Im­ages of doubt

Modern Healthcare - - Outliers -

It all looks so pre­cise and ir­refutable on TV shows such as “Bones” and “CSI,” but a study in the Au­gust is­sue of the Amer­i­can Jour­nal of Roentgenol­ogy sug­gests at least one arm of foren­sic medicine may be more in­ter­pre­tive than ex­act sci­ence.

For the study, “Ob­jec­tive de­ter­mi­na­tion of stan­dard of care: Use of blind read­ings by ex­ter­nal ra­di­ol­o­gists,” re­searchers at the Uni­ver­sity of North Carolina at Chapel Hill’s ra­di­ol­ogy depart­ment set out to de­ter­mine if the di­ag­nos­tic find­ings of ra­di­ol­o­gists who act as ex­pert wit­ness typ­i­cally match up to those of ra­di­ol­o­gists with no in­volve­ment in or knowl­edge of the case. The re­searchers se­lected and sent six CT stud­ies to 31 ra­di­ol­o­gists par­tic­i­pat­ing in the study. None were ex­pert wit­nesses. The six stud­ies con­sisted of three ran­domly se­lected im­ages taken of emer­gency depart­ment pa­tients, one con­trol im­age and two emer­gency room im­ages per­formed on trauma pa­tients.

One of the trauma-case im­ages was used dur­ing a le­gal ac­tion to sup­port a plain­tiff’s in­jury claim. Dur­ing the case, four ex­pert-wit­ness ra­di­ol­o­gists iden­ti­fied three find­ings—T3 and T10 ver­te­bral frac­tures and a 1 mil­lime­ter widen­ing of the T10 facet joints—to sup­port the plain­tiff’s charges. But when the 31 ra­di­ol­o­gists from the North Carolina study read the court case im­age along with the five oth­ers they where given, none of them di­ag­nosed the in­juries cited by the ex­pert-wit­ness ra­di­ol­o­gists.

The find­ing, re­searchers say, prompts ques­tions about the ob­jec­tiv­ity of paid med­i­cal-ex­pert wit­nesses, and sug­gests that the use of blinded read­ings might be a more ob­jec­tive method of eval­u­at­ing le­gal-in­jury cases.

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