N.W.T considers more oversight for radiologists, as massive review begins

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The Northwest Territories health authority plans to increase oversight for radiologists, following concerns that a radiologist working in the territory may have misread scans.

Earlier this month, the N.W.T. Health and Social Services Authority learned that a radiologist who worked at Stanton Territorial Hospital briefly during two periods in 2015 and 2016 is being investigated in B.C. for "inaccuracies in the interpretation of diagnostic imaging examinations."

The territory is following up with its own review.

Over the next three months, nearly 2,400 X-rays, CT scans, ultrasounds and mammograms done at Stanton Territorial Hospital — which had been read by the radiologist in question — will be re-examined by a team of visiting radiologists.

Over the longer term, the territory plans to introduce a "peer review" system.

"Obviously we're shooting for 100 per cent [accuracy], but there are sometimes missed reports; we're finding this, it's not an uncommon challenge in the field," says Les Harrison, director of clinical integration with the health authority. 

Using a peer review system, a second radiologist would "review a statistically significant number of exams provided by a given radiologist and then that peer review would help inform what is the quality of exams being read," said Harrison.

A significant percentage of radiology scans in the territory are already subject to peer review, Harrison added. 

Roughly 65 per cent of scans from Stanton Territorial Hospital and Yellowknife's Primary Care Centre last year were sent south to be read by a private company that uses a peer review system.

How common are errors?

Emil Lee, the incoming president of the Canadian Association of Radiologists, says errors by radiologists are uncommon. Although he says reading scans is fine art, and most radiologists are in ongoing communication with colleagues, in a kind of informal peer review.  

"There is a great deal of overlap between pathology and normality, so this is where the art of what we do comes in. There's black and there's white and there's a great deal of grey in between.

"In a peer review system, if a radiologist looks at a given set of images of a CT Scan and another radiologist looks at the same set of images they might come to slightly different conclusions, so there needs to be a dialogue between them to come to a mutual conclusion."

B.C. has been trying to formalize this system of communication since a 2010 scandal, when scans misread by radiologists in Powell River were linked to three deaths.

Lee says the province is still working on the system. Plans for the peer review system in the N.W.T., in turn, are at a "very preliminary" stage, according to David Maguire, manager of communications with the N.W.T health authority.

"Obviously no one wanted to have their care questioned in any way… But I think [N.W.T patients] can be assured that the system was able to identify a possible question, and there was a very appropriate response," Lee added.