Legal Ramifications of Computer Aided Detection in Mammography

Computer aided detection (CAD) is increasingly utilized in radiology, and is most prevalent in screening mammography where it is reimbursed by Medicare. While CAD may be helpful to the clinician in highlighting nodules and asymmetric or suspicious breast density the clinician may not have otherwise observed or noted, its use is not without legal ramifications.

Important legal questions associated with the use of CAD include to what extent CAD is becoming the legal standard of care in our subspecialty, and whether radiologists or surgeons now feel obligated to follow or biopsy CAD findings as a component of “defensive medicine,” even if they deem the CAD findings questionable.

Also of legal significance is whether radiologists choose to archive CAD markings. And if they don’t, is there a worry that current or even future, improved versions of CAD might later be used in a courtroom setting to show that findings were “CAD evident,” or alternatively, that discarded CAD findings might be deemed “spoliation” (destruction of evidence).

To better address the legal ramifications of CAD use (and non-use), we are conducting an online survey of diagnostic imagers who perform mammography to better understand the extent to which radiologists are using CAD, and their views on the legal ramifications of CAD use. We suspect there are mixed opinions regarding its current utility, and are curious to see if radiologists have concerns about CAD’s potential legal consequences.

Responses to the survey will remain anonymous. The goal of the survey will be to present data at a national meeting and/or publish it in a radiology related publication. The results will also be shared here with the readers of Diagnostic Imaging.

All clinicians with experience with CAD in mammography are invited to complete the survey at the link below. Thank you for your assistance.

Survey: https://www.surveymonkey.com/s/9MLR6TT

Jonathan L. Mezrich, MD, JD, MBA, LLM, a former practicing attorney, is a third-year radiology resident at the University of Maryland. Eliot Siegel, MD, FACR, FSIIM, is professor of radiology at the University of Maryland School of Medicine Department of Diagnostic Radiology and Nuclear Medicine and chief of imaging for the VA Maryland Healthcare System.