Canadian rad investigation expands to 4 rads

The Vancouver Island Health Authority review of the quality of CT scans in British Columbia has widened as health authorities have identified concerns with the quality of studies performed by two licensed and credentialed radiologists, a radiologist practicing out of St. Joseph’s General Hospital in Comox and a locum radiologist temporarily practicing in the Fraser Valley in 2009 and 2010. In addition, the authority has released recommendations based on phase one of the investigation.

Ongoing reviews and discrepancies
In mid-December 2010, the British Columbia College of Physicians and Surgeons recommended a review of CT scans interpreted by an out-of-province radiologist who practiced temporarily at Abbotsford Regional Hospital and Chilliwack General Hospital between mid-August and mid-September 2010.

All CT scans interpreted by this radiologist were reviewed for possible discrepancies. Of the 170 patient cases, 12 contained significant discrepancies. Each patient, or family, and the physicians managing the care of these patients were notified. One patient is receiving follow-up testing to determine whether the discrepancy would have changed his treatment plan. One patient case was reclassified as a significant discrepancy following further clinical review and discussion with his physician.

In a separate investigation, Fraser Health is reviewing 407 CT scans that were interpreted between November 2010 and March 4 by a physician who, as an internationally-trained radiologist, held a provisional license that required quarterly assessment of his practice by his physician supervisor.

At the end of his first three months of practice, a random selection of his medical reports was assessed. A full review followed. Of 197 cases reviewed so far, nine are considered to have significant discrepancies in the medical interpretation of the scans. Referring physicians for the nine patients have confirmed that the discrepancy did not alter the course of treatment.

A review of the remaining 210 CT scans is under way, and Fraser Health also is reviewing x-rays and 184 mammograms interpreted by the radiologist. Finally 1,933 CT scans interpreted between November 2008 and October 2009 will be reviewed.

Phase one findings
The first phase of a review into concerns regarding the quality of medical scans in British Columbia has concluded all physicians currently providing medical scan interpretation in the province are appropriately qualified and licensed. However, the report recommends a new peer review approach will help better support individual radiologists, improve quality and strengthen public confidence.

“Based on my initial work, I am confident the 287 physicians currently providing diagnostic imaging services are appropriately licensed,” said Doug Cochrane, MD, who is leading the review. “However, to ensure the quality of their work, medical staff need opportunities to upgrade their skills as diagnostic technology evolves, and they need the support of colleagues through a structured, rigorous review of their work on an ongoing basis – to ensure high-quality patient care.”

He added that increased checks and balances within the healthcare system can better support radiologists, particularly those who are more isolated from their colleagues in rural areas.

Specifically, Cochrane recommends:

• The Ministry of Health Services implement a province-wide peer review system for diagnostic imaging on a phased-in basis–where a proportion of medical scans initially read by each radiologist in a health authority would be re-read by another radiologist–with any discrepancies reported to both the health authority and their board.
• The British Columbia College of Physicians and Surgeons immediately implement retrospective peer reviews, focusing on hospitals identified by health authorities where radiologists may have been operating without peer support and review.
• The College’s Diagnostic Accreditation Program initiate medical reviews to assess the quality of physicians reporting in any facility that houses a CT scanner or MRI in British Columbia if this had not taken place as part of the accreditation process.
• Health Authority boards instruct their Medical Advisory Committees to include regular in-depth performance reviews as part of their appointment processes for medical staff.

Part two of the review will include a comprehensive fact framework of the known incidents, analysis of the response by health authorities when they learned of the issue, a review of the health authority physician credentialing and privileges – including the role played by the British Columbia College of Physicians and Surgeons – and any further issues identified during the course of the review.

None of the four radiologists linked to the issues – including the two identified in the announcement of the review – are currently practicing in British Columbia, and health authorities have been actively working to inform patients and physicians as discrepancies have been identified and follow-up is required.