Jonathan Mezrich MD, Presenter: Nothing to Disclose

Eliot L. Siegel MD, Abstract Co-Author: Research Grant, General Electric Company Speakers Bureau, Siemens AG Board of Directors, Carestream Health, Inc Research Grant, XYBIX Systems, Inc Research Grant, Steelcase, Inc Research Grant, Anthro Corp Research Grant, RedRick Technologies Inc Research Grant, Evolved Technologies Corporation Research Grant, Barco nv Research Grant, Intel Corporation Research Grant, Dell Inc Research Grant, Herman Miller, Inc Research Grant, Virtual Radiology Research Grant, Anatomical Travelogue, Inc Medical Advisory Board, Fovia, Inc Medical Advisory Board, Toshiba Corporation Medical Advisory Board, McKesson Corporation Medical Advisory Board, Carestream Health, Inc Medical Advisory Board, Bayer AG Research, TeraRecon, Inc Medical Advisory Board, Bracco Group Researcher, Bracco Group Medical Advisory Board, Merge Healthcare Incorporated Medical Advisory Board, Microsoft Corporation Researcher, Microsoft Corporation

Computer assisted detection (CAD) is increasingly utilized in radiology, and its use is presently most prevalent in screening mammography. While CAD may be helpful to the clinician in highlighting findings the clinician may not have observed, it is not without legal ramifications. To what extent is CAD use becoming the standard of care in the subspecialty? If CAD is performed, is one then obligated to follow or biopsy CAD findings one finds questionable or would have otherwise ignored? Will a questionable finding not mentioned or dismissed by the radiologist, but marked by CAD, which ultimately did develop into a malignancy, be grounds for malpractice? To what extent do clinicians archive CAD markings, and if not, is there a worry that future better versions of CAD might be used in the courtroom to show that findings were “CAD evident”? If CAD markings are discarded, is this not a case of “spoliation” that should be determined in favor of an injured plaintiff?

A link to a SurveyMonkey survey was posted on the website of the Society of Breast Imaging and circulated to subscribers of Diagnostic Imaging.com, in order to evaluate opinions regarding CAD use and its underlying legal issues. There were 45 responses.

91.1% of respondents indicated they always use CAD in their screenings, and 79.5% consider CAD use in conjunction with their own analysis the standard of care in mammography. 24.4% routinely archive CAD output into PACS along with the study, while 71.1% rarely or never do. 82.2% of respondents worry that archived CAD markings may lead to more lawsuits or greater liability, and 80.0% indicate that CAD results may influence their willingness to take a position as an expert witness in a malpractice case.

This study suggests that a majority of breast radiologists consider CAD use the standard of care in screening mammography, and worry about CAD’s potential to increase litigation or liability.  The majority of respondents indicated they are not archiving CAD results. CAD is a tool with potential legal ramifications, and radiologists should carefully consider how best to integrate CAD into their archiving policies and within their reports.

This study is of interest to all radiologists who use computer aided detection in their practices and are concerned or cognizant of the legal ramifications of such technology.

Mezrich, J, Siegel, E, Legal Ramifications of Computer Aided Detection in Mammography.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13044239.html