Teleradiology Mistakes Can Kill You!

Dan Frith
Dan Frith
Contributor
Posted by Dan FrithMay 02, 2008 9:59 AM

Teleradiology, what is it? It is the electronic transmission of radiological patient images, such as x-rays, CT's and MRI's, from one location to another for the purposes of interpretation and/or consultation....and almost all hospitals today are using these services. Hospitals like to use teleradiology services because it provides around the clock professional services, often at lower cost than having a fully-staffed radiology department on site.

How can it kill you?  When the radiologist who is sitting in China, or India, or just hundreds miles away in another state makes a mistake in reading and interpreting the diagnostic studies emailed to them via the Internet. 

My firm just settled a case involving just such a sad situation....and the patient died.  The teleradiology company involved in the case is one of the largest such companies in the world, NightHawk Radiology Services. Our local hospital, Carilion Roanoke Memorial Hospital, contracted with NightHawk to provide radiologic services. The patient arrived at the hospital with a history of a thoracic aneurysm and complaining of back and flank pain. The attending Emergency Room doctor was aware of the possibility that the aneurysm could be the cause of the patient's symptoms and was also aware that a ruptured thoracic aneurysm meant certain death. So he correctly ordered a thoracic/abdominal CT scan to verify the status of the aneurysm.

No radiologist was available at the hospital so the CT films were sent, basically as an attachment to an email, to NightHawk Radiology Services. NightHawk then forwarded the CT films, again via the Internet, to a radiologist sitting at his home in Louisiana for interpretation. Unfortunately, the radiologist mis-read the CT films and determined there had been no change in the aneurysm and reported his findings back to the Emergency Room doctor, who gave the patient pain medication and sent him home. The CT film actually showed the aneurysm had gotten larger and was leaking, or bleeding. The patient was found dead by a family member 5 days later. The cause of death - ruptured thoracic aneurysm!

I am all in favor of technology but when I go to my local hospital I like to know who is caring for me.  Is it a local physician with a known reputation as a competent and caring healthcare provider?  Or is it like Dorothy in the "Wizard of Oz" and someone we don't know is pulling all of the levers behind the curtain? 

Just something to think about.


 

3 Comments

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JD
Posted by JD
May 02, 2008 9:35 PM

Sad case for certain! Unfortunately, even the best trained "local" Radiologists could make the same mistake. Currently, local mistakes dwarf remote mistakes since most remote interpretaions are only preliminary. The transmission of this case to a remote Radiologist had nothing to do with the "mis-read" study.

Sad regardless.

MC
Posted by MC
May 13, 2008 1:18 PM

"reading and interpreting the diagnostic studies mailed to them via the Internet."

e-mailed? Are you sure....nobody I know uses email to transmit medical images...it would be slow and unsecure.

Most sites use a secure VPN with some sort of DICOM compression router.

Jim Stone
Posted by Jim Stone
May 13, 2008 5:27 PM

I have been around a lot of hospitals, practices and teleradiology services in my time in radiology, and I have never heard of images being emailed. All teleradiology groups including private practices who cover their hospitals from their own homes have electronic transmission and high resolution viewing of images identical to that found in the PACS system at the hospital when reading studies as final interpretations from outside the hospital.
Error is inherent in radiology. Whether it is by a board-certified radiologist sitting in their home covering their local practice, or sitting at home a few hundred miles away or in a different country, the possibility for error is no different. It is unlikely that we will see in our lifetime all hospitals fully staffed around the clock by in house radiologists (who tend to be more stressed and thus more prone to error). That is the great benefit of teleradiology--it allows access to expert care when the hospital is unable to provide it directly. Additionally, hospitals such as this which have lost their permanent radiology staff often seek the assistance of locums-tenems providers, who usually have much less if any quality screening regarding the radiologists they represent as compared with teleradiology companies such as Nighthawk.
Shame on anyone who would take advantage of a sad situation such as this to try to make an example with such a flawed argument as this, to serve their own purposes. I am sure it is in lawyers' best interests to demonize teleradiology to set themselves up for high paying juror rewards in the future.
Let me ask you, if your child was in the ER and had a radiology study performed on them, would you want it not to be interpreted because the hospital was unable to provide a radiologist, or would you want a qualified, certified radiologist reading via teleradiology to interpret the study in order to provide the best care possible at that moment? Chances are you will never even know "who is caring for me" in either instance.

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