Page 40 - 2022 Risk Basics - Radiology

SVMIC Risk Basics: Radiology

At SVMIC, we are typically viewing care after a claim has been asserted

or a threat has been made. Under these circumstances (after-the-fact),
referring providers seem to always take the position that they not only

preferred, but also expected, a phone call from the radiologist. This is
often true even if the finding was not an emergent or unexpected finding.

See the following case example.

C A S E S T U DY

A 57-year-old male smoker (2-3 packs per day for 40 years)
presented to the emergency department with chest pain radiating

to the left arm. Chest pain protocol was ordered along with a CT of
the chest to rule out PE. The CT was interpreted by the radiologist

as negative for pulmonary embolism. The report did mention that
there was a 7-10mm nodule present in the left-upper lobe which

should either have had a follow-up scan in four months or a PET CT
for further evaluation, but the radiologist never called the referring

physician. Fourteen months later, the patient complained of left
shoulder pain and an MRI of the left shoulder was obtained, which

showed a lesion suspicious for metastatic disease. A CT of chest,
abdomen, and pelvis showed multiple lesions within the bone and

liver metastasis. The patient died and a wrongful death lawsuit was
filed.

The claim against the radiologist included that he failed to call with

“unexpected” findings (instead of suspicious), which is a violation

of policy. Weak points included that the radiologist’s review of the
CT scan was inadequate in describing the nodule in the left-upper
lobe, which at that time, was 1 cm in size and was a “red flag”, and

the clinician should have been alerted with a phone call to that

effect.

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