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Radiology report question ... do these types of mistakes happen? UPDATE

jasminsaba
Posts: 157
Joined: Jul 2011

Hi everyone - I was hoping you can help me with something.

Yesterday, we met with mom's oncologist who went over her CT scanr results/reports (contrast-enhanced chest, abdomen and pelvis). The news was GREAT - God is good. According to the scans, mom's in the clear. I noticed as the onc was going over the report for the abdoment/pelvis ... she did a double take on the impressions section and thought that was a weird reaction.

So I asked for a copy and read it on my own after I came home from celebrating with my mom.

Here's the confusion:

Report, in detail, indicates that all abdominal organs are unremarkable and normal. There is no evidence of disease in the liver (where she originaly had a met).

Under impressions, the report states the following:

" There is no definitiave evidence of recurrence on this exam with an anastomotic line within the pelvis demonstrating no thickening or associated soft tissue mass. There is evidence of metastatic disease within the abdomen and pelvis on this exam."

The second part of the above statement is what's throwing me for a loop. According to the doc and the detailed portion of the report, she is in the clear. Why is the impression in contradiction then?

I called the radiology dept. where the scan was done and the "manager" immediately saw that same glaring contradiction. She said an addendum would have to be published to the report by the same radiologist who read the scans and wrote the report.

Has this ever happened to anyone else??? I was really hoping to get one or two care-free days out of this week with the scan and chemo being over and behind us ... but it looks like, that won't be possible until I hear back from teh friggin radiology department.

Any thoughts? experiences? your feedback would be appeciated.

Thanks for your support.

ellamenno's picture
ellamenno
Posts: 145
Joined: Aug 2010

There is NO evidence of metastatic disease within the abdomen and pelvis on this exam. Could just be a typo?

Peace, Laurie

jasminsaba
Posts: 157
Joined: Jul 2011

I was thinking the same thing. These radiologists use voice-recogniton software for the most part and the error rate, I know, is very high with those. But for the love of God, read the darn thing before you sign off and share with the patient. We worry enough as is, don't need these confusing artifacts mixed in.

janie1
Posts: 753
Joined: Apr 2011

I'm thinking too, just a typo.
But what I'm really curious about is the onc. Was she just going to let this slide??
Seems she should have been the one to check on that- pronto.
It just pains me everyday to see how much everyone has to micro-manage the high-salaried oncs.
What a shame.
Hope to see your follow-up, Jas. Thanks.

z's picture
z
Posts: 1414
Joined: May 2009

I was thinking it was a typo also. Please let us know. Lori

smokeyjoe
Posts: 1428
Joined: Feb 2011

It looks like a typo to me too, looks like the word "no" was left out. Let us know.

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi people: You have to check the reports, all of them, and look at them all together (if you've had several). I have gone through all of my scan reports (both CT scans and MRI scans) and caught several errors and omissions, some serious. For example, on several MRIs early on my peritoneum cancerous nodules showed up as gone so chemo was stopped when in fact they were still there, big as life. Thankfully,my surgeon ordered a CT to be done on me to fix my incisional hernia and yup, there they were, so more chemo. But what if he hadn't caught this omission???? As well, the details that were asked for were just not there like size, specific location, appearance, etc. I gave my oncologists spreadsheets summarizing the scans and highlighted the incorrect or confusing data! So, yes, it could be a typo (which in itself is heart breaking - aren't these things checked for that???????) but then again maybe not. Radiologists are human and make mistakes particularly when stressed, which means they should be checked and double-checked by someone!
I'm venting but mistakes when you have cancer is terrifying.
Cheryl

PhillieG's picture
PhillieG
Posts: 4912
Joined: May 2005

Whenever I get a scan, and I've had many of them, I pay more attention to what my Oncologist says about the scan than to the piece of paper. Frankly, I don't even get a printout of it. Mainly because I'm not a radiologist so it's akin to me trying to read the fine print in a legal document. Hopefully your oncologist actually views the scans and doesn't just read the report.
I would put a call into your Mom's Onc, explain what happened, and ask her to review the scan as well as the report. More than likely it's a typo but instead of having techs who aren't Oncs determine what they THINK is going on, I'd want to find out what actually IS going on.
Phil

John23's picture
John23
Posts: 2140
Joined: Jan 2007

Of the three oncologists I have had since 2006, none read the
scans, x-rays, or sonograms. They all relied on the radiologist's
reports for their data.

