Momin Muzaffar MD, Presenter: Nothing to Disclose

Teresa A Smith, Abstract Co-Author: Nothing to Disclose

Thomas Tomsick MD, Abstract Co-Author: Nothing to Disclose

Multiple scenes or “runs” are acquired in digital subtraction angiography (DSA), some of which may be non-diagnostic because of poor image quality, and therefore not archived. However, the software in most angiography suites automatically assigns a sequential number to each DSA attempt. Discrepancies in the numbering sequence upon later study review suggest that images were inadvertently not archived or deliberately deleted, the latter of which may pose a medicolegal problem. Our purpose is to prospectively document the frequency and cause of non-diagnostic DSA scenes.

Over a 6-month period (May-October 2004), non-diagnostic runs (where repeat injections were performed) during diagnostic and therapeutic cervicocerebral angiography were recorded, with a reason ascribed to each instance.

Four attending angiographers performed 245 arteriograms, 58 of which were performed as part of a therapeutic procedure. 81 patients had non-diagnostic runs (33.1%). The number of non-diagnostic runs was 126 out of a total of 2718 runs (4.6%). Dividing the data between patients undergoing cerebral angiography without and with intervention revealed no significant difference in frequency. The most common causes of non-diagnostic runs were catheter displacement from the vessel, patient motion, inadequate contrast density, incorrect DSA parameter setting, and power injector malfunction, in order of decreasing frequency.

Non-diagnostic runs during cervicocerebral angiography occur in approximately one third of procedures at our institution. Many instances could be prevented by more careful assessment of filming technique, review of power injection programming prior to each run, and measures to encourage better patient cooperation. Image archive, nursing note, or dictated documentation of non-diagnostic runs can prevent the perception of incomplete record keeping or malicious deletion of information in the future.

Incomplete documentation of deleted non-diagnostic angiographic scenes may be a spurious source of medicolegal action.

Muzaffar, M, Smith, T, Tomsick, T, Absent Angiographic Images May Be Claimed as Physician Spoilage of Data in Medicolegal Actions.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4429453.html