Mock Trial Focuses on Malpractice Suit over "Incidentalomas"

By Paul LaTour

A Mock Jury Trial being conducted at RSNA 2014 involves a case bridging the 100th annual meeting's theme of "A Century of Transforming Medicine" and the future—the dilemma radiologists face regarding incidental findings on images, known colloquially as "incidentalomas."

Leonard Berlin, M.D.

Because of the advances in technology in CT scans, radiologists are now able to see higher-quality images that show much more than in the past. This has led to uncertainty about what findings are important enough to report to a referring physician.

"The resolution of CT scans today is so much better than it was 10 years ago, so we're seeing all these tiny densities that we never saw before," said Leonard Berlin, M.D., the event's moderator. "This presents a dilemma for the radiologist who must decide whether to note it and perhaps suggest it is benign, or ignore it because the statistical likelihood of it developing into cancer is no more than 1 percent."

The Mock Jury Trial, will be held today from 10:30 a.m. until 3:30 p.m. in Room S406A. It focuses on a hypothetical allegation of negligence against a radiologist who observed an incidentaloma on an abdominal CT scan that was obtained for reasons unrelated to the finding. The radiologist evaluated the finding, and determined that it was an insignificant and clinically unimportant finding, and thus reported that the finding can be ignored by the referring physician.

The finding was forgotten until 18 months later, when it was determined that the incidentaloma had in fact been an early carcinoma. By that time the patient was inoperable, and despite treatment, died eight months later. The deceased patient's family filed a malpractice lawsuit against the defendant-radiologist, alleging negligence because the radiologist had failed to raise the suspicion of malignancy and suggest additional studies.

"This is a very hot topic right now," Dr. Berlin said. "There have been several white papers with certain criteria for incidentalomas, trying to educate the radiologist community about it. The problem is there is no consensus."

For the mock trial, Dr. Berlin assembled a team that includes a judge who presides over actual malpractice suits, and two prominent Chicago practicing attorneys: Judge Clare E. McWilliams, a Cook County circuit judge, will preside; Keith A. Hebeisen is the attorney for the plaintiff; and Timothy G. Nickels is the attorney for the defendant, who is being portrayed by Dr. Berlin's son, Jonathan W. Berlin, M.D.

RSNA 2012 Mock Jury Trial

Two expert witnesses—Lincoln L. Berland, M.D., for the defendant, and Mark E. Baker, M.D., for the plaintiff—will provide testimony. The jury consists of 12 laypersons with no connection to radiology to heighten the real-life aspect of the trial.

When testimony concludes, the audience will be able to watch the jury deliberations via video and audio feed. Following the rendering of a verdict, participants and the audience will be invited to take part in an open discussion. "It's a learning opportunity for everybody involved," Dr. Berlin said.

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