Research dismisses legal worries about lossy compression

Radiologists need not fear the specter of increased lawsuits if irreversible compression of medical images is endorsed as a standard of practice, according to research done in Canada and presented at the Society for Computer Applications in Radiology meeting in Orlando.

Canada Health Infoway, a nonprofit organization that promotes adoption of electronic health information systems in Canada, determined in cooperation with the Fraser Health Authority of British Columbia that the use of lossy compression presents no greater risk for litigation, said Paul Brownrigg, president of Insite Consultancy.

Canada performs more than 35 million imaging exams a year, but over 60% of them are done in rural facilities with limited bandwidth capabilities. These rural hospitals could especially benefit from the use of lossy compression, Brownrigg said.

Radiologists have been slow to adopt lossy compression, however. By definition, lossy compression involves lost information, and many physicians struggle with the idea that they might miss a finding and get sued, according to Brownrigg.

A legal firm employed by Canada Health Infoway and the Fraser Health Authority took the following steps:

• reviewed regulatory requirements for Canada, the U.S., the European Union, and Australia

• were briefed on current lossy compression research

• investigated and commented on guidance offered by professional bodies

• reviewed legal cases if there were any

• determined if any legal action had been taken in the U.S./Canada resulting from lossy compression use

While the study is ongoing, Brownrigg reported on preliminary results at the SCAR meeting. Researchers found that current case law does not cover the topic of lossy compression in the U.K., the U.S., or Canada and that no radiologists or physicians have been sued for misdiagnosis due to its use.

Aside from the Canadian Association of Radiologists, which recently endorsed the use of lossy compression, regulatory bodies reviewed by the firm did not endorse or oppose the use of compression. Courts have not presented views on the appropriateness of the technology, leaving it to a professional body to set standards of practice, according to the report.

Brownrigg listed several recommendations for radiologists: refer to the literature to obtain the best current information, learn about the concept behind JPEG2000, select the appropriate compression per modality, and ask health boards to produce a formal policy.

"We've considered every potential risk except the risk of avoiding all risks," he said.