Mammography, Ultrasound at High Risk for Medicolegal Claims

In radiology, breast imaging (mammography and ultrasound) is among the highest with medicolegal claims, according to a study published in the Journal of the American College of Radiology.

Australian researchers undertook a retrospective analysis of 443 medicolegal closed claim files from two medical defense organizations that provide medical indemnity insurance to Australian private practitioners to determine which imaging examinations were subject to the most claims and to identify opportunities for system change. Of the 443 closed claims, 20 were considered to be nonincidents and five were duplicates, leaving 418 relevant claims.

The researchers calculated a procedural risk ratio for CT, ultrasound, radiography, MRI, and nuclear medicine, as well as some procedures. After an incident type was determined, a classification of 12 patient safety fields was conducted for each closed claim.

A total of 62% of the error types were a delay or failure to correctly read images (misdiagnosis). The procedures at higher risk of this type of claim were:

• Mammography

• Breast ultrasound

• Total MRI[[{"type":"media","view_mode":"media_crop","fid":"39163","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6127323655469","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3935","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 133px; width: 199px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©-Taurus-/Shutterstock.com","typeof":"foaf:Image"}}]]

• Total CT

• Obstetrics and gynecology ultrasound

The lower risk modalities and procedures were:

• Cardiac ultrasound

• Radiography extremities

• Total radiography

Other principal natural categories included:

• Problems occurring during the procedure – 11%

• Postprocedural complication – 6%

• Injury from the procedure – 4%

• Missing radiology report – 3%

• 3 Cs (correct site and side, patient, procedure) – 2%

• Patient instruction or information – 2%

• Allergic reactions – 2%

• Documentation – 2%

• Extravasation – 2%

• Misdiagnosis (pathology failure) – 2%

• Misdiagnosis (failure to investigate) – 1%

• Radiation exposure during pregnancy – 1%

• Medication – 1%

• Equipment failure – 1%

• Misdiagnosis (failure to obtain adequate diagnostic quality – 1%

• Medical registration – 0% (1 patient)

• Patient assault – 0% (1 patient)

• Problem with referral – 0% (1 patient)

“A total of 270 (67 percent) claims involved a single imaging modality, and 11 (3 percent) involved two modalities,” the researchers wrote. “The modality could not be determined for 87 claims, owing to a lack of detailed information.”

The researchers concluded that the most common group of error types was misdiagnosis from reading the images or in delays, and the riskiest modalities for claims were mammography, breast ultrasound, total MRI, total CT, and obstetrics and gynecology ultrasound.

“Standardization of data collection by MDOs [medical defense organizations] from radiologists at the time a claim is made, in the manner outlined earlier, could improve the utility of claims reviews for this purpose,” they wrote.