Every surgeon I have had rejected the radiologist's reports,
and insisted on reading the scans, x-ray, and sonograms, and
compared them against the older versions.

I would prefer to have someone who's career relies on the ability
to read a road map, is the one that interprets where the town is.

(just sayin')

Best of health!

John

tanstaafl's picture
tanstaafl
Posts: 1303
Joined: Oct 2010

Thanks John. An interesting possibility for an alternative CT consult, although my experience with radiologist and surgeons is a mixed affair.

PhillieG's picture
PhillieG
Posts: 4912
Joined: May 2005

"Of the three oncologists I have had since 2006, none read the scans, x-rays, or sonograms.
They all relied on the radiologist's reports for their data."

That probably explains a lot...What's the point of having an oncologist?
I've had my Onc catch a few "mis-reads" over the years.
-p

LivinginNH's picture
LivinginNH
Posts: 1458
Joined: Apr 2010

Well, when my Rick had his initial colon surgery, the radiologist told us that there were several tumors on both sides of his liver and that he was inoperable. Then two hours later a surgeon looked at the scans and told us that Rick was indeed operable and had less tumors than we were told earlier. Rick subsequently had a liver resection four months later.

And only last month my best friend was told by a radiologist that she had several breast tumors, most likely cancerous, but a recent biopsy revealed only fatty deposits. And I too was told several years ago that I had breast cancer, but no, that wasn't the case either, thank goodness.

And if that isn't bad enough, it's now well known that a large number of radiologists cheat on their medical exams - check out this recent CNN article: http://www.cnn.com/2012/01/13/health/prescription-for-cheating/index.html

Take care,

Cynthia

tanstaafl's picture
tanstaafl
Posts: 1303
Joined: Oct 2010

This has ominous sounds for MCAT (premed school) and USMLE (dr licensing) tests that have similar tools. This and similar issues are a problem throughout our current "trained and certified" society. How do we measure scholarship, individual effort and professional knowledge amongst the our young? What happens as canned stuff largely replaces knowledge caught in the wild? How can we balance?

plh4gail's picture
plh4gail
Posts: 1238
Joined: Oct 2010

Could be a typo..but follow up!

plh4gail

Sundanceh's picture
Sundanceh
Posts: 4408
Joined: Jun 2009

I know you told me you were in the DFW area with me. I don't know which facility you are using for your care...but you might want to consider switching over to UTSW in Dallas...St.Paul's and Zale Lipschy are the top rated hospitals in the metroplex area.

And Simmons Cancer Center has been upgraded this past year to NCI status, which is top-tier designation for cancer care. UTSW is now the MD Anderson of North Texas - make no mistake about it.

I've got the top colorectal surgeon now in the metroplex as well....one of the top rated radiation oncologists there - and one of the top 3 cardiovascular/thoracic surgeons in our area as well.

I'm steadily assembling my medical team and putting my entire care in the UTSW system. I've got an ENT there now....about to find an Internist...and a Dermatologist.

And it's great to be under ONE ROOF. With their medical system online and coordinated, anywhere you go on the campus has your entire medical record, so any of your doctors can just pull up your records and scans and all have the same information.

Priceless.

Just the other day, I had a question for my lung guy...it's been 18 months since I came out from under his scalpel...but his good old PA was still there...I had a question on my recent CT scan and sent them an internal email to see if they could shed some light.

Sure enough, she pulled up my scan and looked it over...and sent back a reply with my question - and just a couple of hours before my consult.

I just love these guys!

Just something to consider...

BTW: I'm not a paid spokesperson or anything:) LOL! I just owe these people my life and I believe so strongly in them and the care that they have provided me.

-Craig

jasminsaba
Posts: 157
Joined: Jul 2011

thanks for your feedback ... here's an update: I spoke with the director of the radiology department yesterday - she was apologetic and based on the detailed report agrees that it's most likely a typo; however, to be on the safe side, she'll have the same radiologist who issued the report review the scans again and write an addendum. Of course, nothing's easy in life and this guy apparently works on multiple campuses so we'll have to wait until Monday for him to get back to this campus and correct his work.

