Page 46 - 2022 Risk Basics - Radiology

SVMIC Risk Basics: Radiology

the same radiologist as “normal”. Three months later, another left
shoulder x-ray was read as left rotator cuff tendonitis. Ten months

after that x-ray, the patient was diagnosed with non-small cell
carcinoma of the left-upper lobe and died three months later. The

cancer was visible on all of the previous films.

At trial, the radiologist testified that he was reading 700-800

examinations a day during this time period and each examination
contained one to five images. He also testified that his “compensation
was based upon the number of examinations that he reviewed”. He

said that subsequent to this case, he had decreased the number of

examinations to around 400-450 per day. This testimony was not
well-received by the jury, resulting in a seven-figure payout.

Rapid film interpretation can obviously be a source of error. The accuracy
in lung cancer detection decreases significantly with viewing times of less

than four seconds according to one study. When radiologists were asked
19
to interpret studies at twice their baseline speed, the number of major

misses increased from 10 percent to 26.6 percent. A sustained artificially
high interpretive rate can result in additional interpretive errors from both

general and oculomotor fatigue. See the following case example.

C A S E S T U DY

A 15-year-old male suffered a head injury and presented to the
emergency department via ambulance with complaints of head

and neck pain. CTs of the head and neck were performed which the
radiologist read as normal. The patient was discharged. Approximately

three hours later, the patient returned with confusion, aggressive
behavior, vomiting, and worsening headache. He experienced a

19 “Interpretive Error in Radiology,” AJR:208, April 2017

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