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.”

The findings, he adds, stress the importance of communication between radiologists and clinicians, as well as with patients prior to surgery and other procedures. To ensure this takes place, he suggests the following tips:

• Physicians who order radiology studies should include information with their orders for tests. If the radiologist does not receive the information that they need, they should reach out to ordering physicians to gather that information and learn what the ordering physician expects to find and why they expect to find it.

• Radiologists should be integrated into the healthcare team. If findings are not consistent with clinical information provided by the ordering physician, radiologists should have a conversation with the ordering physician to analyze the situation and determine next steps in the diagnostic process.

• After radiological studies are performed and read, we recommend that critical findings, unexpected findings, and interpretations that require follow-up be reported by radiologists to ordering physicians.

• Radiologists should create or update the process for notifying the appropriate clinicians regarding discrepancies between preliminary readings and final reports. They should document these communications.

• Physicians should ask the receiving clinician to repeat back the message to ensure accurate transmission and understanding of findings, including patient identification.