SEPTEMBER/OCTOBER 2013 RADIOLOGY MANAGEMENT 18
Risk Management in Radiology
potential to put the safety of a patient
at risk should be reported as suspected
adverse drug reactions.
Whatever adverse event occurred
in a medical imaging setting, incident
reporting strategies should be developed among healthcare practitioners
and patients in order to reduce risk.18
Incident reporting strategies vary from
documentary analysis to questionnaires,
interviews, and patient complaints. In
radiology, corrective strategies to address
safety concerns related to new technologies, patient transfers, and inadequate
test result notification policies seems to
be relevant.18 Results from a recent report
outlined that incident reporting strategies should be made “easy,” informal,
and person-centered instead of rigid. 25
This behavior may suggest that applying
current guidelines to the local healthcare
reality may result in a more practical and
acceptable method for risk prevention.
One study reported standard incident
reporting systems (based on voluntary
reporting by the healthcare staff) could
not report all incidents in hospitals so
they should be combined with complementary information from patient complaints and retrospective chart review. 26
However, risk prevention strategies may
have a positive effect on safety, not only
by determining changes in patient care
workflows, but also by changing staff
behavior and knowledge. It is paramount
that incident reports should be analyzed
and discussed by the whole healthcare
staff. In the clinical reality, there are
usually some difficulties and barriers
(organizational and individual factors)
in reporting incidents and also in applying the “learned lesson” from incident
reports to improve patient safety. 27, 28
Finally, some measures to overcome such
troubles have been proposed: enhanc-
ing safety culture, introducing a reward
system, implementing incident report-
ing systems, improving staff awareness
of patient safety and incident reporting
and others. 28
Considering the US and European
studies of malpractice in radiology, an
increasing trend is notable. The risk of
legal complications in Italy is progressively approaching that of the United
States, where it is estimated that 40% of
radiologists are taken to court, on average, once every 5 years. To guarantee a
good medical practice, the entire medical team must be familiar with guidelines and developments that affect the
facility, keeping up to date with laws,
guidelines, and regulations in order to
improve quality. Moreover, any information about patients should be clearly
recorded (eg, relevant clinical findings,
decisions made and actions agreed, who
made the decisions and agreed to the
actions, information given to patients,
any drugs prescribed or other investigation or treatment, and who is making the
record and when).
A culture that allows all staff to raise
concerns openly if patient safety, dignity,
or comfort is or may be compromised
should be promoted and encouraged. A
comprehensive risk management strategy
in radiology is strongly recommended
in order to avoid and prevent potential
errors and adverse events that may occur
through the workflow. Finally, preventing
errors and limiting adverse events may
help prevent malpractice lawsuits.
1Hubbard DW. The Failure of Risk Management: Why It’s Broken and How to Fix It.
John Wiley & Sons. 2009.
2ISO/IEC Guide 73:2009. Risk management —
Vocabulary. International Organization for
3Reason J. The contribution of latent human
failures to the breakdown of complex systems. Philos Trans R Soc Lond B Biol Sci.
4Brook OR, O’Connell AM, Thornton E,
Eisenberg RL, Mendiratta-Lala M, Kruskal
JB. Quality initiatives: anatomy and patho-physiology of errors occurring in clinical
radiology practice. Radiographics.
5Cristofaro M, Busi Rizzi E, Schininà V, Chi-appetta D, Angeletti C, Bibbolino C.
Appropriateness: analysis of outpatient
radiology requests. La Radiologia Medica.
6American College of Radiologist (ACR)
Appropriateness Criteria®. Available at:
August 19, 2013.
7American College of Radiologist - Society of
International Radiology (ACR-SIR) Practice Guideline on Informed Consent for
Image-Guided Procedures® Res. 39 – 2011
Available at: http://www.acr.org/~/media/
Accessed August 19, 2013.
8CIRSE Standards of Practice. Available at:
Accessed August 19, 2013.
9Hendee WR, Becker GJ, Borgstede JP, et al.
Addressing overutilization in medical
imaging. Radiology. 2010;257:240– 5.
10Berlin L. Suboptimal radiologic examinations.
AJR Am J Roentgenol. 2011;196:W482.
11Wallis A, McCoubrie P. The radiology
report—are we getting the message across?
Clinical Radiology. 2011;66:1015–1022.
12“Convention for the Protection of Human
Rights and Dignity of the Human Being
with regard to the Application of Biology
and Medicine: Convention on Human
Rights and Biomedicine.” Available at:
Html/ 164.htm. Accessed August 19, 2013.
13The Royal College of Radiologists, Board of
the Faculty of Clinical Radiology, Stan-
dards for Patient Consent Particular to
Radiology. 2nd edition. The Royal College
of Radiologists; London, UK. 2012.
14Antoniutti M, Doratiotto S. Risk management in computed tomography using an
incident reporting system. Oral Presentation ECR Wien 2013.
Risk prevention strategies may have a positive effect on safety,
not only by determining changes in patient care workflows,
but also by changing staff behavior and knowledge.