What do kidney cancer patients need to know about errors with radiology reports?
Today’s media story came from Mississauga ON where a review of 3,500 CT scans and mammograms is being conducted to look for possible errors due to “performance issue” with a particular radiologist. Previously we have seen stories from Alberta, British Columbia, Quebec, so Ontario is not alone. To some extent, we should be pleased that the hospital (Trillium in this case) is being transparent and ensuring an expert review of all scans from April 2012 to March 2013. But we can be nervous too because our lives and our treatment decisions depend upon those reports being accurate in the first place.
Certainly we need to appreciate that reading a CT scan or MRI for kidney cancer is extremely complex. Have you ever seen your CT images? Imagine 1200 or more images to move through and not miss a one cm tumour buried in an usual place for mrcc. The radiologist has an incredibly difficult job to do to report on abnormalities and yet not “over-report” to prompt treatments or interventions that a patient does not really need. As patients, we all understand that mistakes can happen. We are human and radiologists no less. However, to make up for our human-ness, some provinces such as British Columbia and Alberta have recently introduced Quality Assurance systems that will ensure a certain (small) percentage of scans are re-reviewed. The intent is that any patterns of misreading will be caught sooner and that quality improvements can be made.
As a patient or caregiver, what do you need to know?
Firstly, as Canadians, we have a good healthcare system that we can trust to work for us. Secondly, you can play a role in ensuring you get the very best from the healthcare system available to you in your province. Here are some thoughts I’ll throw out there:
1. Perhaps it doesn’t matter too much WHERE you have you scans, but it does matter WHO is reading them. Kidney cancer is an unpredictable disease at best. Advanced kidney cancer requires an expert radiologist who measures more than just the longest dimension of a tumour, but also discusses the density, enhancement, inner necrosis (cells dying). We know that when it comes to mrcc tumours, size matters, but size is not all that matters. As a patient, you could review your CT report with your doctor and ask questions about what the radiologist is reporting and why. (You were going to ask for a copy of your CT report anyway weren’t you?)
2. Perhaps it would be helpful if Radiologists across Canada could come up with a standardized approach to reporting on their findings. (Pathologists and Surgeons have done this and call it “synoptic reporting”). The trouble right now with radiology reports is that they can be completely different from one radiologist to another. One will report in great detail with precise measurements (e.g., 2mm growth). Another will use descriptive language to say “slightly increased”, and a third will mention very little detail at all. Some standardization would be helpful to oncologists reading the report and to patients who have a vested interest in comparing one scan report to another.
3. If you have kidney cancer, chances are you’ve had a kidney (or part of a kidney) removed. So, you need to ask about your kidney function and whether it is safe for you to have the contrast for the CT or MRI. One oncologist recently said that he prefers to order non-contrast CTs because he would rather deal with fuzzy images than renal function issues with his patients. Others would say that as long as your GFR (creatinine etc.) is ok, and as long as you are well hydrated, you should not be unduly concerned. The Canadian Association of Radiologists has a guideline if you have questions:
4. And now I really am dreaming, but perhaps one day we will see a system here where patients can have imaging and results delivered in one day. All patients and caregivers I know complain about that horrible waiting interval between the CT scan or MRI and the appointment to learn the results. Clearly there is no technical reason why scans cannot be read within 24 hours (we see this done routinely in ER and for emergency conditions). Perhaps this is one goal that patients can clearly articulate to their healthcare team. What would it take to reduce scanxiety and have a survivorship “visit” that included all necessary appointments and results in the same day? (Yes, we’ve seen these “patient-centric” breakthroughs in centres offering breast cancer imaging, diagnosis, biopsy, etc. all in the same day. These breakthroughs have normally come about thanks to private donors who want to make things better for patients.) In the meantime, it wouldn’t hurt for you to let your doctor know how stressful this time period is for you. Perhaps something CAN be done.
Today’s news is making headlines. (I was interviewed for Global National news to give a patient perspective today). Hopefully they will save the part when I said that (I believe) patients shouldn’t be overly concerned… and yet we can push for system improvements that will catch a pattern of errors long before an issue of this magnitude hits the press again.