As far as reviewing with the onc, mom's oncologist went through the report with us word by word but she didnt even acknowledge this mistake - it was only her reaction that prompted me to request a copy of the report. I agree with Phil that as a lay person, reading these reports and/or reviewing these scans can be somewhat harmful because what you don't understand CAN drive you crazy. I almost wish now that I hadn't requested this copy because everyone walked out of that office happy and relieved except for me. I am still in limbo until Monday.

As to whether or not the oncologist reviews these scans, I can't say that I've ever seen her review anything other than the report in our presence. Not sure if she does so during their board meetings?

Radiology, as a discipline, in general makes me very uncomfortable ... it's very based on the individual and less standardized. Two radiologists can look at the same film and arrive at very different conclusions; but I guess that can be true with other specialties as well.

Craig - mom's being treated at Baylor Irving although her oncologist is affiliated with UTSW (she is an adjunct professor) and has an office at St. Paul. Her CRC surgeon was Cleveland clinic trained and is also a professor at UTSW.

Her liver surgeon (although she hasn't had a liver resection) is the chief of surgery at Baylor Irving and was educated and trained at UTSW.

As an alumni, I'm also very partial to UTSW and have complete faith in their academic and clinical knowledge. I would appreciate it if you would send me a PM with names of your docs at UTSW. Perhaps I can start assembling a second-line team just in case.

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: You might want to check out discussion threads at the Colon Club website. They're discussing the same things. I'm a trained image analyst (as a botanist - do vegetation not humans) and always always always have someone else, likely more than one person, check out my analyses and still I'd want to go and look at the thing in question (easier than opening up a body though!). Everyone makes mistakes or has differences in background and experience. My oncologist doesn't go through the reports with me in detail but I see him looking at the images in the main office at the cancer centre. Trouble is, most oncologists are chemist types and radiologists aren't medical doctors but surgeons look at our insides day after day after day. Worthwhile pondering. I have a team at the cancer centre comprised of an oncologist, a surgeon, a dietician, and an oncologist nurse. Which should be the way to go but ...
Cheryl

jasminsaba
Posts: 157
Joined: Jul 2011

I'll check out colon club ... I've been taking a break from that site but perhaps it's worth revisiting for more information on this topic.

By the way, radiologists ARE medical doctors. I am not sure if that's different in Canada.

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: Yes, many of them are but not all of them, here anyways. The radiology doctor signs off on the scan reports but usually (here) does not do the actual scan, well-trained technologists do. I think what I meant to say was that radiologists aren't surgeons and they aren't necessarily oncologists and wouldn't it be nice to have a team with all of them on it, all of them looking at one's scans!
Thanks for correcting that.
Cheryl

sharpy102's picture
sharpy102
Posts: 371
Joined: Apr 2009

Hey Jasmin:

I also think it was a typo and it meant "NO evidence" but regarding your question, yes these DO happen. In my Mom case even worse happened. She went for her first scan and it came out that she's clean, the reason for her stomach ache was said to be probably she ate something bad. Then she went home saying "oh okay". Two months passed by and the pain didn't go away, so she went to see another doctor this time and not the same one she went the first time. She got scheduled for a scan, and got the results back. The doctor told her that if she came two months ago she would have been probably operable and start chemotherapy, but it's too late now, just "go home and live as you can" as literally what the doctor said. That's how my Mom became diagnosed with cancer.
Then when my Mom told me this, I was confused saying that cannot be. She was clean 2 months ago, why this doctor says if she came two months ago she would have been fine?? So, I took both of the scan results and biked to see this second doctor to explain to me why he said what he said, and what is really going on. He started analyzing the first scan and all of a sudden he looked at me and said "Well, I'm sorry to tell you. But on her first scan by the other doctor they FORGOT to use contrast dye, so hence nothing got detected." I was shocked, and was sooooooooooo upset that I stormed home. So, yes, these things do happen....whether it "just" a typo, or basically someone's life....it happens. And yes, my Mom did go home and lived as long as she could...3 months. Ever since this occasion I'm still today thinking of going and finding that first doctor and spit in his face and just tell him "thanks, you killed my Mom". I am still today very upset about this, and cannot believe it. And once I'll be an adult, I will for sure go and see this doctor and yelled his head off- doctor here, doctor there, I don't care!
Anyway....all the best to your Mom!
Please take care,
- Sophie

