Facts about Malpractice in Radiology

"I would give great praise to the physician whose mistakes are small, for perfect accuracy is seldom to be seen. Hippocrates, On Ancient Medicine, IX (tr. By Francis Adams)"

Facts and Commentary by Dr MGK Murthy

1."Errors"  "Wrongs" "faults"in Radiology, as perceived  is a result of skewed assumption that Perfection is  possible , propagated by public ,media, and ironically  by  some clinicians  themselves.

2. Radiologist usually makes decisions under  conditions of  uncertainty(Titrating the  data available) 

3. Radiological answers to a  question are often not binary(Normal/Abnormal) (Cancer/ No cancer) / (yes/No) etc 

4. Erros in Radiology should be better  labelled as discrepancy (Opinion is  defined as  conclusion arrived at , after some weightages of evidence, by an expert, but  is subject to debate or  suggestion)

5.Unlike physical examination/ endoscopy/ Surgery, Radiology picture is  a permanent record and is subject to retrospective debates / opinions (71% lung cancer nodules on screening radiograph were actually identified on previous X rays , reported  as normal  for an example, 30% of visible findings on Barium enema were actually missed .) 

6.An  average inter observer difference of 10-20% cases  in all modalities was observed by a large study in USA

7. A retrospective study in 2001 (of 20 years data) concluded  an average error rate of 2-20% across all modalities . This compares favourably with a Mayo clinic study in year2000, finding clinical diagnosis was missed on average of 26% when compared to Autopsy findings 

8. Availability of relevant clinical  data  showed a  significant  decrease in error rates (23%  missed findings in the absence of data , while compared to only20% when data  was made available amongst  the experienced faculty  for  chest X-rays )

9. Prolonged attention to a particular area (called  Visual Dwell) (study done on X-rays)  has produced increase in both false positives and negatives

10. A viewing time of less than 4 secs for each radiograph has increased errors, amongst all 

11. Various  radiology expert bodies  have conveyed to courts in USA, regarding the concept of necessary fallibility in Radiology and each complaint  is being viewed with relevant question of "whether standard of care that is expected in the given situation has been delivered or not "

12. It is estimated appx 10 million Radiological examinations are performed  per day in the  world (unconfirmed and subject being wrong) , of which 90% are Chest and Abdominal X-rays 

13.Indian reports suggest 100 million X-rays per year (Cf-USA exposes  2 billion X-rays per annum) and 10% repeats as acceptable and 50% not being acceptable , with grey zone in between

14.An article in reputed journal claims  53% X-rays   across all continents as of poor quality and not readable 

15. WHO estimates appx 30% of patients who seek medical advice need  imaging  to arrive at a diagnosis , and 80% of them can be decided up on with the help of Xray/ USG.  Another 9% would benefit  from  CT and 4% by MRI, with the rest needing multiples/ others 

16. The urgent need of the societies  =====complete replacement of  world Xray Technology with Digital  X-rays , including Retrofitting, extendable to critical care units with Wifi technology 

17. Such a complex scenario  demands Radiologists  to be ever vigilant , and keep abreast of ever expanding knowledge base 

Errors in judgement must occur in the practice of an art which consists largely in balancing probabilities. Sir William Osler (1849-1919)