Reducing the Risk of Misread Mammograms

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Failure to appreciate findings on mammogram resulting in cancer accounts for 7% of diagnostic imaging malpractice claims at MagMutual. Despite the advances in mammography techniques, radiologists still face a number of limitations with the images, missing about one in eight breast cancers.

To help radiologists reduce that number, MagMutual’s medical faculty and risk consultants have analyzed our claims data, determined the main causes of diagnostic imaging claims related to misread mammograms resulting in cancer, and developed strategies to improve patient outcomes. 

Top Risks

Top Strategies for Reduction

Based on these top risk drivers, implementing the following clinical and operational strategies can help you prevent unexpected outcomes and increase defensibility of a medical malpractice claim:

Clinical strategies

• Palpable complaints are a common source of medical malpractice. All palpable complaints are evaluated with ultrasound and mammography, when appropriate. If the ultrasound is positive or not definitively benign, biopsy the lesion. Limit BIRADS 3 designation to only when strictly appropriate. Short-term follow-up is not protective medically or legally.
• Follow the ACR guidelines, as they are the accepted standards of care regarding breast management. The rules are straightforward and reproducible. Adhere to the BI-RADS lexicon for interpretation and follow-up recommendations. Recommend spot/mag views for concerning findings.
• Radiologists reading mammography should consider annual CME requirements to be at least partly in breast imaging. 

Operational strategies

• Fewer mammograms are being performed by dedicated mammographers, which is compromising the quality of the studies. When possible, every effort should be made to employ mammographers. Talk to patients when possible. Many studies have repeatedly demonstrated that radiologists who speak to patients establish a connection and are less likely to be sued.
• If reading remotely, ensure that the monitor resolution (at least 5 megapixel), luminance, contrast threshold and other parameters meet ACR criteria and have FDA clearance. Using a lower standard for a mammography reading station could increase liability in both areas.

Other Top Risks

Though failure to appreciate findings on a mammogram resulting in breast cancer accounts for a significant amount of diagnostic imaging claims according to our data, we’ve identified several other 

Risk Drivers by Top Cause

Risk Drivers by Frequency

Data Collection & Methodology

Data is based on MagMutual closed claims from 2011-2021 and corresponding exposure data. Clinical and non-clinical loss drivers are based on an in-depth review of each claim by a medical professional or clinical risk consultant. Risk reduction strategies are based on input from practicing physicians.