Radiology Claims Case Study: Delayed Diagnosis and Treatment of Lung Cancer

Incomplete imaging studies can lead to life-threatening situations for patients. Radiologists often receive film from the patient’s physician/provider without the necessary patient or clinical information to perform the review, potentially resulting in missed or delayed diagnosis.

It’s important that hospitals and practices establish workflow processes to identify these incomplete studies and close the loop on any outstanding reviews to avoid a delay in diagnosis and treatment of a patient’s condition.

In this study, we review how the failure to follow processes for tracking returned films adversely affected one patient’s treatment. We also share risk management strategies for dealing with imaging studies that are returned without completed interpretations.

The Case

A female patient with a family history of lung cancer and a personal history of smoking established care with a family practitioner after relocating to a new area. She requested and received annual chest x-rays due to her personal and family histories.

A chest x-ray was performed at the family practitioner’s office in October, and it was forwarded to a radiologist for interpretation. Because the paperwork submitted with the film did not include an indication for the chest x-ray or a signed Medicare waiver form, the radiologist refused to perform the review. He noted on the film jacket “needs waiver” and returned the film to the family practitioner’s office. At the time, the film remained unread.

Roughly five months later, the patient returned to the family practitioner’s office with complaints of persistent cough. A chest x-ray and EKG were ordered and performed a week after the office visit. Again, the film was forwarded to the same radiologist for review. At this time, he compared the current film with the October film and recommended a CT scan for further evaluation. The study was performed a week later and confirmed the radiologist’s suspicion of cancer.

Following consultation with the family practitioner and a pulmonologist, the patient underwent extensive treatment, including chemotherapy. Despite the oncology efforts, metastatic cancer was discovered in her pelvis, and she succumbed to the disease nearly a year after diagnosis.

What Went Wrong?

The radiologist failed to open or review the chest x-ray film upon initial presentation, because paperwork was incomplete and missing both the clinical indication for the study as well as a patient-signed Medicare waiver form. Neither the family practitioner nor the radiologist had processes in place for follow up of returned film.

As a result, the film from the October study wasn’t read until the patient returned with complaints and a comparison study was completed. The radiologist may have been able to provide an earlier diagnosis if this issue had been remedied immediately, providing additional time for treatment.

This case was settled by the hospital on behalf of the radiologist prior to trial.

Risk Management Takeaways

Imaging centers and medical practices should:

1. Implement verification processes to ensure the radiologist receives all necessary paperwork along with imaging study films.
2. Contact the ordering physician directly by telephone to inform about missing paperwork and inability to proceed with requested review of film.
3. Develop a tracking system for all film returned without a completed interpretation to allow for timely follow-up.

For further guidance on this issue, Curi members are encouraged to reach out to our Risk Management Department at 800.662.7917.