For those cases resulting in decisions against the radiologist, the average colon carcinoma award was $289,156, whereas the average perforated viscus award was $858,333.

"Why was there a discrepancy in the size of the two awards?" McGuire said.

The researchers theorized that it's because radiologists are the only physicians to make the diagnosis of perforation, whereas the radiologist may be removed from the case in colon cancer suits, as other physicians are involved.

To help avoid lawsuits, radiologists must image the entire abdomen, from the top of the hemidiaphragm to the obturator foramen, McGuire said. He also suggested that radiologists get two films if necessary, or a CT scan, because free air in the upper abdomen may not be seen on KUB (kidney, ureter, and bladder) alone.

Pneumoperitoneum cases typically involve middle-aged or even younger patients who have acute onset. If the diagnosis is not made by the radiologist in the first 24 hours, the patients get very sick or die, Baker told Diagnostic Imaging.

"You don't have to use CT to make the diagnosis, but you cannot image the entire abdomen with one film," Baker said. "You need to get two views, which is our standard, and we've found very small pneumoperitoneum, as small as you can find with CT, over the liver shadow."

The team of researchers concluded that because imaging may be the only means to make this diagnosis, the responsibility to detect perforation and the consequences for the radiologist of failure to recognize it are particularly high.

AVERAGE MALPRACTICE
AWARD IN LUNG AND GI