Oncologic imaging represents 44% of radiology malpractice cases with diagnostic allegations, according to a study published May 28 in the Journal of the American College of Radiology.
The findings highlight how important it is to reduce errors in oncologic imaging, wrote a team led by Dr. Andrew Rosenkrantz of NYU Langone Health in New York City.
"Oncology accounts for the largest share of errors leading to allegations of diagnostic failure in radiology -- a share greatly disproportionate to the share of imaging that is oncologic," the team wrote.
Medical errors are known to cause preventable harm to patients, with diagnostic errors in particular on the rise, the authors noted. They investigated the prevalence of oncology-related errors in diagnostic radiology using information gleaned from the Comparative Benchmarking System of the Controlled Risk Insurance Company, a database that includes about 30% of medical malpractice claims in the U.S.
They examined errors from 2008 to 2017. The group categorized radiology claims as oncologic or nononcologic, diagnostic or nondiagnostic, and by imaging modality.
Over the study time frame, radiology was the primary responsible medical service for 3.9% of all malpractice claims and 12.8% of claims that asserted diagnostic error. Of these diagnostic error claims, oncology made up 44% of cases, and "high-severity harm" was found in 79% of these (compared with 42% of nononcologic cases asserting diagnostic error).
"Diagnostic errors in radiology are significantly more likely to be high impact when they concern oncology as opposed to other conditions," the investigators wrote.
The group also found the following:
- Of all oncologic radiology cases, 97.4% had diagnostic allegations, while only 55% of nononcologic radiology cases did.
- Imaging misinterpretation was a factor for 80.7% of oncologic radiology cases with diagnostic allegations.
- Half of "total paid dollars [50.1%] for radiology cases with diagnostic allegations related to oncology," according to the group.
Rosenkrantz and colleagues also found particular imaging modalities to be more susceptible to diagnostic error malpractice claims, with mammography having the highest percentage.
| Percentage of oncologic malpractice claims with diagnostic allegations by modality | |||
| Modality | All cases | Nononcologic cases | Oncologic cases |
| Mammography | 19.1% | 0.5% | 40.3% |
| CT | 28% | 33.4% | 21.9% |
| X-ray | 26.1% | 36.8% | 13.9% |
| Ultrasound | 13.7% | 14.7% | 12.5% |
| MRI | 13.1% | 14.6% | 11.4% |
Diagnostic errors in cancer imaging must be mitigated, the team wrote. Ways to do this could include increasing the number of dedicated oncologic imaging fellowships, using teleradiology to centralize interpretation, establishing second-opinion networks, and incorporating artificial intelligence tools.
"We believe these initiatives would promote consistently high-quality imaging services and safer, less error-prone care for oncology patients across all practice settings, including community settings, in which a large volume of oncologic imaging is performed," the group concluded.