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Oh Sophie I'm am so sorry what happened to your mom. That is terrible. I, too, would be tempted, and would probably do it. It happened to a friend's husband, too. It just re-enforces to me that we have to be more vigilent when it comes to scan reports, blood reports, etc. People make mistakes and there don't seem to be many checks in the system. But it is difficult.
Cheryl

coloCan
Posts: 1956
Joined: Oct 2009

Even tho my onc schedules them, i usually call radiologist ASAP for quick rundown.When i meet with her and onc, they both go over scan itself with me. My lung doctor goes over the lung part and since i've started seeing a urologist, he too goes over the scan, as does surgeon, so i get five perspectives.....I suppose i could get disc of scans but they won't really mean anything to me; have photo of inside my bladder and now , a year plus later and i don't remember what i'm looking at...Do have written report of my last scan and it can get scary when you read it til it gets explained in words you understand. I'm surprised some of you have oncs who don't go over scans with you....steve

jasminsaba
Posts: 157
Joined: Jul 2011

Hi everyone - I hope you had a great weekend. Go GIANTS!!!

I had promised you an update on mom's radiology report debacle ... just got the report addendum ... scans were reviewed by the radiologist again and the addendum states there is NO evidence metastatic disease witin the abdomen or pelvis on this exam.

PRAISE GOD. I am so relieved ... everyone has been relishing in the good news since last week but I just needed this confirmation before I could really let loose :-)

Thanks for your support.

smokeyjoe
Posts: 1428
Joined: Feb 2011

Great to hear!!!

jasminsaba
Posts: 157
Joined: Jul 2011

I appreciate it.

z's picture
z
Posts: 1414
Joined: May 2009

Great news for your mom. I hope that dr is more careful with the next report and proof reads it. I wish your mom and your family well. Lori

jasminsaba
Posts: 157
Joined: Jul 2011

I'll be ON her case from here on out ... even more so that usual. I appreciate your well wishes and wish you and yours all the best.

pepebcn's picture
pepebcn
Posts: 6352
Joined: Aug 2010

Congratulations now rest calm you deserve!

jasminsaba
Posts: 157
Joined: Jul 2011

I appreciate your sweet comment.

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: I'm so glad for your mom! That is great news! And I'm so glad you started this discussion thread to wake us all up. We have to be more vigilent! Thanks!
Cheryl

jasminsaba
Posts: 157
Joined: Jul 2011

I am so glad we've got this forum to support each other through this journey. I agree, we have to be more vigilent ... mistakes happen when docs deal with high volumes.

TNConsultant
Posts: 1
Joined: Jun 2012

If it's true that a radiologist signed off on a report that has a "typo," I would encourage you to report it to all overseeing agencies/hospitals/etc. including the medical group the radiologist belongs to. While other people are so quick to accept this was probably a "typo" due to voice recognition software, I see it very differently. I spent many years working for a large insurance company that provides medical malpractice insurance to physicians. Something like this could cost somebody their life. It happens every single day, and it DOES cost people their lives every single day. While your personal story has a very happy ending, the fact that this physician signed off on such a report is very scary and could have devastating, irreversible consequences. Physicians have a responsibility to NOT make this kind of mistake, voice recognition software or not. I promise you that if the proper complaint procedures are followed, this physician will never again make this "mistake" again (I'm giving him/her the benefit of the doubt; sadly, the reality is that some doctors just don't care).

Please, don't let this drop just because you heard great news, which I am so grateful for. Take the steps necessary to ensure the next person doesn't experience something similar. For all you know, the next person's report may say that they do not have evidence of cancer when they actually do. I've seen this happen time and time again. It happened to a personal friend of mine last year, and she actually had Stage IV lung cancer. Unfortunately, many doctors (non-radiologists) do not look at the actual images on a scan. Many simply look at a radiology report and move on, so the accuracy of the report is critical with life-and-death consequences .... literally.

tanstaafl's picture
tanstaafl
Posts: 1303
Joined: Oct 2010

My wife's initial radiology report failed to note a major cluster of periaortic nodes last year. However, the malignant nodes were showing up on the CEA and CA19-9 trends, where I had data points every ~3 weeks. So I went and got a second reading done independently and found the Easter egg.

It was time to move fast.

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