpreted the overall

note is that clinical correlation was suggested. If mastoiditis were
a concern, the post-contrast imaging and CT scan of the temporal
bones would be the test the radiologist would order. Whether the

radiologist “recommends” follow-up testing or thinks follow-up

testing “may be beneficial”, it is still up to the attending physician.
But, in this case, the words chosen did not convey to the attending
physician the urgent need to order the follow-up testing.

As a defense expert observed, the problem with a radiology case
like this is that the plaintiff can put up specific images and show

where there are areas of whiteness. Although our experts can
explain that these findings are subtle, or explain by averaging or

artifact, the problem is that lay people can see the whiteness on
the images. It may be difficult for them to look past the whiteness

when there are experts on the plaintiff’s side who are pointing to it
and saying the whiteness represents edema.

Prompt verbal communication with the referring clinician is essential
in cases involving acute or potentially life-threatening findings, an

incidental finding that will immediately influence patient management or
is wholly unexpected, or a nondiagnostic radiological evaluation that may

necessitate immediate further evaluation.

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