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Abstract:Just as radiologic studies allow us to see past the surface to the vulnerable and broken parts of the human body, medical malpractice claims help us see past the surface of medical errors to the deeper vulnerabilities and potentially broken aspects of our healthcare delivery system. And just as the insights we gain through radiologic studies provide focus for a treatment plan for healing, so too can the analysis of malpractice claims provide insights to improve the delivery of safe patient care. We review 1325 coded claims where Radiology was the primary service provider to better understand the problems leading to patient harm, and the opportunities most likely to improve diagnostic care in the future.Keywords: diagnostic error; malpractice claims; radiology. OverviewThe medical diagnostic process involves a complex network of interactions between the patient and the healthcare system. This process is also dynamic, requiring one or more cycles of patient interaction, informationgathering and data synthesis in order to understand the intricacies of each patient's clinical picture and pathology. Failures can occur at any point along the continuum of care, each of which has the potential to result in inaccurate or delayed diagnosis as well as inappropriate treatment. While radiology typically does not play the initial role in the diagnostic process, misinterpretation or delayed communication of imaging findings can certainly lead to a breakdown in the progression towards clarity of diagnosis and appropriate patient care.Analysis of the CRICO Comparative Benchmarking System (CBS) determined that 29,777 medical malpractice cases, asserted between 2010 and 2014, had completed an in-depth review by CRICO's team of Clinical Taxonomy Specialists. Reviewing the medical and legal files of each of these cases, an experienced clinician used CRICO's propriety coding taxonomy to capture and code multiple case attributes including allegation, patient demographics, diagnosis and injury, location, tests and services, and the key causation factors contributing to the clinical error or failure.Of the 29,777 medical malpractice cases available for analysis, 1325 cases named Radiology as the Primary Responsible Service -42% resulted in high severity (based on National Associationn of Insurance Commissioners clinical injury severity score) clinical injuries including 235 deaths (Figure 1). Diagnostic related events represent nearly 60% of the 1325 radiology claims, followed by procedural issues (22%), equipment issues, (7%) and falls and safety issues (6%). In those cases involving diagnostic radiology, nearly 50% of the cases involved one of these four modalities: computed tomography (CT) scans (20%), mammography (11%), magnetic resonance imaging (MRI) (10%) and diagnostic ultrasound (4%). Cases occurred in a variety of settings though ambulatory cases were the most common at 63% followed by inpatient (26%) and emergency department (11%).In many cases, Radiology is not the only clinical service identified as "responsible" o...

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As technology continues to improve within the neuroprosthetic landscape, there has been a paradigm shift in the approach to amputation and surgical implementation of haptic neural prosthesis for limb restoration. The Osseointegrated Neural Interface (ONI) is a proposed solution involving the transposition of terminal nerves into the medullary canal of long bones. This design combines concepts of neuroma formation and prevention with osseointegration to provide a stable environment for conduction of neural signals for sophisticated prosthetic control. While this concept has previously been explored in animal models, it has yet to be explored in humans. This anatomic study used three upper limb and three lower limb cadavers to assess the clinical feasibility of creating an ONI in humans. Anatomical measurement of the major peripheral nerves- circumference, length, and depth- were performed as they are critical for electrode design and rerouting of the nerves into the long bones. CT imaging was used for morphologic bone evaluation and virtual implantation of two osseointegrated implants were performed to assess the amount of residual medullary space available for housing the neural interfacing hardware. Use of a small stem osseointegrated implant was found to reduce bone removal and provide more intramedullary space than a traditional implant; however, the higher the amputation site, the less medullary space was available regardless of implant type. Thus the stability of the endoprosthesis must be maximized while still maintaining enough residual space for the interface components. The results from this study provide an anatomic basis required for establishing a clinically applicable ONI in humans. They may serve as a guide for surgical implementation of an osseointegrated endoprosthesis with intramedullary electrodes for prosthetic control.