Radiologist Violated Code by Failing to Detect and Report Abnormal Lymph Nodes 23HDC00211

The Deputy Commissioner for Health and Disability has found that a radiologist breached a woman’s consumer rights by failing to detect abnormal lymph nodes during a CT scan, knowing that the woman was at higher risk of developing metastatic cancer.

In the decision announced today, Dr. Vanessa Caldwell said the radiologist had breached the Health and Disability Services Consumer Rights Code by failing to provide an appropriate standard of service.

The woman had been undergoing annual CT scan surveillance, which the radiologist reviewed, since her 2017 diagnosis of melanoma that had spread to her right thigh. For this he was successfully treated with immunotherapy.

On the 2021 CT scan, the radiologist reported no evidence of recurrence or metastasis. The radiologist told HDC that since the melanoma in this case would usually have spread along the lymph nodes on the right side of the limb and into the abdomen, he focused on that and did not notice the visible enlarged lymph nodes on the left. .

In 2022, a routine mammogram detected a lump in her left breast. Further testing found metastatic breast cancer located in her left lymph nodes and had spread to her liver. Unfortunately, the woman received a fatal diagnosis.

He expressed concern about how quickly the cancer had spread to his liver. He requested review of the 2021 CT follow-up scan reported by a second radiologist, also in 2021, and a separate MRI scan for the shoulder injury. Examinations of the CT scan revealed that abnormal lymph nodes were visible in 2021 and needed to be eliminated. reported. Dr Caldwell criticized this comment: “Dr B agreed that the abnormal nodes were visible in hindsight. He said Ms A had experienced involuntary blindness associated with her previous melanoma as she searched for pathways that were expected to cross her right side. This led Dr B to say that the scan was reversed.” “It raises concerns that it focuses on the expected path of the disease at the expense of a comprehensive analysis of the rest.”

Dr Caldwell formed the following view: “… although I accept that the radiologist is focusing on a particular area of ​​interest, he has a duty to be careful to note other abnormalities that are visible, and in this case a reasonable radiologist would act reasonably in Mrs A’s care and skill.” could detect and report abnormal lymph nodes.”

Review of the 2021 MRI scan also revealed that abnormalities in the left lymph nodes were visible and should have been reported. However, he noted that there were extenuating circumstances in the failure to detect abnormalities, given that the radiologist had only assessed one shoulder injury, although he was critical that another opportunity to recognize this was missed.

Dr Caldwell made a number of recommendations, including that both radiologists formally apologize to the woman. He suggested that the radiologist who violated the woman’s rights arrange for a clinical peer review of the accuracy of 10% of the CT scans report. This will be provided to HDC along with the actions it has taken to alleviate any issues found.

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