Medicolegal implications of the Royal College of Radiologists standards for the interpretation and reporting of imaging investigations: a retrospective review of claims in abdominal radiology.

AIM: United Kingdom medicolegal claims are rising. Many radiological allegations cite failure to report incidental findings, but these are often inconspicuous and asymptomatic and therefore difficult to detect. Nevertheless, claimants often support their allegations by citing the Royal College of Radiologists standards for the interpretation and reporting of imaging investigations. We examined our medicolegal practice to determine the proportion where allegations cited incidental pathology.

METHODS: Five medicolegal expert witnesses, working in abdominopelvic radiology, reviewed their medicolegal practice and determined the proportion of recent cases in which allegations of substandard reporting cited failure to diagnose incidental pathology.

RESULTS: We identified 112 individual cases, comprising 176 imaging examinations; 99 (56 %) were computed tomography and 36 (20 %) magnetic resonance imaging. One hundred forty-four (82 %) were reported in the National Health Service, 14 (8 %) outsourced, and 18 (10 %) private practice. Medicolegal allegations cited failure to report incidental pathology in 41 (37 %) of the 112 patients. The commonest allegation in this group was failure to identify tumour (23 of 41 patients, 56 %). Interpretation was judged as substandard in 12 (29 %) of these patients compared with 23 (32 %) of the 71 patients in whom allegations did not cite incidental findings.

CONCLUSION: A substantial proportion of medicolegal allegations in abdominal radiology cite failure to report incidental pathology. College standards should recognise that unanticipated pathology is sometimes difficult to detect, especially without a clear steer from the referring clinician.