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Did Malpractice Risk Kill V/Q Exams? | Microsoft AI Models
October 14, 2024
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Together with
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“The story of V/Q imaging’s decline is as much a story about linguistics as it is about clinical validity.”
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Kulkarni S et al, in an article on the decline of V/Q imaging for PE.
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The workforce shortage is putting a severe strain on radiology facilities. But new technologies like enterprise imaging, the cloud, and artificial intelligence should offer relief by enabling radiologists to work more efficiently. In this Imaging Wire Show, we talked to Rob Mayer and Kyle Souligne of AGFA HealthCare about these exciting new developments.
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CT perfusion angiography exams have largely replaced nuclear medicine-based ventilation/perfusion (V/Q) studies for detecting pulmonary embolism. But a new article in Academic Radiology suggests that CT’s rise wasn’t entirely based on clinical efficacy – fears of malpractice risk may have played a role.
V/Q studies can help diagnose PE by enabling clinicians to visualize lung perfusion, showing defects such as blockages in pulmonary vessels. The scans are typically performed in three phases …
- An albumin injection to show pulmonary vasculature.
- A radiopharmaceutical that’s inhaled and imaged with a gamma camera.
- A chest radiograph to correlate findings.
The scans dominated PE imaging in the 1980s, but the rise of CT saw radiology facilities begin to shift.
- CTPA was seen as having higher spatial resolution and was easier to perform than nuclear medicine exams.
But the new article suggests that there were other forces at work as well – in particular, fear of malpractice risk from PEs that weren’t adequately followed after inconclusive V/Q exams.
- The problem originated with clinical guidelines for V/Q reporting that classified some 20% of V/Q studies as “low probability” for PE when they probably would have better been classified as “inconclusive” or “non-diagnostic.”
As a result, a number of “low probability” patients weren’t followed up adequately, with tragic results that later figured into medical malpractice cases …
- A patient who was diagnosed with pneumonia after an inconclusive V/Q exam, sent home, and died one day later of a “massive” PE.
- A patient with leg and chest pain who was given heparin after a negative V/Q scan and later suffered internal hemorrhage; fortunately she survived.
- A patient with “vague symptoms” who had an inconclusive V/Q scan and later died of an undiagnosed PE that some claimed would have been detected on CTPA.
Indeed, the theme of PE malpractice cases began to shift over time, from failure to diagnose V/Q scans to failure to order CTPA exams – which were soon seen as the clinical gold standard.
The Takeaway
Given the fast pace of development in radiology, it’s inevitable that some technologies that were once clinical staples fall by the wayside. But the new article offers a fascinating look at how clinical language can lead to medico-legal concerns that influence physician behavior – often in ways that are impossible to detect as they happen.
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Unlocking Value in Healthcare
How can the Value Realization Pyramid help you unlock value from your technological investments? The pyramid outlines how high-quality data from advanced technologies like AI can drive enterprise-wide workflows and better decisions. Learn more on this page from Enlitic.
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Unify Your Imaging to Improve Clinical Outcomes
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The Clinical Value of Soft-Tissue Chest X-Ray
Soft-tissue techniques can improve the visibility and accuracy of chest X-ray. Learn about two important soft-tissue methods – bone suppression and dual-energy subtraction – in this white paper from Riverain Technologies.
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The Growth of AI in Pulmonology
Learn more about the capabilities of AI for chest imaging in this on-demand webinar from Blackford. You’ll hear pulmonology professionals discuss several promising areas, from acute imaging through chest X-ray analysis to lung cancer screening.
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Apple Vision Pro and Radiology
The Apple Vision Pro headset has the potential to revolutionize how radiologists interact with medical images. In this Imaging Wire Show episode, we talked to radiologist Paul Murphy, MD, and Steve Deaton of Visage Imaging about its exciting future.
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Are You Getting the Most Out of Your Image Exchange Solution?
Ask yourself these 5 questions on this page from PocketHealth to find out whether your enterprise image exchange solution is maximizing patient satisfaction and efficiency and driving revenue.
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- Get the 2024 Radiology Practice Development Report: Medality surveyed more than 3,300 radiologists and discovered the most critical training gaps and growth opportunities in radiology for its 2024 Radiology Practice Development Report. Download your complimentary report today.
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