Earlier this year, following concerns about the quality of work performed by a radiologist who worked in several communities throughout the province, the Ministry of Health and health authorities undertook reviews of radiology in British Columbia.

The Ministry of Health review, conducted by Dr. Martin Wale of the BC Medical Quality Initiative, is complete. The review, commissioned in June 2017, examined the factors that led to this incident as well as progress made on the recommendations from the 2011 Cochrane review.

The review found that this incident was different than those that triggered the 2011 review. It also notes that work has been done to improve and standardize licensing, credentialing and privileging of radiologists – all focuses of the Cochrane review. Of the Cochrane recommendations, 22 of the 35 are complete or mostly complete, eight are underway, and five are not done.

Dr. Wale provided 20 recommendations, which range from strengthening the reference-check process for locums to standardizing additional training required of physicians as a condition of receiving privileges. In addition, he recommended the Radiology Quality Improvement System – intended to be a key response to the Cochrane recommendations – be fully implemented and leveraged across the health system to support individuals in their practice and overall quality improvement.

All recommendations are widely supported by British Columbia’s medical leadership. The ministry is developing an action plan in response to the report that will address both the Wale recommendations and bring to completion the Cochrane recommendations.

The impacted health authorities also undertook reviews of scans performed by the radiologist. Interior Health, Island Health, Northern Health and Vancouver Coastal Health reviewed more than 13,000 images for clinical discrepancies once the concern was identified. These images included MRIs, CTs, ultrasounds, mammograms and X-rays from 9,757 patients. All affected patients and their physicians have been contacted.

• Interior Health reviewed 2,190 medical images and found a 6% discrepancy rate. Seven patients needed followup care.
• Island Health reviewed 2,375 CT scans from 2,066 patients and found a discrepancy rate of 15%. Of those, 25 patients required followup care. Island Health is expanding its review to include re-reading all 383 mammography exams and a sampling of ultrasounds and X-rays as a precaution. These images are not as complex as CT scans and regularly have a lower discrepancy rate. This work is expected to be completed in the coming weeks.
• Northern Health reviewed approximately 8,400 medical images and found a 10% discrepancy rate. In instances where a discrepancy was noted, patients and their physicians were contacted.  
• Vancouver Coastal Health reviewed 861 medical images from 626 patients. No clinical discrepancies were found in these scans.

It is important to note that a clinical discrepancy does not necessarily mean treatment for patients would have been altered or that adverse health impacts may have occurred. All clinical discrepancies were referred back to the ordering practitioner, who determined if there was any clinical impact on the patient.  

To read the provincial radiology review, click here:
http://www.health.gov.bc.ca/library/publications/year/2017/investigation-into-quality-incidents-and-peer-review-in-radiology-in-BC-2011-17.pdf