iRADiX

Incidence 1.

Mr. X went to a scan center and had MRI of Knee joint. The scan picked up no abnormality and pt was happy and went back home. Since the knee pain became worse in the same night he went to an institute to have advice. The orthopedician advised him to have another MRI in spite of pt showing him the MRI scan taken on the same day.

Pt became furious and started putting embarrassing questions to this orthopedician.

This orthopedician being a senior man got annoyed and told him to either get a fresh scan at so and so place or get lost.

Relatives convinced the patient to have another scan preferred by the Orthopedician and patient reluctantly agreed to have the scan

Now the report came as meniscus tear... Patient was operated and subsequently doing well.

Now where things went wrong?

1. Is the first radiologist inexperienced and hence missed the meniscus tear?

2. Is it because of carelessness of the radiologist in spite of being experienced? Or

3. Is it because of outdated MRI machine being used?

Assessment

On further analysis it was realized that in the first instance the center is having an out dated refurbished permanent magnet MRI machine .Similar instances can occur with outdated CT machines also.

Mind you the radiologist in this center is quite experienced.

Incidence 2

Mr. Y went to a scan center to have USG thyroid scan done. Radiologist reported the study as normal.

Since the Endocrinologist could not appreciate the images provided along with report. (remember many times one comes across stamp sized images) and lab parameters for thyroid also abnormal ….endocrinologist preferred to have a second scan in a different scan center.

Naturally the patient got upset.

Endocrinologist told the patient since the quality of the images provided are subnormal, he is not able to judge whether to start the treatment or not.( it is a fact that many times ref. consultants would like to see the images first and assess themselves and then only go through our reporting)

Reluctantly patient had scan done in a different scan center and the report came as multiple small colloid cysts. Patient got treated and doing well.

So how is that the first report did not pick up the lesion?

1. Again is the Radiologist inexperienced? Or

2. Has the experienced Radiologist missed the diagnosis?

3. Or the machine used is an outdated one?

Assessment

Review and feedback revealed that the radiologist used convex probe (water filled condom used as waterbath) instead of linear probe and tried to assess the thyroid gland. When he was informed that the diagnosis he made was wrong and still better if he stops using improper frequency probes….he pleaded innocence saying that the center is provided with only one probe (i.e. Convex) and the owner promising to buy the high frequency probe some other time. Here again the radiologist in question is an experienced one.

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The above two incidents tell us….the extreme limitations.

In the first instance of reporting was done with an outdated machine and in second instance reporting was done with an improper probe.

Though radiologists concerned are experienced ….yet reports were wrong.

Ultimately, suffering to the patient and bad reputation to the radiologists concerned.

The blame goes to…….

Now as an independent observer whom do you think is at fault?

1. Is the Owner of the institute to be blamed, for having an outdated machine or

2. You think Radiologist is also equally responsible for taking the risky proposition…

Or

3. Is it the ‘Greediness’ to be blamed… from both sides…. .since owner wanted to

earn money with less investment and the Radiologist never wanted to lose the

Incentives given for the case, being done.

4. Or do you think the Vendors have to be blamed since they keep rotating and

Distributing the refurbished and outdated machines for a cheaper price? And

manufacturers keep the price of newer machines prohibitive?

5. Or blame goes to every player involved?

Where to put in the Accountability?

No snowflake in an avalanche ever feels responsible.”

George Burns

"I am responsible. Although I may not be able to prevent the worst from happening, I am responsible for my attitude toward the inevitable misfortunes that darken life. Bad things do happen; how I respond to them defines my character and the quality of my life. I can choose to sit in perpetual sadness, immobilized by the gravity of my loss, or I can choose to rise from the pain and treasure the most precious gift I have – life itself."

Walter Anderson