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The Canadian Association of Radiologists wants to expand accreditation programs and bring in more peer review — a project that appears timely in light of new investigations of medical scans at three facilities in British Columbia.
In recent years, disturbing cases also have surfaced in Saskatchewan, New Brunswick, Quebec and Newfoundland and Labrador, with concerned medical authorities announcing the need to double-check thousands of imaging scans by certain radiologists.
Some of the reviews have cost millions of dollars and cast doubt in the minds of patients worried about the accuracy of their initial results.
Dr. Edward Lyons, president of the association, said the national organization wants to see what it can do to improve patient safety.
"Perhaps over the years we haven't done as extensive a peer review in medicine that we should have been doing, and I think it's things like this that really sort of step up the attention that people are paying to it," he said in an interview from Winnipeg.
"And that can't be anything but good, if it ultimately provides better health care and better patient care and better safety."
Investigations in B.C.
This month, the B.C. government said investigations had been launched into CT scans by a radiologist at St. Joseph's General Hospital in Comox, and two other radiologists who worked in Powell River and Abbotsford in the Fraser Valley.
Lyons said the association has a group that's working on the accreditation project, and examining what's already in place because they don't want duplication.
"But what we want to do is try and enhance things that they may be doing, give radiologists opportunities and ideas as to how to institute peer review in their facilities," he explained.
The association wants to bring in a full facility accreditation program as quickly as possible, he said.
"One of the provinces and some of the radiologists really would like the CAR to be the prime mover in this area. And so over the last few weeks we have been looking at what the challenges are to ramp up from two modalities that we now accredit — bone mineral density, or BMD, and mammography — to now encompass X-ray fluoroscopy, CT, MR (magnetic resonance imaging) and even ultrasound."
Accreditation would include equipment
An accreditation process would examine how scans are being done.
"We want to look at making sure the equipment meets current standards, is current as far as its ability to produce quality images relative to what is acceptable and expected today, and obviously if it's in good working order with adequate maintenance," Lyons explained.
Accreditation would also ensure technologists are appropriately trained in CT and know how to deal with unforeseen events, and have adequate supervision by a physician who provides quality interpretations, he said.
"So it's really a package that we're looking at."
A program has existed for 15 years for mammography, which is used to detect breast cancer.
The association is seeking a meeting with federal Health Minister Leona Aglukkaq to discuss its plans, and "to try and get some assistance in trying to get this off the ground as expeditiously as possible," Lyons said.
Reviews underway in Saskatchewan
In Saskatchewan, a review is underway of thousands of scans from October 2004, to December 2007, by a radiologist in the Cypress Hills Health Region in the southwestern part of the province.
When 7,213 of the radiologist's scans from January 2008, to May 2010, were scrutinized, there was a variance — different interpretation — in 864 of them.
An earlier review of nearly 70,000 examinations done by a radiologist in Yorkton, Sask., found different interpretations on 18.8 per cent. Differences with the potential to affect patient care were found in 1,988 exams.
'Gut-wrenching impact'
"That's had a real gut-wrenching impact on our profession here, in that people have been shocked to discover that variance interpretation can range as high as we have seen it," said Dr. Dennis Kendel, registrar of the College of Physicians and Surgeons of Saskatchewan.
"And to our dismay when you actually search the literature, if you press the CAR on this, they'll tell you the same, there has been relatively little research conducted worldwide into the variance of diagnostic interpretation."
Both reviews in Saskatchewan came about as a result of the province's peer review program, Kendel said.
"Its primary purpose is continuous quality improvement, so with the exception of these two instances that have arisen in the last three years, what it generates is feedback to the radiologist or other doctor doing interpretation for ways to improve his or her quality of interpretation."
He's "very keen" to hear about what the Canadian Association of Radiologists is planning, and thinks it could make a difference.
